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In today’s podcast, Natalie Tornese, one of our senior solutions managers, discusses dental oral health and dental cysts.

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Hello every one and welcome to our podcast series!

My name is Natalie Tornese and I am a Senior Solutions Manager at Outsource Strategies International. Want to talk a little bit about dental oral health and dental cysts.

Dental and oral health is an important part of your overall health and well-being. Normally, the body's natural defenses and good oral health care habits, (such as daily brushing and flossing) can keep bacteria under control. However, poor oral hygiene can cause different oral infections such as tooth decay and gum disease and has also been linked to other diseases like cancer, diabetes, and heart disease. Even minor growths or dental pain can be the sign of a more serious issue in its earliest stages. Dental cysts are considered one of the most common dental problems that take people to the dentist for emergency treatment. These cysts are relatively rare growths or lesions that develop in the jawbone or the soft tissues in the mouth and face. They are usually non-cancerous and early diagnosis can be difficult because symptoms develop slowly (often over several months or years). Treatment options depend on the type of growth, the stage of growth, and symptoms. Treatment normally includes a combination of surgery and medical therapy.

So, what is a dental cyst?

A dental cyst is typically a closed sac of tissue in your gums that are filled with air, cells or fluid. Cysts are a reaction of the body to a condition and are relatively slow growing. It is a form of inflammation that develops after the dental pulp dies off. As the cyst develops, the bone structure around the tooth will feel an extreme amount of pressure and get weakened. The dental cyst left to grow without treatment can lead to severe infections or other problems affecting your oral health.

So why do they form?

Well, typically, dental cyst can form at the tip of the roots of dead teeth and also around the crowns (and roots) of buried teeth. A cyst will develop as the bacteria around the dead tooth grow. In some cases, this may be worse if a tooth has not erupted or developed properly. This is particularly observed with wisdom teeth. In rare cases, cysts occur due to a genetic syndrome like “Gorlin's syndrome”, but that has other symptoms also.

What part of the mouth do the dental cysts normally affect?

They develop in any of the soft oral tissues in the mouth including – the mucosal lining of the lips, the gums, cheeks, oral cavity, the jaw bone, the throat and the salivary glands. In most cases, these cysts, when they first start forming, remain infection free. But the inflammatory nature of a cyst becomes visible as the old dental pulp material starts to wear out at the root of your affected tooth. As this process unfolds, a great amount of pressure will be felt around the bone structure of the affected tooth weakening it.

There are a few different types of dental cysts –

  • There are periapical cysts caused by trauma, a crack in the tooth, or decay that has infected or killed the nerve of the tooth. These typically form at the root tip.
  • Dentigerous cysts also called follicular cysts. They grow around un-erupted or partially-erupted teeth, particularly the wisdom teeth.
  • Keratocysts are aggressive in nature. This type occurs due to trauma or genetics and it is found mostly in the posterior area of the lower jaw or mandible, and exhibit a high rate of recurrence, even after surgical removal.
  • Periodontal cysts are caused by advanced periodontal or gum disease, and they are bacterial in nature.
  • Mucocele (Mucous Cyst) affects the soft tissue in the mouth such as the tongue, inner cheek or lip, mucous cysts forms in response to irritation or trauma to the tissue. Unlike other oral cysts, these usually do resolve on their own.

So, what are the symptoms of dental cysts?

Dental cysts that are infected may normally cause several symptoms like - ulcers, sores, or tender areas in the mouth. You know, these usually will not heal after a week or two. They will cause pain or toothache, swollen gums, pain with chewing or biting, swelling of the face and clicking of the jaw. If any of these symptoms are accompanied by a high fever and facial or neck swelling, it is really important to seek medical emergency treatment.

The difference between a dental cyst and a dental abscess is that a dental abscess is a buildup of pus that forms inside the teeth or gums and abscess typically develops from a bacterial infection - that gets accumulated in the soft pulp of the tooth. An abscess can cause acute pain, swelling of your gums, face or cheek and can sometimes cause an unpleasant smell or taste in the mouth. Abscesses can form inside or near dental cysts, which is where the confusion sometimes occurs. Dental cysts aren't necessarily infected and can grow slowly or even years without any symptoms.

Diagnosis of dental cysts may begin with a detailed analysis of symptoms and other risk factors associated with the condition. Several imaging tests like X-rays, MRI or CT scan will be performed to identify the type and size of the cyst, severity of symptoms and extent of the cyst. In some cases, a biopsy may be recommended wherein a sample of fluid or lining from the cyst will be removed and sent to dental pathology lab for microscopic examination just to check for any abnormalities, abnormal cells, etc.

Treatment modalities for dental cysts vary depending on the location, the type and size of the cyst, the stage and the severity of the infection. Treatment usually involves surgical care. In some cases, treatment may include medical therapy or a combination of surgery and medical therapy.

Generally, small cysts do not cause any specific symptoms that may not require immediate treatment. Since cysts can grow bigger over time, early removal is often advisable to prevent structural damage to the mouth. If the cyst is abscessed, antibiotics are normally prescribed to stop the infection. If the cyst is simply removed, it may recur. Therefore, the primary goal is to remove the entire membranous sac along with its contents. This gives the surrounding tissue a chance to heal and fill in the space left by the cyst. However, in some rare cases, a bone graft may be used to fill the gap left after the removal of a large cyst in the jawbone. Reconstruction of the jawbone or other structures may also be done as part of the treatment.

The ICD-10 codes associated with this condition are:

  • K09 - Cysts of oral region, not elsewhere classified
  • K09.0 - Developmental odontogenic cysts
  • K09.1 - Developmental (nonodontogenic) cysts of oral region
  • K09.8 - Other cysts of oral region, not elsewhere classified
  • K09.9 - Cyst of oral region, unspecified)

There are preventative measures that you can take in order to prevent this from occurring. One is maintaining good oral hygiene. Scheduling dental check-ups may help identify dental cysts early. Since they are usually asymptomatic when they first develop, you may not even know that you have one, until you develop some problems or until you have an X-ray. Make a habit to brush your teeth twice a day with fluoride toothpaste. Floss every day. Teeth that remain healthy rarely have cysts developing or forming around them. Make certain to eat a balanced diet and get regular professional dental cleanings on a schedule.  This will help preserve your dental health in the long-run.

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!