OS- Cysts Flashcards
What is a cyst?
A pathological cavity containing fluid/ semi fluid or gaseous contents which is not created by the accumulation of pus.
How can you differentiate between an infected cyst and an abscess?
Because infected cysts lose their cortication they look similar to abscesses so we need to consider the shape/size of the radiolucency.
Cysts will often be round and displace the teeth/bone around them.
Abscesses often have more irregular shapes and don’t displace the surrounding hard tissues. (but they can cause tissue breakdown)
What are the symptoms of a cyst in the jaw?
Pain
Tenderness
Slow growing swelling.
Displacement of teeth.
Mobility of teeth.
Discoloration of the tooth.
Although cysts are often asymptomatic until they get infected.
How can we tell if a cyst comes from the tooth or the periodontium?
Sensibility testing the tooth.
If the cyst comes from the tooth- the tooth will be non-vital.
If the cyst comes from the periodontium- the tooth will be vital.
What initial radiographs do we select to investigate a cyst?
Oblique occlusal/ Periapical / OPT (not for anterior)
What are the radiographic features we look for in a cyst?
- Shape (spherical or egg shaped)
- Margins (defined and corticated unless infected)
- Locularity- often unilocular
- Multiplicity- single/ bilateral (multiple would indicate a syndrome)
- Effect on the surrounding anatomy-
How aggressive is it- Displace (cortical plates/ adjacent teeth/ maxillary sinus/ inferior alveolar canal)
Root resorption? - Inclusion of unerupted teeth in the cyst.
How can we classify cysts?
Structure (epithelial or non epithelially lined)
Pathogenesis (Inflammatory or pathological)
Origin (Odontogenic or non-odontogenic)
What is an odontogenic cyst?
The most common type of bony swelling in the jaw (>90% of bony swellings are odontogenic cysts)
This is an epithelial lined cyst that arises from tooth tissue and is formed in a tooth bearing area.
How do ontogenic cysts form?
From leftover tooth tissue when it is broken down in the jaw.
Rests of mallasez- remnants of hertwigs epithelial sheath (dentine production)
Rests of Seres- remnants of the dental lamina (produces the dental papilla)
Reduced enamel epithelium- remnants of the enamel organ .
What are the two most common types of odontogenic cyst?
Radicular and residual.
What is a radicular cyst?
This is an inflammatory odontogenic cyst that is always associated with a non vital tooth.
What is the presentation of a radicular cyst?
Often asymptomatic (unless infected)
Typically slow growing with limited expansion.
How does a radicular cyst form?
There is proliferation of the epithelial rests of malassez at the apex due to the inflammatory change caused by pulp necrosis:
Either through
- Proliferating epithelium with central necrosis.
- The centre gets cut off from the blood supply & becomes necrotic. (This cyst inside is known as a microcyst which brings fluid into the granuloma)
- The epithelium surrounds the fluid area.
How do periapical granulomas differ from a radicular cyst?
**Peri apical granulomas could be treated by RCT of the tooth, A radicular cyst could not. (Conflicting information) **
Radicular cysts are larger than periapical granulomas. (>15mm diameter then 2/3 of cases would be a radicular cyst)
What are the radiographic features of a radicular cyst ?
- Well defined round/oval radiolucency.
- Corticated margin continuous with the lamina dura of the non-vital tooth.
- Larger lesions may displace the adjacent structures.
- Long standing lesions may cause external root resorption &/ contain dystrophic calcification.
What are the histological features of a radicular cyst?
stratified squamous epithelial lining.
Connective tissue capsule (with inflammation in the capsule)
What is a residual cyst?
When the radicular cyst remains after removal of the tooth or treatment via root canal
What is a lateral reticular cyst?
This is a radicular cyst that is associated with an accessory canal. This is located at the side of the tooth instead of the apex.
What are inflammatory odontogenic cysts?
These are odontogenic cysts associated with a vital tooth.
Give and describe two examples of inflammatory odontogenic cysts?
Radicular (and residual)- cyst occuring at the apex of a non vital tooth.
Paradental cyst- Cysts typically occuring at the distal aspect of a partially erupted mandibular third molar.
Buccal bifurcation cyst- typically occuring at the buccal aspect of the mandibular first molar.
What is a dentigerous cyst?
A cyst associated with the crown of an unerupted (and usually impacted tooth)
(Most common with the 3rd molars in the mandible)
What are the radiographic signs of a dentigerous cyst?
Corticated margins attached to the ADJ of the tooth.
Larger cysts may begin to envelope around the root of the tooth.
Tend to expand symmetrically initially but larger cysts may expand unilaterally.
Discuss the histology of a dentigerous cyst?
Thin non-keratinised Stratified squamous epithelium.
No significant inflammation- BUT may resemble a radicular cyst if inflamed
What do we measure when diagnosing a dentigerous cyst?
And how do we interpret the results?
The radius of the follicle.
If it is >4mm consider that it is a cyst.
If it is >10mm assume it is a dentigerous cyst.