Cysts are tissue cavities that are lined with an epithelial cell layer and may contain fluid collections of tissue water, blood or, in the case of inflamed cysts, pus. In the case of cysts of the jaw, these cavities are located in the lower or upper jaw bone or in the adjacent soft tissue.
What are cysts of the jaw?
Jaw cysts develop more frequently in the upper jaw than in the lower jaw and usually occur in middle age. There are two types of jaw cysts: odontogenic cysts, which develop from tooth tissue, and non-odontogenic cysts, which develop in the surrounding soft tissue. The cyst is separated from its surroundings by the cyst wall (capsule or envelope of soft tissue) and has no drainage. The contents of the cyst are usually produced by the epithelial cells lining the inner cyst wall. Because the cyst contents cannot drain, the cyst grows over time and presses on adjacent tissue. In the vast majority of cases, jaw cysts are benign and are not noticed until they cause discomfort by growing.
Causes
Causes include growth disorders or maldevelopment, genetic predispositions, and inflammation, which can contribute to the formation of a jaw cyst. About 80% of all jaw cysts are odontogenic cysts that form when inflammation occurs at the root tip of a diseased or dead tooth. These inflammations may result, for example, from root canal treatment with irritation of the root membrane and are also known as radicular cysts. Follicular cysts, on the other hand, develop in the fetus in the womb when the tooth germ is formed. This type of jaw cyst surrounds the deciduous tooth even before it erupts. Some follicular cysts also lie directly on the tooth and bulge up the gum even before the tooth breaks through the gum. Periodontal cysts form on healthy teeth, while gingival cysts are often found near canines or the anterior molars. Non-odontogenic cysts arise from the soft tissue surrounding the jawbone. They are usually located in the palate or maxillary sinus and can lead to tooth misalignment, among other problems.
Symptoms, complaints and signs
Jaw cysts usually do not cause any clear symptoms at the beginning. The first symptoms appear when the cavities have reached a large size. They can then be felt from the outside, and when palpated with a finger, a cracking or crackling sound may be heard. As the cysts progress, they cause tissue damage in the adjacent region. Pressure sores, swelling and infection are possible, as well as fractures or deformation of the bone. If the cysts press on a nerve or displace tissue in the jaw area, pain also occurs. The pain is usually described as dull or throbbing. It usually occurs in phases and may radiate to surrounding areas of the body. If the growth of the jaw cysts progresses further, tooth misalignment or loosening may occur. Further growth of the cysts eventually leads to tooth loss in the affected region. This is accompanied by abrasion of the jaw bone. This process can last for months or years and is manifested by increasing pain and instability of the jawbone. If the cysts remain untreated, the jaw may fracture. In addition, the cysts can rupture and cause inflammation or infection.
Diagnosis and progression
Because jaw cysts grow very slowly and do not cause symptoms for a long time, in many cases they are discovered only by chance during X-ray or ultrasound examinations or dental treatments. If the cysts become larger, they can cause pain and nonspecific pressure sensations in the area of the jawbone due to the displacement of the surrounding tissue. If the jaw cyst is not treated, it can even “soften” and deform the jawbone. If you press your finger against a jawbone swollen by the cyst, a kind of crackling sound can be heard. In further stages, the cyst can deform the jawbone to such an extent that it loses its substance and stability, which can even lead to facial disfigurement. Nerve damage with accompanying paralysis is also possible.
Complications
In many cases, jaw cysts do not cause any particular discomfort or complications.They can spread in the patient’s body for several years and do not cause pain or other discomfort. However, jaw cysts can also cause swelling of the jaw, which is usually visible. Likewise, a gentle squeeze on the jaw can diagnose the cyst. Likewise, the cyst can deform the bone of the jaw, causing severe pain. Likewise, disfigurement of the face occurs, which not infrequently leads to depression or other psychological discomfort. As a result, the patient’s quality of life is significantly restricted and reduced. Paralysis of the face can occur, so that the intake of liquids and food may be difficult for the affected person. Removal of jaw cysts is usually performed by a surgeon or by a dentist. There are no particular complications associated with this procedure. However, affected patients are still dependent on taking antibiotics to prevent inflammation after removal. The patient’s life expectancy is usually not reduced by the jaw cysts.
When should you see a doctor?
Because a cyst of the jaw often remains asymptomatic for a long period of time, the affected person should attend regular dental checkups. In many cases, incidental findings lead to the discovery of existing cysts. A visit to the doctor is necessary as soon as discomfort and irregularities develop in the oral cavity. If there is pain, shifting or loosening of the teeth, a doctor is needed. If pain spreads further into the head area via the face, a doctor’s visit should be made. In case of sleep disturbances or interruptions of concentration, a clarification of the complaints is also recommended. If there are problems with chewing, swelling or a feeling of tightness in the mouth, a doctor should be consulted. If irregularities are noticed when wearing braces or if disturbances set in with an incorporated denture, a doctor should be consulted. Refusal to eat for several days and severe hypersensitivity to foods and liquids are indications that should be evaluated by a doctor. If, in addition to the discomfort of the teeth, there are abnormalities of the gums or jaw, a check-up visit to a doctor should be made. Discoloration of the mucous membranes and pus formation in the mouth should be presented to a medical professional. If there is a misalignment of the jaw, visual changes in the shape of the face or sudden bleeding in the mouth, a doctor should be consulted.
Treatment and therapy
If a cyst of the jaw was discovered during an imaging procedure, its removal is always advised. On x-ray and ultrasound images, a cyst often cannot be distinguished from a rarely occurring tumor, so only removal by a dentist or oral surgeon and possible subsequent histologic examination can provide information about the type of cyst. Radicular cysts can be removed with tooth extraction in many cases. For smaller cysts in the jawbone or soft tissue, a cystectomy (removal) is usually performed, while larger and awkwardly located cysts may just be incised (cystostomy) to allow the contents of the cyst to drain. If the cyst has created a cavity in the jawbone, it is filled with bone substitute material to maintain or restore the stability of the jawbone. Both removal and incision of the cyst require subsequent treatment with antibiotics to prevent inflammation. Jaw cysts can recur, meaning they can later form again in the same location.
Outlook and prognosis
Jaw cysts are usually discovered quite by accident by the treating dentist. In most cases, the doctor diagnoses them on the basis of an X-ray taken because of a diseased tooth. Generally, such jaw cysts are considered harmless, but should be treated promptly. If the affected person decides to go to the doctor for treatment, the existing jaw cyst is removed by means of surgery. The resulting cavity is filled with a special material so that possible complications can be ruled out at an early stage. If such an operation is not performed, the affected person must expect considerable problems.An existing jaw cyst can enlarge within a very short time, so that it is even visible from the outside. In addition, misalignments of the jaw or teeth are possible, which are very difficult and costly to correct afterwards. For this reason, the removal of such jaw cysts is urgently required. If the affected person decides to undergo medical and drug treatment, a quick and at the same time complete recovery can be expected. Without any medical intervention, self-healing is almost impossible. Jaw cysts will not regress on their own, so going to the doctor is essential.
Prevention
The best prophylaxis is good dental care and oral hygiene, a healthy diet and regular dental checkups. Even in the case of minor or unclear complaints, one should not shy away from visiting the dentist in order to detect a possible developing jaw cyst in time. If a cyst has been removed or treated, regular follow-up is necessary to detect a possible recurrence in time.
Follow-up
Follow-up care mainly concerns diseases that may recur after initial therapy. Tumors are among them. Doctors hope for a better prognosis by starting treatment early. Such a procedure may also be appropriate after the removal of a jaw cyst. This is because in certain cases, a new formation occurs. The rhythm of a follow-up is agreed between the doctor and the patient depending on the cause. X-rays on which the cysts can be clearly seen are suitable for diagnosis. Furthermore, follow-up care aims to prevent pain and complications. This is best achieved by taking it easy immediately after surgery. Solid foods should be avoided for a short time. The doctor often prescribes special mouth rinses to ensure hygiene. Once the wound on the gum has healed, the acute aftercare can end. There is only the question of a new formation. Jaw cysts usually do not require treatment while they are still small. Because there are no symptoms, doctors often refrain from surgical removal. Instead, they choose long-term therapy or aftercare, in which they observe the development of the cysts. Annual checkups are suitable, for example, in which the stage of development is analyzed by X-ray.
What you can do yourself
A cyst in the jaw does not usually cause any discomfort, but it still needs to be treated by a dental professional. Otherwise, the cavity enlarges and can displace healthy tissue or cause tooth misalignment. As a self-help measure, it is recommended that affected persons consult a dentist or oral surgeon at the first sign of a cyst. Until the visit to the doctor, the affected area should not be irritated or touched with the tongue, if possible, to avoid injury or the development of a bacterial focus. After treatment, the advice and instructions of the medical professional should be followed first. In principle, thorough dental and oral care is important. In order for the recovery to proceed smoothly, the body should be sufficiently spared. Immediately after the operation, this means abstaining from eating and drinking. Gradually, liquid foods such as soups or porridge can be consumed again. Alcohol, coffee and nicotine should be avoided if possible, as the body is already exposed to a great deal of stress. In the days that follow, strenuous activities and sports should be avoided. In addition, regular check-ups with the dentist are indicated. In case of undesirable complications, the dental office should be consulted directly.
