Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 209--211

Dentigerous Cyst in a young child: Clinical Insight and A Case report


RJ Hegde1, SS Khare1, VN Devrukhkar2,  
1 Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India
2 Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India

Correspondence Address:
R J Hegde
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai - 400 614, Maharashtra
India

Abstract

A dentigerous cyst or follicular cyst is an odontogenic cyst - thought to be of developmental origin - associated with the crown of an unerupted tooth. Such cyst remain initially completely asymptomatic unless when infected. The purpose of this case report was to describe the diagnosis and management of dentigerous cyst in a 9-year-old boy. The chosen treatment was cyst enucleation and tooth extraction.



How to cite this article:
Hegde R J, Khare S S, Devrukhkar V N. Dentigerous Cyst in a young child: Clinical Insight and A Case report.J Indian Soc Pedod Prev Dent 2013;31:209-211


How to cite this URL:
Hegde R J, Khare S S, Devrukhkar V N. Dentigerous Cyst in a young child: Clinical Insight and A Case report. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2020 Apr 4 ];31:209-211
Available from: http://www.jisppd.com/text.asp?2013/31/3/209/117967


Full Text

 Introduction



Dentigerous cysts are odontogenic cyst, which enclose the crown and are attached to the neck of the tooth. Thus, they generally appear during tooth development in young patients. The frequency of dentigerous cysts in children has been reported low in dental literature.

Dentigerous cysts occur predominantly in the third molar region of the mandible. These cysts are often asymptomatic unless there is an acute inflammatory exacerbation and, therefore, these lesions are usually diagnosed on routine radiographic examination. [1] Swelling, tooth mobility, teeth displacement, and sensitivity may be present if the cyst reaches the size larger than 2 cm in diameter. [2] Radiographs show a unilocular radiolucent lesion with well-defined sclerotic margins that is associated with the crown of an unerupted tooth. Radicular resorption of teeth in the region of the lesion is common. The complications associated with dentigerous cyst include pathologic bone fracture, loss of permanent tooth, bone deformation, and development of squamous cell carcinoma. Since the cyst may increase in size, the indicated treatment is surgical removal of lesion and involved teeth, or decompression to salvage the involved teeth. [3]

This article presents a case report of a 9-year-male child patient having dentigerous cyst associated with unerupted 2 nd premolar with its detailed management.

 Case Report



A 9-year-old male patient reported to the department of Pedodontics and Preventive dentistry, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, with a chief complaint of swelling and pain on left lower side of the mandible. The patient was apparently alright one month back, when he noticed a swelling on left side of face, which gradually increased in size. The patient also gave a history of intermittent pain in the region of the chief complaint.

On general examination, the patient was healthy, and there was no apparent history of past illness or hospitalization or trauma to the jaw. On extra-oral examination, a single diffuse swelling was noted on left side of face with no sinus or active discharge of pus. On intra-oral examination, a hard swelling in 74, 75 regions were found with obliteration of buccal vestibule. The swelling was bony hard with expansion of buccal cortex in 74, 75 regions with no expansion of lingual cortex. There was a "typical egg shell cracking" found in 75 region, which was grossly decayed.

Orthopantamograph (OPG) revealed an oval-shaped unilocular radiolucency around the developing second premolar with sclerotic border. The deciduous second molar was grossly decayed with loss of bone in the bifurcation area [Figure 1].{Figure 1}

Based on clinical and radiographical examination, a provisional diagnosis of dentigerous cyst was made. The contents of the swelling were aspirated and sent for investigation, which revealed yellowish, straw-colored fluid. Other routine investigations were within normal limits.

Surgical enucleation of the dentigerous cyst was done, and extraction of unerupted mandibular second pre-molar with deciduous second molar was done followed by primary closure of wound. The cyst was seen attached to the neck of the involved tooth [Figure 2] and [Figure 3].{Figure 2}{Figure 3}

The specimen was sent for histopathological examination, which revealed cystic wall lined by 2-3 layered thick flattened squamous epithelium with occasional presence of mucosal cells. Suture removal was done after one week, and the healing was uneventful. The patient was given functional removable space maintainer till further treatment was advocated.

 Discussion



Dentigerous cysts are usually solitary, benign developmental odontogenic cysts associated with the crowns of unerupted teeth. Dentigerous cyst accounts for more than 24% of the jaw cyst.

Occurrence of dentigerous cysts according to shear is usually in 3 rd and 4 th decade. [4] In contrast to this finding, Y Shibata et al. showed that the age of discovery of the dentigerous cyst was generally 9-11 years. [5] Our patient was also 9-year-old; this difference in the age-wise prevalence of dentigerous cyst may be attributed to the difference in the ethnicity of the population examined.

Dentigerous cyst is seen associated with 3 rd mandibular molars; [6] but, in our case, the cyst was associated with unerupted mandibular second premolar, and the same findings were reported in the previous study on the Japanese, where lower premolars is the most common site of occurrence of dentigerous cyst. [5]

According to Benn and Altini, [7] three feasible mechanism exists for histiogenesis of the dentigerous cyst. Developmental dentigerous cyst forms from dental follicle and becomes secondarily inflamed, and the source of inflammation is usually a non-vital tooth. The second type develops from radicular cyst, which forms at apex of a non-vital deciduous tooth. The permanent successor erupts into radicular cyst and results in dentigerous cyst that is extra follicular in origin. Third type is due to peri-apical inflammation from non-vital deciduous tooth or other source, which spreads to involve follicle of permanent successor, as a result of inflammatory exudate, dentigerous cyst formation occurs as seen in our case.

The surgical approach to cystic lesions of the jaws is either marsupialization or enucleation. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, and its proximity to vital structures.

It is been suggested that marsupialization of the cyst lining is the treatment of choice for dentigerous cyst in children in order to give a chance to the unerupted tooth to erupt, [8] the major disadvantage of marsupialization is that pathologic tissue is left in situ, without a thorough histologic examination; [9],[10] but, in our case, cystic sac was surrounding the unerupted premolar and was firmly attached to it. So, it was decided to do enucleation of the cyst. Three months post-operative result showed good prognosis of the case [Figure 4].{Figure 4}

In summary, dentigerous cyst development associated with an unerupted permanent tooth is not uncommon. As dentigerous cysts are asymptomatic, they can attain considerable size without the notice of the patient, and this warrants the early clinical and radiographic detection of the cyst, so that early treatment strategies will prevent or decrease the morbidity associated with the same.

References

1Ikeshima A, Tamura Y. Differential diagnosis between dentigerous cyst and benign tumor with an embedded tooth. J Oral Sci 2002;44:13-17.
2Bodner L, Wonderberg Y, Ban-Zir J. Radiographic features of large cysts lesions of jaw in children. Paediatri Radiol 2003;33:3-6.
3Motamedi MH, Talesh KT. Management of extensive Dentigerous cysts. Br Dent J 2005;198:203-6.
4Shear M. Speight Paul Cysts of the Oral and Maxillofacial Regions. 4 th ed. Blackwell publishing, Bristol; 2007.
5Shibata Y, Asaumi J, Yanagi Y, Kawai N, Hisatomi M, Matsuzaki H, et al. Radiographic examination of dentigerous cysts in the transitional dentition. Dentomaxillofac Radiol 2004;33:17-20.
6Ishikawa G. Oral Pathology 2, Kyoto Nagasueshoten Co; 1982. p. 379-81.
7Benn A, Altini M. Dentigerous cysts of inflammatory origin. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:203-9.
8Scott B Otolaryngology, Vol. 5, 6 th ed. UK: Butterworth-Heinemann; 1997. p. 5-6.
9Takagi S, Koyama S. Guided eruption of an impacted second premolar associated with a dentigerous cyst in the maxillary sinus of a 6 yr old child. J Oral Maxillofac Surg 1999;56:237-9.
10Peterson LJ, Ellis E III, Hupp JR. Contemporary Oral and Maxillofacial Surgery. 3 rd ed. St Louis, MO; Mosby; 1998.p. 540.