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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 53-57

Evaluation of the frequency and demographic profile of inflammatory dentigerous cyst in Central Indian population


1 Department of Pediatric Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication19-May-2016

Correspondence Address:
Ritesh Kalaskar
Department of Pediatric Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra
India
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DOI: 10.4103/0976-433X.182658

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  Abstract 

Objective: Inflammatory dentigerous cysts (IDCs) are the most common cysts of inflammatory origin involving immature unerupted premolars or incisors. These cysts develop as a result of intrafollicular spread of periapical inflammation from an overlying nonvital primary tooth. Recently, many case reports have been reported in the literature indicating their presence at an early age. The objective of this study was to evaluate the frequency and demographic profile of IDCs in Central Indian population. Materials and Methods: Retrospective observation of the study was made on 112 IDCs from 6625 new children reporting to the Department of Pediatric Dentistry. Following variables were recorded: Frequency, demographic profile, radiographic features, treatment, and risk factors. Descriptive analysis was made of study variables using the SPSS Version 21.0. Results: The frequency of IDC was found to be 1.7% in Central Indian population. There was male predominance with a mean age of 8.8 years. Posterior mandibular region was the most common site followed by maxillary posterior. Marsupialization was the most commonly used treatment modality. Conclusion: Oral healthcare professionals should be aware of the frequency, demographic profile, and radiographical features of IDCs so that early diagnosis and definitive treatment of these lesions can be planned.

Keywords: Demographic profiles, dentigerous cysts, inflammatory cysts, marsupialization, nonvital tooth


How to cite this article:
Kalaskar R, Kalaskar A. Evaluation of the frequency and demographic profile of inflammatory dentigerous cyst in Central Indian population. SRM J Res Dent Sci 2016;7:53-7

How to cite this URL:
Kalaskar R, Kalaskar A. Evaluation of the frequency and demographic profile of inflammatory dentigerous cyst in Central Indian population. SRM J Res Dent Sci [serial online] 2016 [cited 2020 Oct 22];7:53-7. Available from: https://www.srmjrds.in/text.asp?2016/7/2/53/182658


  Introduction Top


Dentigerous cysts (DCs) are odontogenic jaw cysts (OJCs) usually associated with the crowns of unerupted permanent teeth.[1],[2],[3],[4],[5],[6] They are of two types;[7] (1) developmental DCs that occur in mature permanent teeth as a result of impaction and (2) inflammatory DCs (IDCs) that occur in immature permanent teeth as a result of inflammation from an overlying nonvital deciduous tooth in missed dentitions (due to caries or trauma). Radiographically, it appears as unilocular radiolucent lesion with well-defined sclerotic margin surrounding the crown of an unerupted tooth.[3] If enlarged, it may cause displacement and resorption of adjacent teeth and may obliterate the maxillary antrum and nasal cavity, paresthesia of the inferior alveolar nerve or metaplastic and dysplastic changes [Figure 1].[5],[6] IDCs which are usually progressive and painless may lead to pathological malformation. These include delayed or noneruption of the permanent tooth, displacement of adjacent teeth, root resorption, pathological fracture of bone, and malignant transformation.[6]
Figure 1: Panoramic radiograph showing well-defined unilocular radiolucency surrounding the crown of 45 suggesting inflammatory dentigerous cyst

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Radiographic finding of IDC shares the same radiographic features with other odontogenic and nonodontogenic cysts; therefore, histological analysis of these lesions is mandatory for final diagnosis. Histologically, the cyst is lined by stratified squamous epithelium with distinct feature of inflammation including numerous proliferating blood vessels and mixed inflammatory cells [Figure 2].[6]
Figure 2: Histopathological image of inflammatory dentigerous cyst showing cystic cavity lined by stratified squamous epithelium

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Several case reports of IDC are reported in the literature which reflects its high rate of occurrence.[8],[9],[10],[11],[12],[13],[14],[15] There are no reports of incidence of IDCs in the literature because of lack of documentation. Many children with IDC are reporting to Government Dental College and Hospital, Nagpur, for years. These children are from both rural and urban areas of Central India. Despite high number of cases of IDCs, no study was planned to examine the frequency, demographic profile, and risk factors of the cases already recorded or from prospective reporting cases.

The aim of the present study was to determine the frequency, demographic profile, radiographic features, most commonly involved tooth, treatment modality, and related risk factor drawn from records of children reported and treated at Government Dental College and Hospital, Nagpur, of Maharashtra Government, India.


  Materials and Methods Top


Retrospective observational data of IDC between January 2010 and December 2015 were obtained from the Department of Pediatric Dentistry, Government Dental College and Hospital, Nagpur. The Department Pediatric Dentistry provides primary, comprehensive, preventive, and therapeutic oral health care for children who are referred from various districts of Central India. Children reporting to the department are routinely placed in two groups: (1) New children who visit the department for the 1st time and (2) old children who had visited the department previously. Department maintains the systematic record (demographic profile, history, clinical and radiographical examination, histopathological observation, and follow-up treatment) of IDC.

Systematic data of IDCs were evaluated, and following data were recorded: Age, sex, region, involved tooth, number of IDC, other cystic lesion, associated pathologies (displacement, root resorption, mal-position, impaction, etc.), treatment modality, and risk factor (dental caries, trauma). Eight patients' records were lacking some or other information regarding IDC, so they were excluded from the study. Panoramic radiograph (Kodak 8000 Panorex, Carestream Dental, Atlanta) were used to evaluate the full extent of IDC. These patients with probable diagnosis of IDC were further evaluated using fine needle aspiration which showed straw colored fluid. The final diagnosis was made by histopathological examination. IDCs were treated either by marsupialization or by surgical removal of the entire lesion. Syndromic IDC was excluded from the study. The data obtained were subjected to descriptive statistical analysis using the SPSS Version 21.0 statistical package (SPSS Inc., Chicago, USA) (license of the University of Barcelona, Spain).


  Results Top


A total of 6625 new children reported to the department for treatment between January 2010 and December 2015. Of these 6625 children, 112 children had IDC corresponding to frequency rate of 1.7% (112). Approximately 89.4% (5923) of the children had one or more decayed filled teeth/decayed, missing, and filled teeth, and 1.11% (74) of the children were exposed to traumatic dental injury (TDI) [Table 1]. Approximately 9.5% (628) of the children neither had dental caries nor history of TDIs. Gender distribution showed male predilection, i.e. 63.04% (4176) corresponding to ratio of 1.7:1 [Table 1]. Radicular cyst was the most commonly diagnosed odontogenic cyst representing 68% (301) of the total cysts (n = 442) [Table 2].
Table 1: Distribution of new registered children according to sex and risk factors

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Table 2: Frequency of different types of odontogenic cysts

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IDC which represents 25% (71) of the total odontogenic cysts showed male and maxillary jaw predilection [Table 2]. Posterior region of both the jaws were the most common location for IDC. Mandibular posterior region was the most common site of all the four quadrants [Table 3]. The mean age of the patient with IDC was 8.8 years (standard deviation 2.05), with a range of 5–12 years [Table 3]. Second premolars (67.85%, n = 76) were the most commonly involved teeth with IDC followed by first premolars (14.3%, n = 16), central incisor (12.5%, n = 14), and lateral incisors (5.4%, n = 6) [Table 4]. In approximately 82.2% (88) of the cases, caries was the risk factor for IDC [Table 4]. Displacement of impacted teeth was the most common radiological observation noted with IDC [Table 5]. Approximately 39% (43) of the IDC were 21–25 mm in size. The average size of the lesion was 20.82 ± 3.36 mm [Table 5]. In relation to treatment modality, 75% (84) of the cases were treated by marsupialization followed by complete cystic enucleation [Table 6]. One hundred percent of failures were observed with cystic enucleation along with involved permanent tooth and replacement of the tooth back again in the socket.
Table 3: Distribution of inflammatory dentigerous cyst according to site and age

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Table 4: Distribution of inflammatory dentigerous cyst according to involved tooth and etiology

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Table 5: Distribution of radiographical effects of inflammatory dentigerous cyst on the adjacent structures and size of the lesion

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Table 6: Distribution of treatment modality

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  Discussion Top


The frequency of IDCs in the present study is 1.7%. Surprisingly, no studies have been reported till date highlighting its prevalence and risk factor. In the current study, dental caries and TDI were evaluated as risk factors for IDC. Approximately 79% of the children with IDC had history of dental caries. Second, it was the second (30.7%) most observed odontogenic cyst. The possible explanation for this observation is rapid intrafollicular spread of periapical infection from the overlying carious nonvital primary teeth. Radicular cyst is the most prevalent odontogenic cyst having no significant difference in the distribution by patient's age and gender – an observation that coincides with the present study.[16],[17],[18],[19] The agreement of these observations between consulted literature and the present study may be explained by the high prevalence of dental caries and TDI, and conservative treatment carried out for esthetic reasons in this group of teeth.[16],[17],[18],[19],[20]

The most involved sites for IDC are posterior region of mandible (42.8%) and maxilla (39.3%). Like the reported cases worldwide, IDC are mostly seen in first decade of life.[21] Further, the most prevalent involved teeth are premolars (82.25%). This observation is similar to the various case reports of IDC reported in the literature.[8],[9],[10],[11],[12],[13],[14],[15] The reason for these observations is that the roots of primary molars are in close approximation to the follicle of developing premolars facilitating rapid spread of infection.[21] As the IDCs are routinely observed in the first decade of life, every child should be screened by panoramic radiograph at the time of eruption of first permanent molar for early diagnosis and to avoid surgical complications.

Literature review showed male predominance for odontogenic cyst (developmental or inflammatory).[16],[22] Similar observation is reflected in the current study for IDC. The greater frequency in males may be because they are more likely to neglect their teeth or they are more exposed to TDI, compared to females, all of which may be the etiology for cyst formation.[23],[24]

The size of the lesion would be directly influenced by the pain episode. As IDCs are painless and slow growing, patient usually reports to clinic in advanced stage of the lesion. In the current study, the average size of the lesion was 20.82 mm. Approximately 52% of the IDCs were in the size of 16–20 mm and 39% were of 21–25 mm. Similar observations were reported by isolated cases reported in the literature in which majority of the cases were in the size of 21–25 nN.[16],[22],[23],[24],[25]

Displacement of the involved unerupted permanent teeth is the most common radiographical observation noted in the current study. This observation is in accordance with the reported case reports of IDC.[8],[9],[10],[11],[12],[13],[14],[15] Açikgöz et al.[25] reported prevention of eruption of adjacent teeth as the most common observation whereas root resorption is more commonly associated with radicular cyst than IDC.

Management objective of IDC should restore the morphology, form, and function of the affected area. In the current study, marsupialization was the preferred treatment approach. In most of the studies, marsupialization has been advocated for treating IDC than enucleation.[26],[27] Probable reason for this, marsupialization relieves intracystic pressure and accelerates the healing of the cystic cavity. Second, involved permanent tooth erupts in the oral cavity without the need of orthodontic correction.[28]

This is the first ever study on IDCs evaluating the frequency and demographic profile. Insufficient data made comparative analysis impossible. Therefore, further worldwide studies are required to evaluate the prevalence and demographic profile of IDCs.


  Conclusion Top


The study represents radicular cyst and IDC cyst as the most common OJC in pediatric age group. Marsupialization was the choice of treatment modality. The oral health care provider should have the knowledge of prevalence, demographic profile, clinic-radiographical features that would assist in early diagnosis and accurate treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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