Dental Cyst: Symptoms and Whether the Tooth Can Be Saved

What a dental cyst is and why it is dangerous

A dental cyst often does not hurt for years, and in many cases the tooth can be saved. In short, a dental cyst is the result of chronic infection inside the tooth. The nerve dies because of deep decay or an injury. Bacteria then pass through the canal to the tip of the root. Young inflamed tissue grows around the focus, and this is how a granuloma forms. In some cases a cavity with an epithelial wall, that is, a thin lining of cells, forms inside it. This is the cyst.

According to international studies, this kind of cyst is more common than all other cysts of dental origin. But far from every dark spot at the root turns out to be a cyst. And even a large focus does not always mean the loss of the tooth.

We take the second figure from international studies of lesions at the root, and the third from a clinical series in which patients were followed for 2 to 10 years.

A cyst at the root is called a radicular cyst or a periapical cyst. In our practice, it is more common in the upper jaw. Is a tooth cyst dangerous? It is dangerous not because it grows fast but because it grows unnoticed:

• it gradually destroys the bone around the root;
• it can fill with pus and turn into an abscess with swelling of the face;
• in teeth of the upper jaw it sometimes affects the maxillary sinus, the cavity in the bone above the teeth;
• a large cyst weakens the jaw and makes future dental implants harder.

Why a radicular cyst appears

The main cause is a dead nerve, with bacteria left in the canals afterwards. This happens:

• with deep decay that was not treated;
• after an injury to the tooth, even without a visible chip;
• after root canal treatment, if the infection in the canals remained.

Does a dental cyst hurt

Often it does not. While the focus is quiet, you feel nothing. We find the cyst on an X-ray during a routine check-up, when preparing for prosthetics, or on an image taken for a completely different reason. These may put you on your guard:

In a flare-up there is pain, swelling and a raised temperature. This is already a reason to see a dentist the same day.

How the diagnosis is made

On an X-ray a cyst looks like a rounded dark spot with clear edges at the tip of the root. An ordinary image does not always tell a cyst from a granuloma. So where necessary we take a CBCT scan (3D dental scan). The exact type of formation is confirmed by examining the tissue under a microscope after removal.

It depends on the size and character of the focus whether root canal treatment is enough or surgery is needed. That is why we compare images before and after treatment and do not rely only on how you feel.

How a dental cyst is treated

We choose the approach by the size of the formation, the condition of the tooth and whether it has been treated before. Below is the typical order.

Root canal treatment is part of our endodontics service, and the surgical stages are handled by our surgeon.

At consultations we are often asked whether a tooth has to be removed if a cyst has been found on an X-ray. In our practice, there is no need to rush. First we look at whether the tooth was treated before, whether the canals can be accessed and how much bone is left around the root. If the tooth can be restored, we start with root canal treatment and compare follow-up images. We leave extraction for when the tooth really cannot be saved.

What to do to make a dental cyst go away

Folk rinses and tablets will not dissolve a cyst, however convincing the advice on forums sounds. Only one thing gives a chance of shrinking: removing the infection inside the tooth with good-quality root canal treatment. Small foci often heal after this, and we see it on follow-up images. A cyst with a dense wall may not disappear. Then we remove it.

Can a cyst in a tooth go away on its own

No. Without treatment, the source of infection inside the tooth does not go anywhere. The focus slowly grows and destroys the bone around the root. The absence of pain only postpones the moment when you find out about the focus.

Will antibiotics help

Not on their own. An antibiotic can relieve a flare-up for a while, but it does not get inside the dead tooth where the bacteria live. When the course ends, the focus stays where it was. According to international studies, the source of an acute infection at the root is removed first. Antibiotics are indicated when the infection spreads or there are general symptoms. That is why we prescribe tablets only in such cases and together with root canal treatment, not instead of it.

Can a dental cyst come back

Yes. The focus can form again in the same place. This happens if the infection in the canals remained or the cyst was not removed completely. A so-called residual cyst appears if part of it was left in the bone after the tooth was removed. That is why after treatment we always look at follow-up images.

Where to go

An X-ray may have shown a dark spot at the root. Or a pimple on the gum may bother you. Either way, start with a consultation at Cristi Dent in Chișinău. We save the tooth whenever possible. If the focus does not shrink after root canal treatment, we carry out an apicoectomy with removal of the cyst.