Oral Cysts: A Comprehensive Guide 

DEFINITION: 

An oral cyst is defined as a fluid-filled sac or pocket lined by epithelium, which can develop in various regions of the mouth, including the gums, lips, inner cheeks, or around the teeth. 

Oral mucous cysts, commonly referred to as "mucoceles," are often associated with obstruction of the salivary gland ducts and typically manifest in the soft tissues of the oral cavity, particularly on the lips and inner surfaces of the cheeks.  

Gingival cysts or oral cysts on gums, can be categorized into two types: those that occur in children and those that develop in adults  

The gingival cysts found in adults are primarily soft tissue cysts that are frequently located in the premolar region of the mandible.  

In newborns, oral cysts may present as "Bohn's nodules," which form at the posterior muscular part of the roof of the mouth, while "Epstein's pearls" appear along the midline of the palatal region.  

“Oral lymphoepithelial cyst” are rare entities that typically develop on the floor of the mouth near the tonsils; they are usually painless and small in size. 

When considering the removal of an oral cyst, the approach depends on the size and location of the cyst. Small cysts may be drained, while larger ones often necessitate surgical excision.  

Cysts generally do not cause pain, although discomfort can occur. Dentists may prescribe antibiotics if an infection is present or recommend surgery to prevent recurrence. It is essential to consult a healthcare professional to devise an accurate treatment plan tailored to the specific type of cyst.  

Oral cyst can occur due to couple of reasons: 

1. Trauma 
2. Blocked salivary glands 
3. Infection 
4. Impacted teeth 

Types of Oral Cysts: 

Inflammatory odontogenic cysts are classified as: 

Periapical cyst/ Radicular cyst: 

1. Radicular (referring to root tip) cyst also known as periapical (around the apex) cyst. 
2. These cysts form at the root tip of an infected tooth.  
3. They are mostly caused by a dental abscess. 

Treatment:  

• RCT 
• Apicectomy 
• Extraction with curettage 
• Enucleation 

Paradental cyst: 

1. Occurs in young patients associated with an erupting or erupted first mandibular molar 
2. They appear as gingival swelling, and pus discharge 

Treatment: 

• Enucleation is recommended if 1st and 2nd molars are associated 
• In the case of 3rd molar, extraction is the treatment of choice. 

Developmental odontogenic cysts are classified as: 

Dentigerous cyst:  

1. These are the second most common oral cysts.  
2. These cysts are formed around the teeth that have not erupted in the oral cavity.       
3. They usually show no symptoms but with time can grow large and cause pain or swelling. 
4. Third molar and maxillary canines are mostly affected 

Treatment: 

• curettage 
• Excision  

Eruption cyst: 

1. They occur in young children or infants during deciduous or permanent teeth eruption 
2. They appear as bony swelling with a blueish hue. 

Treatment: 

• No treatment is required, these are self-limiting. 

Lateral periodontal cyst: 

1. They mostly occur in mandibular regions. 
2. Always associated with vital tooth 

Treatment: 

• Curettage 
• Enucleation 

Odontogenic keratocyst (OKC):  

1)- Known for its slow growth and tendency to recur, OKCs are often associated with developmental abnormalities. 

2)- It occurs on the most posterior part of lower jaw in the posterior ascending ramus of the mandible. 

Treatment:  

• Enucleation for small cyst 
• Marsupialization or a resection for large cysts 

Orthokeratinizing odontogenic cyst: 

1. It is clinically similar to OKCs, but they have a more favorable prognosis after treatment  
2. Mostly associated with an impacted tooth. 

Treatment: 

• Surgical excision 

Glandular odontogenic cysts: 

1. They are aggressive and can lead to increased tooth mobility. 
2. Males are predominantly affected. 

Treatment: 

• Enucleation 
• Curettage 

Oral Mucous Cyst (Mucoceles):  

• Mucoceles are fluid-filled cavities that often occur on the lips or under the floor of the mouth.  
• Trauma remains the main cause behind the formation of mucoceles. 
• Trauma to the soft tissues causes mucocele formation. 
• They are commonly caused due to salivary gland duct blockage. 

Lymphoepithelial cysts:  

These cysts typically form on the lateral borders of the tongue and involve the salivary glands.  

They may be associated with autoimmune conditions such as Sjögren's syndrome, where the body's immune response is compromised. 

Causes of Oral Cysts 

The exact etiology of many oral cysts remains unclear; however, several factors contribute to their formation: 

1. Infection 

• Dental Abscesses: These occur when a tooth becomes infected, leading to pus accumulation around the root. 
• Infection-Associated Cysts: Certain cysts, such as radicular cysts, develop as a complication of dental infections. 

2. Trauma 

• Bites: Accidental bites of soft tissues, including the lips and tongue, can cause localized trauma, leading to cyst formation. 
• Injuries: Trauma from accidents or sports-related injuries may also precipitate the development of cysts. 

3. Developmental Abnormalities 

• Developmental Cysts: These cysts may arise during the developmental stages of teeth and jaws and can be congenital, resulting from abnormal growth of the jaw or teeth. 

Symptoms and Diagnosis 

The clinical presentation of oral cysts can vary based on the type and size of the cyst. Common symptoms include: 

• A painless lump within the oral cavity 
• Swelling in the cheek or jaw region 
• Difficulty in mouth opening 
• Pain or discomfort in the affected area 

Diagnosis typically involves a clinical examination by a dentist, who may also request imaging studies such as X-rays to assess the cyst's characteristics and implications. 

Treatment Options

Management of oral cysts depends on their type, size, and location. In some instances, observation may suffice; however, symptomatic cysts or those at risk of infection may require intervention. Treatment modalities include: 

• Incision and Drainage: This procedure involves creating a small incision to allow the cystic fluid to drain. 
• Excision: Surgical removal of the cyst is performed in cases where it poses a risk or causes discomfort. 
• Enucleation: This technique involves the complete removal of the cyst while preserving surrounding tissue. 
• Marsupialization: This method entails making an incision in the cyst to allow it to heal from the inside out. 

Prevention and Management 

While it may not be possible to entirely prevent oral cysts, adhering to good oral hygiene practices can mitigate risks. 

Lifestyle Changes 

• Maintain Good Oral Hygiene: Brush teeth twice daily with fluoride toothpaste, floss regularly, and use an antimicrobial mouthwash. 
• Avoid Trauma: Use mouthguards during contact sports to protect oral tissues. 
• Manage Underlying Conditions: For individuals with autoimmune disorders like Sjögren's syndrome, appropriate management under a healthcare provider's guidance is essential. 

Regular Dental Check-ups 

Routine dental visits are critical for the early detection and management of oral cysts. Dentists can offer personalized advice on maintaining optimal oral health. 

Complications and Risks 

While most oral cysts are benign, some can cause complications, such as: 

• Infection: Cysts can become infected, leading to pain, swelling, and redness.    
• Growth: Some cysts can grow large and interfere with eating, speaking, or breathing.    

Potential Complications 

• Infection 
• Growth 
• Recurrence 

Risk Factors 

• Poor oral hygiene 
• Trauma in oral cavity 
• Underlying medical conditions 

Long-Term Effects 

Most oral cysts do not have long-term effects if they are treated properly. However, some cysts can cause facial disfigurement or interfere with oral functional ability, such as eating and talking.