Otherwise called radicular cysts, periapical cysts are the most prevalent cystic lesions around the tooth area. Besides the discomfort, untreated periapical cysts can weaken the jawbone and affect your tooth structure. As such, urgent treatment is crucial to eliminating the condition and preventing further complications.

What Is a Periapical Cyst?

Periapical describes the tissues around the apex of a tooth’s root. On the other hand, dental cysts are tissue sacs in the gums filled with semi-solid, liquid, and even gaseous material. Periapical cysts occur when a tooth infection causes the tissue around the apex to decay. Although the cyst is initially asymptomatic and small in size, secondary infections can cause pain and tooth damage.

According to a study published in the Journal of Clinical and Experimental Dentistry, periapical granulomas and periapical cysts are most prevalent in individuals in their fourth to fifth life decades. This could be a result of progressive root canal infections, inadequate endodontic treatment, and the need for extraction due to decay.

Dentists can also identify the following cysts:

• Dentigerous Cysts: They form around the unerupted crowns of permanent upper canines or lower wisdom teeth. 
• Odontogenic Keratocystics (OKCs): These benign lesions form at the back of the lower jaw. Because they resemble other dental cysts, the dentist may order an x-ray, microscopic examination, or biopsy to confirm their presence.
• Gingival Cysts: They can affect both newborns and adults and originate from the gingival soft tissue.

Causes of Periapical Cysts

Radicular cysts have different risk factors, including:

Leading Factors

A periapical cyst results from pulpal necrosis (death of the pulp tissue), a condition secondary to trauma or dental caries. Pulp necrosis is irreversible and occurs when bacteria reach the pulp through cavities and cracks. These toxins will trigger your body’s inflammatory response, causing periapical inflammation. The cells and proteins rushing to the infection site will increase osmotic pressure in the periapex and cause the cyst to grow. 

Risk Factors

Failure to brush and floss causes bacteria to invade the pulp tissue and cause infection. Another risk factor is botched dental procedures. For instance, filling leakages or inadequate cleaning can leave bacteria and infected tissue within the tooth, creating an environment for periapical cysts.

Symptoms of Periapical Cysts

Here’s how to identify radicular cysts.

Recognizing the Signs

The cyst manifests as a hard, painful swelling around the gums. However, as the body sucks in the cyst wall, you’re left with a softer bump of fluid accumulation. Your teeth might also be sensitive to pressure and temperature changes.

Advanced Symptoms

The larger the cyst, the likelier it is to displace the root and cause bone expansion. The pulpal infection may also result in discharge and gum discoloration.

Diagnosing Periapical Cysts

Periapical cyst diagnosis involves the following steps:

Examination and Assessment

Periapical cysts, especially when small in size, can be difficult to spot. As such, x-rays might be necessary to differentiate cysts from other dental conditions. An experienced dentist will also perform a physical exam to look for sensitivity, loose teeth, swelling, discoloration, pain, and discomfort. The sooner you get checked, the likelier you are to catch periapical cysts in their asymptomatic stages.

Differential Diagnosis

In plain radiographs and CTs, periapical cysts appear as lucent, round, unilocular, or pear-shaped lesions in the periapical area. They’re usually less than one centimeter in diameter and are surrounded by cortical bone.

On the other hand, MRIs display the cysts as non-enhancing lesions at the tooth’s apex, returning low and high T1 and T2 signals, respectively. Dentists might need a biopsy to identify the exact lesion under a microscope.

Book an appointment with LeCroy Dental for an accurate diagnosis and treatment of your periapical cysts.

Periapical Cyst Treatment Options

Here’s what happens during radicular cyst treatment.

Conservative Treatments

Treatment involves removing the infected cyst, including the wall’s epithelium, to reduce the chances of a relapse. Root canal therapy can also be performed on your tooth if previous treatments were unsuccessful.

Remember, it’s not enough to remove the inflamed tissue—sealing the canals and fitting a crown is also necessary to help the tooth heal without infection. Additionally, the doctor can prescribe medications to treat the infection and manage pain and other symptoms.

Surgical Interventions

If root canal therapy cannot benefit your previously treated teeth, the dentist can recommend cystectomy, cystostomy, or marsupialization. Cystectomy removes the cyst, wound enclosure, and mucosa and is ideal for smaller cysts.

Conversely, cystostomy targets larger cysts that can affect the surrounding areas. The periapical cyst is tamponaded to channel its contents away from the bone. This reduces the cyst size over time to let the bone regenerate within the cavity.

Another option is marsupialization which sutures the gingiva around the cyst. This way, the cyst can empty its contents and heal without closing prematurely. Note that cystostomy and marsupialization might require root resectioning in case of root resorption.

Prevention and Maintenance

You can take several measures to avoid periapical cysts. They include: 

Oral Hygiene Practices

Preventing periapical cysts starts with upholding oral hygiene. Make sure to brush and floss daily to remove plaque and prevent tooth decay. Additionally, see your dentist regularly for professional cleanings and comprehensive check-ups of your teeth and gums.

Lifestyle Adjustments

Your lifestyle directly impacts your oral health. For starters, incorporate fruits, lean proteins, whole grains, and vegetables into your diet to strengthen the teeth and gums with essential nutrients. Similarly, avoid tobacco products and sugary foods and drinks that increase the risk of tooth decay. Moreover, see your dentist for timely diagnosis and treatment as soon as you suspect an infection.

Conclusion

Now that you know how periapical cysts occur and their impact on oral health, it’s time to book an appointment with an experienced dentist. In addition to advanced technologies, our team offers personalized expert care for periapical cysts and other dental conditions. If you have any concerns about your oral health or just want to keep up with routine dental care, LeCroy Dental is your professional, compassionate partner. Contact us today for the highest quality of dental services.