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Table of Contents   
CASE REPORT  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 148-151
Eruption cyst: A literature review and four case reports


1 Department of Pedodontics & Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
2 Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
3 Department of Orthodontist, Armed Forces Medical College, Pune, India
4 Department of Dental Surgery, Armed Forces Medical College, Pune, Maharashtra, India

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Date of Submission07-Dec-2009
Date of Decision16-Feb-2010
Date of Acceptance25-Feb-2010
Date of Web Publication25-Apr-2011
 

   Abstract 

Eruption cyst is a benign cyst associated with a primary or permanent tooth in its soft tissue phase after erupting through the bone. It is most prevalent in the Caucasian race. Intraoral examination of four patients revealed eruption cyst. Among these, in three patients it occurred in the maxillary arch and one had it in the mandibular arch. All were associated with permanent tooth. Surgical treatment was done in three cases and in one case the cyst disappeared gradually and tooth erupted in normal pattern. Four cases of eruption cyst from India are presented and literature on this condition is reviewed. It is clinically significant in that knowledge among general dentists is very essential regarding this developmental disturbance to reach the correct diagnosis and to provide proper treatment.

Keywords: Benign cyst, eruption cyst, eruption hematoma, simple excision

How to cite this article:
Nagaveni N B, Umashankara K V, Radhika N B, Maj Satisha T S. Eruption cyst: A literature review and four case reports. Indian J Dent Res 2011;22:148-51

How to cite this URL:
Nagaveni N B, Umashankara K V, Radhika N B, Maj Satisha T S. Eruption cyst: A literature review and four case reports. Indian J Dent Res [serial online] 2011 [cited 2017 Sep 22];22:148-51. Available from: http://www.ijdr.in/text.asp?2011/22/1/148/79982
The eruption cyst is a form of soft tissue benign cyst accompanying with an erupting primary or permanent teeth and appears shortly before appearance of these teeth in the oral cavity. [1],[2] Eruption cyst is the soft tissue analogue of the dentigerous cyst, but recognized as a separate clinical entity. [1],[2],[3],[4] Although there are a number of theories about their origin, [5] both seem to arise from the separation of the epithelium from the enamel of the crown of the tooth due to an accumulation of fluid or blood in a dilated follicular space. [6] Because of this common origin, some authors do not classify the eruption cyst separately from the dentigerous cyst. [7]

Literature shows small number of reported cases of eruption cysts and they appear to be more prevalent in the Caucasian race. [1],[5],[6] The aim of the present article is to report four cases of eruption cysts from India and to review the literature regarding this condition.


   Case Reports Top


This paper presents four patients of Indian origin with eruption cysts who reported to the Department of Pedodontics and Preventive dentistry, College of Dental Sciences, Davangere, India. [Table 1] shows age, sex, tooth involved, history and chief complaints, clinical features and the treatment rendered in four cases.
Table 1: Characteristics of eruption cysts and associated treatment

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   Discussion Top


Prevalence

Prevalence of eruption cyst has not been thoroughly studied. Extensive review of literature revealed low prevalence of these cysts. [1],[3],[5] This may be due to the fact that many authors classify them among the dentigerous cysts. In addition, since they are benign, there are a few studies in which the authors have done a definitive diagnosis using biopsy. [1],[3] This may also suggest that either the eruption cyst is an unusual lesion or it is an accepted local disturbance that is associated with the eruption of many teeth. The clinical impression of low prevalence may also be due to the fact most often the dentist sees only symptomatic eruption cysts and the majority resolve unnoticed. [1],[6],[8],[9] Anderson [1] reported on 54 cases over 16 years, which were histologically confirmed. Aguilo et al.[3] reported on 36 cases in their retrospective study of 15 years. Later, Bodner [5] found a prevalence of eruption cysts of 22% among various maxillary cystic lesions in 69 children. Recently, in 2004, Bodner et al.[10] once again presented 24 new cases of eruption cysts.

Clinical features

Reports [1],[3],[5],[11] show that most eruption cysts occur in an age range of 6-9 years, a period coinciding with the eruption of permanent first molars and incisors. However, recently, occurrence of eruption cyst in a neonate has been reported. [12] Aguilo et al., [3] in their study, have shown that 2.8% of eruption cysts occurred in the incisal and molar areas, the remaining 17.2% occurred in the canine-premolar areas. In our cases, two eruption cysts were found associated with incisors, one with canine and the other one with premolar tooth. 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 a ratio of 2:1 could be based on their greater visibility in the incisal area. [1],[10]

Clinically, eruption cyst appears as a dome shaped raised swelling in the mucosa of the alveolar ridge, which is soft to touch and the color ranges from transparent, bluish, purple to blue-black. [1],[3],[5],[11] The color of the cyst ranged from reddish black to bluish black in all the four cases presented here. Sometimes, the cyst occupies the whole or part of an unerupted crown area including the lingual area [Figure 1]. It has been reported that approximately it measures about 0.6 cm in diameter. [11] However, the size depends on whether it is associated with a primary or permanent tooth and the number of teeth involved. In one of the four patients, the cyst was larger in size, measuring about 1 × 1cm in diameter. They can occur unilateraly or bilateraly, and are either single or even multiple. [3],[6] Boj and Garcia-Godoy [6] reported a case of simultaneous occurrence of six eruption cysts in a 15-month old child.
Figure 1: Large eruption cyst involving 21 labial view (left) and lingual view (right)

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Eruption cyst occurs most frequently on the right side than left and among males than in females. [1] In this report, three cysts occurred on the right side and one on the left side, and all the four cysts were found in males. This was in line with other reports. [3],[5]

These cysts are most frequently found in the permanent dentition and the preference for the permanent dentition could partly be due to the fact that eruption cysts in the primary dentition may be dealt with by pediatricians. [1] They appear to be more prevalent in the maxillary arch [Figure 2]. [1] Three cases presented in this report occurred in the maxillary arch and one case in mandibular arch and all were found in relation to the permanent tooth. This finding was also in agreement with other reports. [3],[5]
Figure 2: Eruption cyst associated with 11

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On radiographic examination, it is difficult to distinguish the cystic space of eruption cyst because both the cyst and tooth are directly in the soft tissue of the alveolar crest and no bone involvement is seen in contrast to dentigerous cyst in which a well-defined unilocular radiolucent area is observed in the form of a half moon on the crown of a non-erupted tooth [Figure 3]. [1],[13] Histologically, this cyst presents the same microscopic characteristics as the dentigerous cyst, with connective fibrous tissue covered with a fine layer of non-keratinized cellular epithelium. [1]
Figure 3: Periapical radiograph showing erupting 11. Cystic cavity not visible

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Histopathologic features

Microscopically, eruption cysts show surface oral epithelium on the superior aspect. The underlying lamina propria shows a variable inflammatory cell infiltrate. The deep portion of the specimen, which represents the roof of the cyst, shows a thin layer of non-keratinizing squamous epithelium. [8]

Etiology

The exact etiology of occurrence of eruption cyst is not clear. Aguilo et al., [3] in their retrospective clinical study of 36 cases, found early caries, trauma, infection and the deficient space for eruption as possible causative factors.

Clinical symptoms

Most of the time, eruption cysts are found to be asymptomatic but there can be pain on palpation due to secondary factors such as trauma or infection. [3],[5],[6] Literature search on clinical histories for symptoms shows that the main reason to visit a dentist for the first time is appearance of the cysts along with missing of tooth in that area. [1],[3],[6] Pain was reported as a secondary factor. [1],[11]

Eruption cyst associated with other abnormalities

Most of the time eruption cyst occurs as an isolated phenomenon. However, a case has been reported showing other associated anomalies like hamartomas, natal tooth and epstein pearls in a premature newborn baby. [14] Recently, a case of eruption cyst has been published in a patient medicated with cyclosporin-A. [15] Nomura et al [16] have reported a rare case of Kinky hair disease with multiple eruption cysts. Also, two cases of eruption cysts associated with natal teeth have been reported by Bodner et al.[10] Rushton [17] has reported a malformed tooth associated with an eruption cyst.

Differential diagnosis

Differential diagnosis should be considered before delivering any treatment and varies from granuloma, amalgam tattoo and Bohns nodule to eruption hematoma. [3] The eruption hematoma occurs because of bleeding from the gum tissue during eruption and the accumulation of blood is external to the epithelium of the enamel. [5] While in the eruption cyst, it is the cystic fluid that mixes with the blood. The exact difference between the two is still unknown. The eruption cyst glows under transillumination but the hematoma does not glow. [3],[11] Other authors [1],[8],[9],[18] reported that if bleeding occurs within the cyst, due to trauma or local infection, the eruption cyst becomes bluish in color and is then known as an eruption hematoma, or a blue stain, which may be the first sign of a follicular cyst.

Treatment

Mostly, the eruption cysts do not require treatment and majority of them disappear on their own. [6],[8],[9] Surgical intervention is required when they hurt, bleed, are infected, or esthetic problems arise. [1],[5] Treatment has to be performed in order for the child to lead a healthy and comfortable life. The relatively high rate of such cysts and the fact that they occur in an area of rapid developmental change suggests the need for a conservative management in the young patient population. Interventional treatment may not be necessary because the cyst ruptures spontaneously, thus permitting the tooth to erupt. [5] If this does not occur, simple excision of the roof of the cyst generally permits speedy eruption of the tooth [Figure 4]. [5] 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. [7] A novel treatment modality has been suggested by Boj et al., [19] which consists of use of Er, Cr-YSGG laser for treatment of eruption cysts. It has certain advantages over conventional lancing with scalpel. They can be listed as non-requirement of anesthesia, no excessive operative bleeding, does not produce heat or friction and patient will be comfortable. It is bactericidal and has coagulative effects, tissue healing is better and faster, and it is not associated with postoperative pain. [19]
Figure 4: Exposure of 11 crown

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In case 1, partial excision of soft tissue followed by compression of cyst was done as the cyst was larger in size. In case 2, incision and exposure of the crown was performed [Figure 4]. For case 3, primary canine was extracted and compression of cyst was done to drain its content [Figure 5]. In fourth case, the cyst disappeared spontaneously with the eruption of the tooth and without surgical treatment [Figure 6].
Figure 5: Eruption cyst (arrow) involving 13

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Figure 6: Eruption cyst (arrow) associated with 44

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Clinical significance

Knowledge among clinicians is very essential regarding this clinical entity to provide appropriate treatment.

 
   References Top

1.Anderson RA. Eruption cysts: A retrograde study. J Dent Child 1990;57:124-7.  Back to cited text no. 1
    
2.Nunn JH. Eruption problems: A cautionary tale. J Dent Child 1993;60:207-10.  Back to cited text no. 2
    
3.Aguilo L, Cibrian R, Bagan JV, Gandia JL. Eruption cysts: Retrospective clinical study of 36 cases. J Dent Child 1998;65:102-6.  Back to cited text no. 3
    
4.Kramer IR, Pindborg JJ, Shear M. The WHO histological typing of odontogenic tumors: A commentary on the second edition. Cancer 1992;70:2988-94.  Back to cited text no. 4
[PUBMED]    
5.Bodner L. Cystic lesions of the jaws in children. Int J Pediatr Otorhinolaryngol 2002;62:25-9.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Boj JR, Garcia-Godoy F. Multiple eruption cysts: Report of case. J Dent Child 2000;67:282-4.  Back to cited text no. 6
    
7.Eversole LR. Clinical outline of oral pathology: Diagnosis and treatment. Philadelphia: Lea and Febiger; 1984.  Back to cited text no. 7
    
8.Neville BW, Damm DD, Allen CM. Oral and maxillofacial pathology. Philadelphia: WB Saunders Co; 1995. p. 496.  Back to cited text no. 8
    
9.Stewart RE, Barber TK, Troutman KC. Pediatric Dentistry. Scientific foundations and clinical practice. St. Louis: CV Mosby Co; 1982. p. 178-9.  Back to cited text no. 9
    
10.Bodner L, Goldstein J, Sarnat H. Eruption cysts: A clinical report of 24 new cases. J Clin Pediatr Dent 2004;28:183-6.  Back to cited text no. 10
[PUBMED]    
11.Seward M. Eruption cyst: An analysis of its clinical features. J Oral Surg 1973;31:31-5.  Back to cited text no. 11
    
12.Ricci HA, Parisotto TM, Giro EM, de Souza Costa CA, Hebling J. Eruption cysts in the neonate. J Clin Pediatr Dent 2008;32:243-6.  Back to cited text no. 12
[PUBMED]    
13.Counts AL, Kochis LA, Buschman J, Savant TD. An aggressive dentigerous cyst in a seven-year-old child. ASDC J Dent Child 2001;68:268-71.  Back to cited text no. 13
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14.Hayes PA. Hamartomas, eruption cyst, natal tooth and Epstein pearls in a newborn. ASDC J Dent Child 2000;67:365-8.  Back to cited text no. 14
[PUBMED]    
15.Kuczek A, Beikler T, Herbst H, Flemmig TF. Eruption cyst formation associated with cyclosporine A. J Clin Periodontol 2003;30:462-6.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  
16.Nomura J, Tagawa T, Seki Y, Mori A, Nakagawa T, Sugatani T. Kinky hair disease with multiple eruption cysts: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:537-40.  Back to cited text no. 16
[PUBMED]    
17.Rushton MA. A malformed tooth associated with an eruption cyst at birth. Br Dent J 1953;94:254-6.  Back to cited text no. 17
    
18.McDonald RE, Avery DR. Dentistry for the child and adolescent. 5th ed. St Louis: CV Mosby Co; 1987. p. 177.  Back to cited text no. 18
    
19.Boj JR, Poirier C, Espasa E, Hernandez M, Jacobson B. Eruption cyst treated with a laser powered hydrokinetic system. J Clin Pediatr Dent 2006;30:199-202.  Back to cited text no. 19
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Correspondence Address:
N B Nagaveni
Department of Pedodontics & Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.79982

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