Dentigerous Cyst: Symptoms, Types, Causes and Treatment

Dentigerous cysts are among the most common odontogenic cysts encountered in dental and maxillofacial practice. While typically silent and discovered incidentally, these cysts can sometimes cause significant clinical challenges when they expand or become symptomatic. Understanding their symptoms, types, causes, and available treatments is crucial for optimal patient care and positive outcomes.

Symptoms of Dentigerous Cyst

Dentigerous cysts often lurk undetected, only surfacing during routine dental X-rays. However, as these cysts grow, they can manifest a spectrum of symptoms, some subtle and others more severe. Recognizing these signs is vital for timely diagnosis and intervention.

Symptom	Frequency	Typical Presentation	Source(s)
Asymptomatic	Very common	Incidental radiographic finding	1 3 5 6 8 13
Swelling	Common	Facial/jaw swelling, bony expansion	3 4 5 13
Pain	Occasional	Facial pain, tenderness	2 4 5 13
Tooth Displacement	Possible	Mobility, malocclusion	5 18
Nerve Changes	Rare	Paresthesia, numbness	1
Infection	Rare	Redness, abscess formation	5 19
Sinus/Orbital Symptoms	Rare	Nasal congestion, eye symptoms	3

Table 1: Key Symptoms

Overview of Symptoms

Dentigerous cysts are most frequently silent in their early stages, with many found only on dental radiographs taken for unrelated reasons. When symptomatic, their clinical presentation can vary based on size, location, and proximity to vital structures.

Common Symptoms Explained

Asymptomatic Nature

• Most dentigerous cysts are detected incidentally, as patients typically do not report discomfort until the cyst enlarges 1 3 5 6 8 13.
• Routine dental check-ups are crucial for early identification.

Swelling and Bony Expansion

• As the cyst grows, it can cause a visible bulge in the jaw or face, leading to facial asymmetry 3 4 5 13.
• Swelling is the most commonly reported symptom in symptomatic cases.

Pain and Tenderness

• Pain is less frequent but may develop if the cyst compresses nerves or becomes infected 2 4 5 13.
• Facial pain, especially near the jaw or preauricular area, can be a presenting complaint.

Tooth Displacement and Mobility

• Expanding cysts may move adjacent teeth, causing looseness or misalignment 5 18.
• In children, this can result in delayed or abnormal eruption of permanent teeth.

Nerve Involvement

• Rarely, the cyst may compress nerves, most notably the inferior alveolar nerve, leading to numbness or tingling (paresthesia) in the lower lip or chin 1.

Infection and Secondary Symptoms

• Infection may occur, presenting as redness, warmth, or pus discharge 5 19.
• Large cysts in the maxilla may even cause nasal or orbital symptoms, such as congestion or eye discomfort 3.

Types of Dentigerous Cyst

Dentigerous cysts are not a monolithic entity; they can be classified based on their radiographic appearance, origin, and association with teeth. Understanding the types aids in clinical decision-making and predicting outcomes.

Type	Defining Feature	Common Site(s)	Source(s)
Central	Encloses crown symmetrically	Mandibular/Maxillary molars	8
Lateral	Partially surrounds crown	Mandibular premolars	8
Circumferential	Encircles crown & root	Variable	8
Developmental	Associated with normal eruption	Mandibular third molars	6 10 13
Inflammatory	Follows inflammation from primary teeth	Mandibular premolars	10 13
Syndromic	Bilateral/multiple, linked to syndromes	Both arches	4 13
Supernumerary	Associated with extra teeth	Maxillary anterior	7 11
Ectopic	Related to teeth in unusual location	Subcondylar area	2

Table 2: Dentigerous Cyst Types

Radiological Types

Central Type

• The most common type, where the cyst symmetrically envelopes the crown of an unerupted tooth—most often the mandibular third molar 8.

Lateral Type

• The cyst partially surrounds the crown, typically on one side, more common with premolars 8.

Circumferential Type

• The cyst extends to encircle both the crown and part of the root, less frequently encountered 8.

Etiological Types

Developmental Dentigerous Cysts

• Originate from the reduced enamel epithelium of an unerupted, developing tooth 6 10 13.
• Most often seen in adolescents and young adults, frequently involving wisdom teeth.

Inflammatory Dentigerous Cysts

• Develop secondary to infection or inflammation from overlying nonvital primary teeth, spreading to the follicle of the permanent successor 10 13.
• More prevalent in children and younger adolescents.

Special Types

Syndromic and Bilateral Cysts

• Multiple or bilateral cysts are rare outside of syndromic conditions (like cleidocranial dysplasia) 4 13.
• Non-syndromic bilateral cases are exceedingly uncommon.

Supernumerary Tooth-Associated Cysts

• Involve extra (supernumerary) teeth, with the majority seen in the anterior maxilla (often mesiodens) 7 11.

Ectopic Tooth-Associated Cysts

• Occur when teeth erupt far from their normal location, such as the subcondylar area of the mandible 2.

Causes of Dentigerous Cyst

Understanding the mechanisms behind dentigerous cyst formation is key to both prevention and management. While the exact cause can vary, several well-established pathways have been described.

Cause	Description	Typical Age/Context	Source(s)
Developmental	Fluid accumulation between reduced enamel epithelium and enamel	Adolescents/young adults	6 10 12 13 14
Inflammatory	Periapical inflammation from nonvital primary tooth affects follicle of successor	Children/adolescents	10 13
Tooth Impaction	Associated with impacted or unerupted teeth	Any age, esp. 20–40	1 6 12 13
Supernumerary Tooth	Cyst forms around extra tooth	More in maxillary anterior	7 11
Syndromic Factors	Multiple cysts in genetic syndromes	Variable	4 13

Table 3: Causes of Dentigerous Cyst

Developmental Origins

• Most dentigerous cysts arise due to accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. The pressure from erupting teeth or impaction is believed to play a role in separating the follicle from the crown, creating a cystic cavity 6 10 12 13 14.
• This is why these cysts most commonly involve the mandibular third molars and maxillary canines, which are often impacted.

Inflammatory Pathogenesis

• Some cysts, especially in children, originate from inflammation. Here, a nonvital, decayed, or abscessed primary tooth causes infection that spreads to the follicle of the underlying permanent tooth, prompting cyst formation 10 13.
• This mechanism is particularly relevant for mandibular premolars in younger patients.

Role of Tooth Impaction

• Impacted or unerupted teeth—whether due to crowding, abnormal eruption paths, or lack of space—are the most frequently associated finding 1 6 12 13.
• The cyst envelops the crown, preventing eruption and sometimes causing further dental complications.

Supernumerary and Ectopic Teeth

• Extra teeth (supernumerary) or teeth erupting in unusual locations (ectopic) can also be enveloped by cysts, especially in the anterior maxilla 7 11.
• Such cases are rare but well documented.

Syndromic Associations

• Certain genetic conditions, such as cleidocranial dysplasia and Maroteaux-Lamy syndrome, predispose individuals to multiple, bilateral, or extensive dentigerous cysts 4 13.
• In non-syndromic cases, bilateral cysts are rare.

Treatment of Dentigerous Cyst

Treatment strategies for dentigerous cysts are tailored to the patient's age, cyst size, cyst location, and relationship to adjacent teeth and vital structures. Advances in conservative techniques have improved outcomes, especially in children.

Treatment	Approach	Indication/Outcome	Source(s)
Enucleation	Complete removal	Small/medium cysts, adults	5 12 15 17
Marsupialization	Window opening	Large cysts, preserve teeth/structures	4 15 16 17
Decompression	Gradual shrinkage	Children, large cysts, tooth preservation	16 18 19
Tooth Extraction	Remove involved tooth	If non-restorable or impeding eruption	5 12 14 15
Conservative/Orthodontic	Tooth exposure, orthodontic traction	Small cysts in children	16 18
PRP Application	Platelet-rich plasma	Enhanced bone healing	17

Table 4: Treatment Approaches

Surgical Removal (Enucleation)

• The most common treatment; involves surgical removal of the cyst and, often, the associated tooth 5 12 15 17.
• Suitable for small to moderate-sized cysts, particularly in adults or when the involved tooth is non-essential or cannot be preserved.

Marsupialization and Decompression

• Involves creating a surgical window or decompressing the cyst, allowing it to shrink over time 4 15 16 17 18 19.
• Particularly useful for large cysts, especially in children, as it preserves bone and allows for natural eruption of teeth 16 18 19.
• Decompression can be achieved using custom-made appliances, resulting in minimal complications and favorable long-term outcomes 19.

Tooth Preservation and Orthodontic Management

• In children with small cysts, conservative management involving exposure of the tooth and orthodontic traction can lead to cyst resolution and successful tooth eruption 16 18.
• This avoids unnecessary extraction and preserves dental arch integrity.

Extraction of Involved Teeth

• Indicated when the affected tooth is non-restorable, severely displaced, or when cyst removal cannot be achieved otherwise 5 12 14 15.

Adjunctive Therapies

• Platelet-rich plasma (PRP) has been shown to enhance bone regeneration following surgical management 17.

Treatment Planning Considerations

• Factors like cyst size, patient age, tooth involved, and proximity to nerves or other vital structures must be carefully weighed 15.
• Early intervention prevents complications such as bone destruction, infection, or neoplastic transformation 9.

Conclusion

Dentigerous cysts, while common and often asymptomatic, can present a variety of clinical challenges. Early detection and a nuanced understanding of their types, causes, and treatments are essential for optimal management and preservation of oral health.

Key Takeaways:

• Dentigerous cysts frequently remain asymptomatic but can cause swelling, pain, tooth displacement, and rarely, nerve symptoms or infection 1 3 4 5 13.
• They are classified by radiographic appearance (central, lateral, circumferential), etiology (developmental, inflammatory), and association with syndromes, supernumerary, or ectopic teeth 2 4 7 8 10 11 13.
• Causes include developmental abnormalities, inflammation from nonvital teeth, tooth impaction, supernumerary/ectopic teeth, and genetic syndromes 4 6 7 10 11 12 13.
• Treatment ranges from surgical removal to conservative approaches like marsupialization, decompression, and orthodontic management—especially in children to preserve teeth and bone 4 5 12 15 16 17 18 19.
• Individualized, evidence-based care is essential for the best patient outcomes.

Staying informed about dentigerous cysts ensures early recognition, appropriate intervention, and the preservation of both function and aesthetics in dental and maxillofacial health.