Odontogenic Cysts And Tumors
Oral Pathology And Medicine
Contributed By: Dr. Himani
Dentigerous cyst can be defined as an odontogenic cyst that surrounds the crown of an impacted tooth; caused by fluid accumulation between the reduced enamel epithelium and the enamel surface resulting in the cyst in which the crown is located within the lumen.
- This is one of the most common type of developmental odontogenic cyst- 20% of all jaw cyst.
- 10% of impacted teeth have formed a dentigerous cyst.
- Frequency in the general population has been estimated at 1.44 cyst for every 100 unerupted teeth.
- The cyst is usually associated initially with crown of an impacted, embedded or unerupted tooth.
- Dentigerous cyst may also found enclosing a complex compound odontoma or involving a supernumerary tooth.
- Most common site:-
- Mandibular third molar
- Maxillary third molar
- Maxillary cuspid areas
(since these are most commonly impacted teeth)
- Age:- Second and third decade of life.
- Sex:- Male predilection.
- Most dentigerous cyst are solitary.
Bilateral and multiple cyst are usually found in association with number of syndromes including
- Cleidocranial dysplasia
- Maroteaux- lamy syndrome.
- Dentigerous cyst is capable of becoming an aggressive lesion.
- Cystic involvement of an unerupted mandibular third molar may result in “hollowing out” of entire ramus extending up to coronoid process and condyle.
- In case cyst is associated with a maxillary cuspid, expansion of anterior maxilla often occurs & may superficially resemble an acute sinusitis or cellulitis.
- No pain or discomfort is associated with the cyst unless it becomes secondarily infected.
- Three radiological variations of dentigerous cyst are seen radiographically:-
- Central type
- Lateral type
- Circumferential type
In this type the crown is enveloped symmetrically.
This type of radiographic appearance results from dilation of follicles on one aspect of crown.
This type results when the follicle expands in a manner in which the entire tooth appears to be involved by the cyst.
- It is usually composed of thin connective tissue wall with a thin layer of stratified squamous epithelium lining the lumen.
- Rete peg formation generally absent unless it is secondarily infected.
- Inflammatory cells and infiltration of connective tissue is common.
- Presence of Rushton bodies within the lining epithelium is usually seen with the cyst exhibiting inflammation.
- The content of cystic lumen is thin, watery yellow fluid, occasionally blood tinged.
Treatment usually is dictated by size of lesion:-
- Smaller lesions are surgically removed entirely
- Marsupilization :- The large cyst which involves severe bone loss are treated by marsupilization.
- Squamous cell carcinoma
- Mucoepidermoid carcinoma
- Shafer’s Textbook of Oral Pathology, 7th edition, pg no-259-264