Odontogenic cyst

by Jason Wasserman MD PhD FRCPC
January 22, 2024

An odontogenic cyst is a growth arising from tooth-forming tissues in the bones of the jaw (the mandible and maxilla). While most are benign (non-cancerous), some have the potential to become very large which can damage surrounding structures.

What are the most common types of odontogenic cysts?

  • Radicular cyst (periapical cyst): The most common type, usually associated with a non-vital tooth with a necrotic pulp, often as a result of dental decay or injury.
  • Dentigerous cyst (follicular cyst): Forms around the crown of an unerupted or developing tooth, typically the wisdom teeth or lower canines.
  • Odontogenic keratocyst (OKC): Known for its unique histological appearance and a tendency to recur after treatment. It may be associated with the Nevoid Basal Cell Carcinoma Syndrome (NBCCS).
  • Eruption cyst: A soft tissue cyst that surrounds the crown of an erupting tooth, often seen in children.

Can an odontogenic cyst be cancerous?

Most odontogenic cysts are benign (non-cancerous). However, some types like the odontogenic keratocyst can behave aggressively and have a higher chance of growing back after being surgically removed. In rare cases, a previously benign odontogenic cyst can change into a malignant (cancerous) tumour but this is not common.

What are the most common locations for an odontogenic cyst?

The most common location for an odontogenic cyst depends on the type of cyst:

Microscopic features

The microscopic features of an odontogenic cyst depend on the specific type of cyst identified.

Possible microscopic features include:

  • Radicular and dentigerous cysts: Lined by a thin layer of stratified squamous epithelium. Inflammatory cells may be present in the case of infected cysts.
  • Odontogenic keratocyst: Exhibits a distinctive parakeratinized stratified squamous epithelium lining, which is usually corrugated and thin. The basal layer of cells is typically columnar or cuboidal.
  • Calcifying odontogenic cyst: Characterized by the presence of ghost cells, which are enucleated epithelial cells (epithelial cells lacking a nucleus) that have undergone a particular type of keratinization.

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