Dentigerous cyst

Dentigerous cyst
Classification and external resources
ICD-10	K09.0
ICD-9-CM	526.0
DiseasesDB	31222
MeSH	D003803

A dentigerous cyst or follicular cyst is an odontogenic cyst - thought to be of developmental origin - associated with the crown of an unerupted (or partially erupted) tooth. The cyst cavity is lined by epithelial cells derived from the reduced enamel epithelium of the tooth forming organ. Regarding its pathogenesis, it has been suggested that the pressure exerted by an erupting tooth on the follicle may obstruct venous flow inducing accumulation of exudate between the reduced enamel epithelium and the tooth crown.

In addition to the developmental origin, some authors have suggested that periapical inflammation of non-vital deciduous teeth in proximity to the follicles of unerupted permanent successors may be a factor for triggering this type of cyst formation.

Histologically a normal dental follicle is lined by enamel epithelium, whereas a dentigerous cyst is lined by non-keratinized stratified squamous epithelium. Since the dentigerous cyst develops from follicular epithelium it has more potential for growth, differentiation and degeneration than a radicular cyst. Occasionally the wall of a dentigerous cyst may give rise to a more ominous mucoepidermoid carcinoma. Due to the tendency for dentigerous cysts to expand rapidly, they may cause pathological fractures of jaw bones. On Fine needle aspiration, thin straw colored fluid is seen.

The usual radiographic appearance is that of a well-demarcated radiolucent lesion attached at an acute angle to the cervical area of an unerupted tooth. The border of the lesion may be radiopaque. The radiographic differentiation between a dentigerous cyst and a normal dental follicle is based merely on size. Radiographically, a dentigerous cyst should always be differentiated from a normal dental follicle. Dentigerous cysts are the most common cysts with this radiographic appearance. Radiographically the cyst appears unilocular with well defined margins and often sclerotic borders but sometimes it may be multilocular in appearance and may also have a continuous cystic membrane. Infected cysts show ill-defined margins. Follicular space more than 3mm is to be considered a dentigerous cyst. Radiographically there are three types of dentigerous cyst, namely the Central type, Lateral type and the Circumferential type. The most common location of dentigerous cysts are the Mandibular 3rd Molars and the Maxillary Canines, and they rarely involve deciduous teeth and are occasionally associated with odontomes.

A dentigerous cyst is often treated by excision of the cyst along with the extraction of the assosciated tooth. In case of a large cyst marsupialization is done.

Acquired tooth disease (K02–K05, 521–525)

Hard tissues

Pulp/periapical (Endodontal)

Pulpal	External resorption Internal resorption Irreversible pulpitis Reversible pulpitis Pulp necrosis Pink tooth of Mummery

Periapical	Acute apical periodontitis Chronic apical periodontitis Combined periodontic-endodontic lesions Fistula Periapical abscess Phoenix abscess Vertical root fracture

Ungrouped	Pulpitis Radicular cyst Periapical abscess

Gingiva/periodontal
(Periodontal)

Bone cyst

Other

Cracked tooth syndrome

To be grouped
from periodontology

Diagnoses	Chronic periodontitis Localized aggressive periodontitis Generalized aggressive periodontitis Periodontitis as a manifestation of systemic disease Necrotizing periodontal diseases Abscesses of the periodontium Combined periodontic-endodontic lesions

Pathogenesis	A. actinomycetemcomitans Capnocytophaga sp. F. nucleatum P. gingivalis P. intermedia T. forsythia T. denticola

Pathologic entities	Calculus Edentulism Fremitus Furcation defect Gingival enlargement Gingival pocket Gingivitis Horizontal bony defect Linear gingival erythema Occlusal trauma Periodontal pocket Periodontal disease Periodontitis Plaque Recession Vertical bony defect

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