Dental Cyst

Last week I learned I had what’s called a “lateral periodontal cyst” between two of my front teeth that required surgery to remove. I’ve decided to do a blog post because when I googled the condition almost nothing comes up. I guess it must be fairly rare.

Symptoms: One of the problems with this condition is there aren’t symptoms. My periodontist told me that the vast majority are discovered only when they have broken through the bone structure between the teeth and created horrible gum pockets. They can be detected with X-rays, but from the little information I have gleaned, the cysts are most often found between the front teeth, which are not usually X-rayed. My cyst is between tooth 9 (which is the left front tooth) and 10.

However, in retrospect I can report two symptoms: first was the feeling of having something stuck between these two teeth, like a piece of straw, but nothing would be there. I have felt this intermittently for a couple of years, but I really didn’t give it much thought.

Second, about eight months ago it felt as if someone had socked me in the mouth. This has never happened to me, but the feeling was that all my teeth, particularly the top front teeth, were aching. This lasted for a few days. I had a regular dental cleaning not long after this happened so I remembered to mention it to the hygienist. She said that this could be caused by grinding your jaw or a sinus infection. I do tend to clench my jaw so it made sense that this was the cause.

Three weeks ago the aching started again, and this time it didn’t go away. After about a week I got a sharp pain centered on one of my front teeth (#9) and the gum above it. It felt like a gum infection, so I waited a couple of days because I had just been to my dentist for another regular visit and I was a little irritated about having to go back. The gum pain eased over the next couple of days, but the funny feeling in my tooth didn’t. It was very sensitive when I bit into something. There were also a couple of small bumps on the ridge above the front tooth and the one to the side. So I called my dentist.

Diagnosis: The dentist took an X-ray of the affected region. In the space between the teeth, a normal X-ray shows mottled white, which is bone. In mine, between teeth 9 and 10, there was only black, with a tiny strip of white at the bottom where the gum attached. This meant my cyst had almost completely eaten away all the bone. There was almost nothing left to support my gum. Cysts grow slowly but inexorably.

He sent me to a periodontist immediately, because if I lost that little bit of bone it would be very difficult to reattach the gum between my teeth, and he said it would look funny when I smiled.

The good news is that when the cyst is removed the bone will regenerate.

The periodontist confirmed my dentist’s diagnosis and set me up for surgery in 4 days time. He also confirmed that this is rare; he has a busy practice and sees a patient with a cyst once every two years or so.

Treatment: After numbing my mouth, the periodontist sliced through the gum. What was surprising to me was that for the next 15 minutes he scraped away at my teeth. When I imagined a cyst I thought of a fluid-filled sac that would just pop out; instead it was a sticky substance attached to the teeth.

Because of the bone loss, he packed some bone grafting material into the space to act as a scaffold for the new bone growth, then sewed me back up. I set an appointment for a week later to have the stitches removed. I got prescriptions for antibiotic, anti-inflammatory, and pain medications.

The assistant warned me there would be pain, bruising, and swelling in my lip and cheek above the surgery site. I did have some swelling, which I helped by keeping ice against it for the next two days, but no pain or bruising.

I attribute the lack of pain and bruising to my approach to the surgery. I decided this was a good opportunity to practice acceptance and presence, so as I waited for the local anesthetic to take effect I focused on my breathing, relaxing my body, and letting go of thoughts. During the surgery I kept my eyes closed and continued to focus. I think my lack of resistance to the dentist’s movements meant there was less damage done to my tissues, which resulted in no bruising and pain.

I’m writing this post three days after the surgery and my mouth feels very good.

I’ll go back to the periodontist in three to four months for another X-ray to make sure the cyst isn’t growing back.

Update: The stitches were removed a week after surgery. Pulling out the stitches without any anesthetic was rather painful.

The pathology report said that I had a "pyogenic granuloma," which my periodontist called a "benign tumor." He was not pleased; he thought the pathologists had it wrong. I've googled pyogenic granuloma and found this report from the National Institutes of Health. The description of a p.g. says it's usually on the surface of the skin, but the NIH report has similarities to my case. In particular, a p.g. bleeds profusely and my periodontist had commented on the amount of blood my growth produced. I'm not sure it really matters; in either case I need to keep an eye on it to make sure it doesn't grow back.

Another thing that caught my eye in the material on p.g.: one cause of the growth is trauma. I fell not long after my adult front teeth came in, tooth #8 was cracked, and my dentist used some kind of dental-fill material to reshape the bottom of the tooth. My periodontist mentioned that it looked like the upper part of the tooth was slightly fractured, and he planed that area while he was removing the growth.

Update 2 (11/27): For a week after the surgery the area where the cyst had been felt strange. The front tooth still hurt when I bit down, and it felt as if the teeth were "naked" all the way up the root. But after that week had passed everything started feeling more like normal, with the exception of occasional odd feelings where the bone grafting material is.

Update 3 (11/4/15): Cautionary note: a couple of months ago I felt like I got a pimple on the gum at the same spot between tooth 8&9. I went back to the periodontist and he said that was the cyst growing back and the pimple was the cyst draining. So he had to do a minor surgery to scrape that out. So don't assume it's gone after your procedure. Keep an eye on it.