Third molar cysts
Allan G. Farman
agfarm01 at LOUISVILLE.EDU
Fri Feb 9 10:30:04 PST 2001
The debate has been interesting. In reality there is no standard approach to establishing the difference between an early dentigerous cyst and a widenening of the dental follicle around the time of tooth eruption. Certainly, pericoronal radiolucencies that are more than a few millimeters in diameter are more likely to be dentigerous cysts than smaller "lesions." Certainly "expert observation" is needed in many cases, but there is no excuse for not following up with periodic radiographs ("unsuperized neglect") while the patient remains in your care. It should be remembered that many pathoses can invade the dental follocle - or perhaps originate from follicular tissues. These conditions most commonly include unicystic ameloblastioma, odontogenic keratocyst, AOT and calcifying odontogenic cyst - but any unicystic cyst or tumor developing above a tooth could be misinterpreted as a dentigerous cyst. As Laurie notes, where the radiolucency does not originate from the CEJ one needs to be particularly suspicious and early histopathologic analysis is then desirable. It should also be realized that even the dentigerous cyst needs to be taken seriously in terms of it potential effects on the adjacent dentition. External root resorption of adjacent or superjacent teeth is all too common; hence the relationship of the perceived lesion to its neighboring teeth needs to be considered when assessing the time table for possible surgical intervention. Professional judgment is more important than a specific number of millimeters.
Concerning nomenclature, the dentigerous cyst is a class of follicular cyst where the lesion is covered by bone. Soft tissue follicular cysts are known as eruption cysts. Some lateral periodontal or paracoronal cysts might also have a follicular origin.
>>> LCarter at DEN1.DEN.VCU.EDU 02/09/01 07:28AM >>>
Dentigerous and follicular cysts are synonyms for one and the same histopathological entity.
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