|Year : 2020 | Volume
| Issue : 2 | Page : 120-123
Eruption cyst: A case report
Aditya Joseph Parampill1, Parth K Shah2, Rupinder Bhatia1, Charu Girotra2, Reetika Rastogi1
1 Department of Pedodontics and Preventive Dentistry, D. Y. Patil Deemed to be University School of Dentistry, Mumbai, Maharashtra, India
2 Department of Oral and Maxillofacial Surgery, D. Y. Patil Deemed to be University School of Dentistry, Mumbai, Maharashtra, India
|Date of Submission||04-Dec-2019|
|Date of Decision||09-Apr-2020|
|Date of Acceptance||27-Mar-2020|
|Date of Web Publication||21-May-2020|
Dr. Rupinder Bhatia
Department of Pedodontics and Preventive Dentistry, D. Y. Patil Deemed to be University School of Dentistry, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Eruption cysts are benign cysts of soft tissue in association with an erupting primary or permanent tooth. It is defined as a cyst that lies superficial to the crown of an erupting tooth and is lined by stratified squamous nonkeratinized epithelium. Clinically, it appears as soft, often translucent swelling of the gingival mucosa overlying the crown of the involved teeth and may vary from pink to bluish purple in color. Usually seen in children and the most affected teeth include the first permanent molars and maxillary incisors. Radiographically, there is no bone involvement. Eruption cyst may disappear by themselves, but if injured, shed blood, or get infected, then a surgical treatment to expose the tooth and drain the contents may be required. This article describes a case of eruption cyst in a 7-year-old male patient, which presented with a swelling involving the gingiva apical to 51 and involving 11.
Keywords: Eruption cyst, eruption hematoma, simple excision
|How to cite this article:|
Parampill AJ, Shah PK, Bhatia R, Girotra C, Rastogi R. Eruption cyst: A case report. Saudi J Oral Sci 2020;7:120-3
| Introduction|| |
Kramer has defined a cyst as a pathological cavity having fluid, semifluid, or gaseous content, which is not created by the accumulation of pus and is sometimes but not often, lined by the epithelium. Eruption cyst is a benign, developmental odontogenic cyst that accompanies an erupting primary or permanent tooth, forming shortly before the tooth's appearance in the oral cavity. It develops due to the separation of the dental follicle from around the crown of an erupting tooth, present within the soft tissues that overlie the alveolar bone.
The exact etiology of the occurrence of eruption cyst is not clear. Aguiló et al., in their retrospective clinical study of 36 cases, found early caries, trauma, infection, and the deficient space for eruption as possible causative factors.
Although there are number of theories about their origin, it seems to arise from the separation of the epithelium from the enamel of the crown of the tooth due to the accumulation of fluid or blood in a dilated follicular space.,
In the past, they were classified as a dentigerous cyst. However, many authors consider eruption cyst a lesion dissimilar to dentigerous cyst since the last one occurs within the soft tissues overlying a tooth in eruption.
Usually occurs in the first decade of life, in single/multiple, unilateral/bilateral forms, in the maxillary/mandibular arch, but more prevalent in the maxillary arch. Gender predilection of eruption cysts is controversial. Some authors reported a male predilection at a rate of 2:1,, whereas others found no gender differences or a female predilection.
Aguiló et al., in their study, have shown that 2.8% of eruption cysts occurred in the incisal and molar areas, the remaining 17.2% occurred in canine-premolar areas. Other reports have also suggested that majority of eruption cysts occur in the incisal and molar areas, followed by canine and premolar areas and the preference for the incisal rather than the molar area in the ratio of 2:1 could be based on their greater visibility in the incisor area.
This is a case report of a 7-year-old boy who presented with a dome-shaped gingival swelling in relation to the maxillary right primary central incisor.
| Case Report|| |
A 7-year-old male child along with his parents reported to the department of pedodontics with the chief complaint of bluish black swelling on the gums in the front region of the upper jaw. Parents of the child feared this to be a malignant tumor. On history taking it was revealed the child had a fall when he was 2 years old face first. No intraoral injury was noticed by the parents then.
The lesion started appearing 1 month ago as a pinpoint translucent swelling over normal gingiva. At that point, the parents decided to prick the swelling with a needle. White fluid discharge was noticed. The lesion slowly increased to its present size. The color also changed from normal mucosa to bluish black color over a period of 1 month. At this time, there was no fluid discharge or any other symptoms of pain were associated.
The general physical examination of the child showed no abnormalities.
Examination of the oral cavity showed that the child was in his mixed dentition period. #61 had exfoliated while #51 was mobile. Clinically, the gingival lesion was well-demarcated, dome-shaped, bluish black, fluctuant swelling on the buccal gingiva over #51 and unerupted #11. Swelling measured approximately 2.0 cm × 1.5 cm and was soft and fluctuant [Figure 1]. Intraoral radiograph confirmed the presence of #11 in the stage of eruption and there was no sign of bone involvement or any other radiolucency. It was hence clinically and radiographically diagnosed as eruption cyst.
|Figure 1: Preoperative photograph showing eruption cyst with respect to 51|
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Surgical intervention was decided to be the choice of treatment. The treatment plan was explained to the parents. A blood investigation was carried out before the procedure. The weight of the patient was checked so as to calculate the maximum dosage of local anesthesia. The area to be operated was then anesthetized using 2% lignocaine hydrochloride. Surgical incision was done using a 15 number Bard-Parker (BP) blade. #11 was then exposed, and a thorough cleaning of the area and removal of the cystic content and lining were carried out [Figure 2]. Only the labial surface of the gingiva was sutured, and a window was left on the incisal area for the eruption of #11 [Figure 3]. Postoperative instructions were given.
|Figure 2: Surgical exposure and removal of cystic content with respect to 11|
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|Figure 3: Suturing done on the labial surface of the gingiva, leaving a window at the incisal aspect for the eruption of 11|
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A specimen was sent for histopathological examination, which showed surface oral epithelium on the superior aspect, underlying lamina propria showed variable inflammatory cell infiltrate and the deep portion of the specimen which represents the roof of the cyst showed a thin layer of nonkeratinizing squamous epithelium. Thus, the diagnosis of eruption cyst was confirmed.
The patient was recalled after a week for suture removal. There was uneventful healing [Figure 4]. The patient was then recalled after a month and there was a clinical sign of eruption of 11 into the oral cavity [Figure 5].
|Figure 4: Patient recalled after 1 week and an uneventful healing was seen after suture removal|
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| Discussion|| |
Eruption cyst is the soft tissue analog of the dentigerous cyst but recognized as a separate clinical entity. The etiological factor of occurrence is unclear but according to Aguiló et al. in their study of 36 cases found trauma, caries, infection, and less space for eruption as possible factors.
Literature shows a small number of reported cases of eruption cysts and they appear to be more prevalent in the Caucasian race.,, The prevalence of eruption cyst has not been thoroughly studied. Extensive review of the literature revealed a low prevalence of these cysts.,, This may be due to the fact that many authors classify them among the dentigerous cysts. Anderson et al. reported on 54 cases over 16 years, which were histologically confirmed. Aguiló et al. reported on 36 cases in their retrospective study of 15 years. Later, Bodner  found a prevalence of eruption cysts of 22% among various maxillary cystic lesions in 69 children. In 2004, Bodner et al. once again presented 24 new cases of eruption cysts.
Nagaveni et al. and other authors , described it as a dome-shaped swelling in the mucosa present at the alveolar ridge, which in touch is soft and color ranges from transparent, bluish, purple to blue black which was seen in the present case.
Radiographically, the patient presented with a soft-tissue shadow overlying the crown of the erupting tooth which was seen in the region of the cyst but did not have bone involvement, which was also seen by Anderson et al. and Shear et al.
Eruption cyst microscopically shows surface oral epithelium on its superior aspect. A variable inflammatory cell infiltrate can be appreciated in the underlying lamina propria. The roof of the cyst, which is also the deep portion of the cyst, shows a thin layer of nonkeratinized squamous epithelium.
If the cyst does not rupture spontaneously interventional treatment may not be necessary because the cyst ruptures spontaneously, thus permitting the tooth to erupt. If the lesion becomes infected, the roof of the cyst may be opened with a simple excision, generally permitting speedy eruption of the tooth. Simple incision or partial excision of the overlying tissue to expose the crown and drain the fluid is indicated when the underlying tooth is not erupting or the cyst is enlarging. A surgical intervention was undertaken. Surgical treatment using a BP blade was also carried out by Bodner., and Anderson., Shaul et al.,, Figueiredo et al. and Dhawan et al.,
A novel treatment modality has been suggested by Ramón Boj et al. consists of the use of Er, Cr: YSGG laser for the treatment of eruption cysts. It has certain advantages over conventional lancing with scalpel-nonrequirement of anesthesia, no excessive operative bleeding, does not produce heat or friction and patient will be comfortable, bactericidal and has coagulative effects, tissue healing is better and faster, and it is not associated with postoperative pain.
Marques et al. conducted a study to check the quality of life related to eruption hematoma using the Brazilian version of the early childhood Oral Health Impact Scale (B-ECOHIS) questionnaire before and after 2 months of the hematoma regression and found that on the first application of B-ECOHIS, the negative points related by the mother were child with difficulty to eat certain foods, child became angry due to oral problems, and caretaker became upset due to child's oral problems, the oral health status of the child and the general health of the child. On the second application of the B-ECOHIS, it was found that the child's life related to oral health improved after the regression of the eruption hematoma and that this cyst affects the child and his family physically and emotionally.
| Conclusion|| |
Eruption cyst is clinically asymptomatic but when infected causes pain. Patients or parents usually are bothered about their appearance and also affects their quality of life. Since the tooth erupts through the lesion, no treatment may be necessary. If the swelling does not regress, then a surgical or laser approach can be advocated for its treatment. Knowledge among clinicians is essential regarding this clinical entity to provide appropriate treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]