Removal of a tooth cyst. Removal of a tooth with a cyst in the maxillary sinus Cyst under the tooth, a tooth must be removed

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The fact that the patient has a cyst of the maxillary tooth with penetration into the cavity of the maxillary sinus quite often becomes known by chance when diagnostic examination. Usually it does not manifest itself with clear symptoms until it grows significantly. This type of cyst, like all others, is subject to treatment, since a constant source of infection in the body does a lot of harm. Extraction of a tooth with a cyst in maxillary sinus in St. Petersburg is considered the most radical way to prevent dangerous complications.

What is dangerous cyst in the maxillary sinus

Unfavorable and even life-threatening conditions, if a tooth cyst in the maxillary sinus is diagnosed, arise due to the size of the formation and the presence of an inflammatory fluid inside. It leads to

• Compression of surrounding tissues. In this case, the bone tissue atrophies and collapses, there is a danger of developing osteomyelitis. A pathological fracture of the bone is also possible when a large defect occurs in the case of a large cyst. The mucosa also becomes thinner, deformed.
• Reduction to a critical size of the free cavity of the airway sinus, which interferes with its functions, makes it difficult nasal breathing affects hearing and vision.
• Inflammation in the maxillary sinus - sinusitis - with suppuration of the cyst. It is dangerous to spread inflammation to other sinuses that communicate with the cranial cavity with the possible development of encephalitis. The purulent process can go to the organs of the orbit, damaging them. There is a risk of developing sepsis.
• The transformation of a cyst into a malignant neoplasm.

Symptoms

A small cyst, even if it penetrates into the sinus cavity, may not manifest itself in any way or give signs of an unclear malaise. Vivid symptoms of a tooth cyst in the maxillary sinus appear when the entire air cavity is filled with it, sinusitis joins.

1. Pain. It is felt in the cheek, intensifies when leaning forward, gives into the teeth. Headache hurts.
2. Bursting, heaviness and pulsation. May be in the area of ​​​​the sinus and eye sockets.
3. Nasal congestion, purulent or mucous discharge. On the side of the causative tooth.
4. Facial asymmetry. Swelling of the cheek on the affected side.
5. Signs of intoxication - fever, weakness.

The tension that the organs of vision experience when the cyst of the maxillary sinus, which is the lower wall of the orbit, is bursting, can cause a displacement of the eyeball or limit its mobility. This manifests as double vision and blurred vision. Sometimes such a violation is the only symptom of a cyst.

Treatment Methods

Before starting treatment, a thorough diagnosis is carried out. Preference is given to cone-beam tomography, which allows a detailed examination of the formation in volume, minimally irradiating the patient. Also, in a diagnostically unclear case, it is possible to examine the sinus through an endoscope inserted into it through the anastomosis with the nasal cavity.

The main principle of treatment of a tooth cyst in the maxillary sinus is its complete removal. It is impossible to do this with therapeutic methods, but they can be used to treat causative teeth.

Before the operation to remove the cyst, the dentist evaluates the possibility of preserving the teeth whose roots have fallen into the cystic cavity. In case of a positive decision, the roots of canines and small molars are sealed. If the roots of large molars got into the cavity of the cyst, they must be removed.

Stages of treatment

In modern, well-equipped clinics, a tooth root cyst in the maxillary sinus is removed in the most gentle way - with the help of endoscopy in stages:

1. Holding local anesthesia. The nose is cut off with an anesthetic drug (more often it is Ultracaine), the nasal passages are also treated with an anesthetic solution.
2. Through the nasal passage and fistula with the sinus, the doctor inserts an endoscopic tube, pierces the cyst, removes it and rinses the cavity with antiseptics.
3. To facilitate work with the lower segment of the cyst, sometimes it is necessary to puncture the anterior wall of the sinus from the side of the mouth.

After treatment, after 3-4 months, a control diagnosis is carried out, since any left fragment of the capsule serves as a source of recurrence of the disease. A cyst may also form in the maxillary sinus after tooth extraction, which is subject to mandatory surgical removal.

Sometimes it is difficult to remove a cyst endoscopically - in the presence of a bone membrane, large sizes affecting several teeth, with a significant effect of the cyst on the function of the sinus, the organs of the orbit. In this case, a surgical operation is performed, which involves opening the anterior wall of the maxillary sinus from the side of the mouth. It is carried out under local or general anesthesia, considering the expected volume of manipulations. During its implementation, resection of the root of the tooth, retrograde filling of the canal is possible.

Good day, dear readers. The topic of our today's article will be such a disease as a tooth cyst. We will tell you about what it is, what it looks like, why it appears, and most importantly, how to deal with this disease. You will also learn about modern methods of treatment used in dental clinics our country and neighboring countries.

The word "cyst" for many sounds like a sentence. So let's try to figure out how bad everything is. This diagnosis is made annually to millions of people around the world. Some of them are treated in a timely manner, others - upon the appearance of unpleasant symptoms. Someone manages with "little blood", others lose their teeth. There are also more unfortunate consequences. We will also talk about them in this material.

What is a tooth cyst?

So what is it? A cyst in this case is a disease characterized by the appearance of a formation in the area of ​​​​the root of the tooth. It is a selected fragment in the periodontium, which has its own walls. Inside such a site are bacteria, remnants of necrotic tissues, individual cells. The wall is usually thin and can be easily damaged. On the surface of the cell is a layer of fluid-producing cells. From this, the cyst of the tooth grows. The immune system trying to deal with what is happening available means. As a result, an inflammatory process begins, pus collects inside. The size of the cysts varies. A small one has a diameter of about 5 mm, the largest can reach several centimeters.

The word "cyst" itself is of Greek origin. It is related to kystis. This is a "bubble" in the translation from the language of Socrates and Aristotle. It is believed that formations up to 5 mm in size are cysts, and more than 5 mm.

Many patients are interested in whether the tooth cyst itself will pass if left untreated. There are types of cysts that are small in size, do not grow and do not actually pose a threat to human health. But they will not go anywhere on their own, they will not “dissolve”.

Types of dental cysts

There are several types of cysts. They differ, first of all, in the reasons for education. For example:

• residual cyst appears as a result of complications during tooth extraction;
• odontogenic radicular cyst of the tooth appears during various pathological processes (usually of an infectious nature);
• keratocyst. It is also called primary. It is found in a child and appears with pathologies of tooth development in infancy;
• eruption cyst. It is typical for children whose milk teeth are replaced by permanent ones.

Cysts in babies who do not yet have teeth are often close to the surface. They break down when the gums rub and may not require treatment. However, this does not mean that such formations are safe in 100% of cases. Most often in practice there are radicular cysts. Usually the scheme of their appearance is simple - starting with ordinary caries, the infectious process reaches the top of the root. Or a tooth cyst is the result of a filling error root canal. It can also form in the case of root perforation and the exit of the filling material beyond the apex.

Another unpleasant problem is the cyst of the wisdom tooth. It is also called a retromolar and paradental cyst. Appears in case of problems. She can also cover this tooth by moving from the next one. The main problem with this disease is complete absence manifestations over a long period. If the cyst is “local”, that is, it struck the tooth itself, it is unlikely that it will be possible to save it. When moving from neighboring teeth, there are chances for preservation.

A tooth cyst in the maxillary sinus is also a common occurrence. It is problematic to detect it, because the formation is often not visible on the X-ray. The most reliable way to detect CT scan.

The roots of the front teeth are located too close to the maxillary sinuses. If a person develops sinusitis, the infection can spread to the tooth, forming a sac of pus. In most cases, it is necessary to resort to surgical methods of treatment. Cysts are equally characteristic of people of all ages. They can form under milk and permanent teeth.

Why do cysts form?

The reasons for the appearance of cysts are different. Sometimes it is a mechanical trauma to the tooth, in other cases - various violations on the part of the doctor when working with root canals. Also often the appearance of such formations is affected by sinusitis, chronic rhinitis or tonsillitis in a patient. Some people who get a crown may develop inflammation. Ultimately, they lead to the appearance of a cyst on the tooth. Similar problems arise with periodontitis.

In most cases, the problem is infection. It can get into the near-tooth space in different ways. But most often it all starts with a banal caries. It goes into, then periodontitis begins. The purulent process in periodontal tissues ends in different ways. But often it causes the formation of cysts near the roots of diseased teeth.

Any infectious causes of cyst formation are closely related to human immunity. The stronger it is, the less the likelihood of such problems.

Table. Diseases in which a tooth cyst can occur.

Diagnostic methods

How is it carried out modern diagnostics? In addition to the classic X-ray, there is a more accurate device - a radiovisiograph. In some cases, a CT scan is also used. Also, experts know how to identify the disease by symptoms.

The main problem with cysts is that early stages they don't show up at all. After some time, when the disease becomes chronic stage, the tooth may darken, there is pain when biting.

Over time, when the purulent process begins, this leads to the following symptoms:

• headache;
• weakness;
• temperature rise to 37.2 and above;
• enlargement and soreness of the lymph nodes;
• swelling of the gums, flux;
• through which pus oozes.

Possible consequences and complications

If you do not start treatment on time, the patient will experience unpleasant and very dangerous complications tooth cysts. First, the tooth under which it was formed will begin to hurt. Then a swelling forms, which is often confused with flux. Even if at this stage a person does not take the necessary measures, an abscess, periostitis in the surrounding tissues, phlegmon (common purulent inflammation) is formed.

If the infection starts further distribution with blood and lymph, this can lead to damage internal organs and even death. Considering that everything starts with a banal caries, we can only say one thing - go to the doctor on time. Also, do not forget that pus gradually destroys the jaw bone. The worst thing that can happen is the transformation of a cyst into a malignant tumor.

Therefore, the sooner you contact a specialist, the more chances to cure a tooth successfully. It may not even need to be pulled out.

Treatment of cysts

The patient often faces the question - what to do with a tooth cyst, remove or treat? But the decision is not always left to him. Often doctors have to make this decision based on the circumstances. Treatment, in turn, can be both surgical and therapeutic.

In what cases is surgery used:

• the patient regularly complains of swelling and pain in the area of ​​cyst formation;
• the neoplasm has grown to a diameter of more than 1 cm;
• the cyst appeared under the tooth with a crown.

There are three different types surgical operations to help the patient. The choice depends on the type of cyst, its size, and other related factors.

The procedure is not very complicated, both for the doctor and for the patient. However, its use requires a long recovery. The doctor removes the front wall, eliminates the contents of the cyst, uses antiseptics, antibiotics. Cystotomy is used for large diameter cysts affecting several adjacent teeth. Also, this technique is relevant for operations on the upper jaw or on the lower, with thinning of the base of the jaw. Another obvious indication is resolution of the palatal plate and/or bony floor of the nasal cavity.

The second type of surgery is cystectomy. In this case, the entire cyst is removed, as well as the tip of the root of the affected tooth. The wound is sutured, the patient is prescribed antibiotics. Antiseptics are also used for rinsing. Direct indications for cystectomy:

• cyst of the upper jaw without concomitant inflammation;
• absence of teeth in the area of ​​formation of a cyst of large diameter;
• violation of the development of the epithelium in the area of ​​the cyst.

The third method of removal is hemisection. It involves the removal of not only the cyst itself, but also the root, as well as part of the affected tooth. After that, a crown is placed on it to restore functionality.

Also, therapy remains effective in many cases. Modern dentistry has many effective means cyst treatment without removal.

The classical technique involves cleaning and antiseptic treatment of the root canal and the subsequent removal of the drug beyond the top of the tooth root. Then the canals are sealed with a temporary filling, also containing antiseptics. Cleaning and processing procedures can be repeated until the picture shows that they gave the desired effect. In this case, a permanent filling is installed on the canals, and the tooth is closed with a crown.

The second method is called depophoresis. It is used in the treatment of both cysts and granulomas of the tooth. The advantage of this method is that active drug(copper-calcium hydroxide) is injected into one channel, and then, with the help of an electric current, it spreads further, including to the cyst tissues. Thus, it is possible to eliminate germs even where it is problematic to reach with a drill. Usually three such procedures are enough to get rid of the cyst. After that, you can install a seal. The suspension of the drug remains in the channel, counteracting the recurrence of infection. The success of the technique is more than 90%. Minus one - not everywhere there is such a wonderful device.

Laser cyst removal

To date, laser removal is one of the most progressive and effective methods treatment. Experts note several advantages. First, laser surgery is painless. Secondly, the laser copes with the antiseptic function. You won't spread infection with the beam. Thirdly, the wound heals quickly, the recovery process decreases due to the biostimulating function of the laser.

This operation does not require tooth extraction. There is also no risk of bleeding. The procedure is simple:

• first, the tooth is prepared or the filling is removed;
• further, with the help of special tools, the root canals are expanded;
• a laser instrument is inserted into the dilated canals, the beam of which destroys the cyst. In fact, its temperature vaporizes these tissues along with the bacteria.

Often patients are interested in whether it hurts to remove a tooth cyst in this way? As stated above, no. Additional anesthetics are used as needed. Of course, the procedure is more expensive than traditional surgery, but this overpayment is more than compensated by the described benefits.

Treatment of a tooth cyst during pregnancy

Many women are interested in the question of how to treat a tooth cyst during pregnancy. In general, this state imposes many restrictions. Therefore, if the pregnancy was planned, all procedures are best done before conception. What is the problem? Actually, there are two of them:

• it is undesirable for pregnant women to take an x-ray, except in cases of fractures, etc .;
• some drugs used for anesthesia and treatment may be harmful to the unborn child.

Speaking of x-rays. If the tooth cyst does not manifest itself in any way, the woman is unlikely to be checked on x-ray equipment. Therefore, she learns about the problem only upon the fact of the appearance of pain. This is the main problem. Anything can happen in 9 months. With a significant development of inflammation, the tooth has to be removed. In other cases, treatment is possible. You can start it no earlier than at the end of the third trimester. It is important that the specialist uses an anesthetic containing a minimum amount of adrenaline.

If the patient is on early term and corny does not know about her pregnancy, situations may arise when she will be treated according to the standard scheme using conventional drugs for local anesthesia. Is it dangerous? In theory, yes. In practice, among those who gave birth to healthy children, there are many mothers who were injected different drugs during the treatment or extraction of teeth. Everything is very individual. After all, there are no two absolutely identical pregnant women with the same reaction of the body (including the fetus) to an injection of a particular drug. Therefore, it is simply impossible to predict the development of events in such circumstances.

Is home treatment possible?

A tooth cyst is one of those dental problems that cannot be solved by rinsing. You can often see various folk recipes. They temporarily relieve symptoms - relieve pain, reduce inflammation, but sometimes they can even harm your health. There are several important recommendations:

• do not heat the gum in the area of ​​​​the diseased tooth. This will accelerate the reproduction of bacteria, enhance the inflammatory process;
• ice and other cold objects can make the pain worse. There is also a risk of chilling the nerve;
• infusions and decoctions of herbs can be used. But these are symptomatic.

If an aching tooth with a cyst is overheated, the shell may not withstand. This is due to the fact that the amount of liquid inside increases. If the cyst bursts, the purulent contents will begin to spread the infection to the surrounding tissues. Through the blood and lymphatic fluid, bacteria will spread throughout the body. Still want to be treated at home? Are you afraid of the dentist?

cost of dental cyst treatment

Patients are always interested in the price of treatment. In fact, it depends on the plan. If we are talking about the removal of a tooth along with a cyst, then in Kyiv they will charge you from 100 to 350 hryvnias ($ 3.7-13.1) for tooth extraction. It is more expensive to remove a wisdom tooth, including impacted or dystopic, in the area of ​​\u200b\u200bwhich a cyst has formed. If you need to resect the top of the tooth root, such a procedure will cost 900-1000 ($33.7-37.5) hryvnia. Hemisection for 1 tooth - 750-850 hryvnia (28-32 dollars). Cystectomy with resection of the root apex and subsequent filling costs 2700-3300 hryvnia, depending on the location of the tooth (101.3-123.8 dollars).

If you want to remove a cyst with a laser, then one of the Kyiv dentistry offers to perform this procedure for 2000 hryvnia (about $75).

We managed to find prices in Russian clinics. For example, one of them offers to perform cystectomy for 5.6 thousand rubles ($93.2) and root hemisection for 4.3 thousand rubles ($71.6). Laser removal costs an average of 15 to 20 thousand rubles. This amount includes all stages of the procedure, including canal filling and anesthesia.

Treatment is not the cheapest. That is why it is so important to consult a specialist before complications begin. And their elimination, as you know, will result in an even greater amount.

• What is a tooth cyst and why, in fact, it needs to be removed;
• What can happen if the cyst on the root of the tooth is not cured in time (or not removed) and whether it poses a danger to adjacent teeth;
• What are the options for therapeutic treatment of cysts today (that is, conservative, without surgery) and how effective are these methods in the long term;
• Is it worth hoping for the use of depophoresis or laser in the treatment of tooth cysts;
• How is the resection of the apex of the tooth root with a cyst performed (in stages), how much does this operation cost today and is it a 100% guarantee of complete disposal of the root cyst;
• In what cases are teeth with a cyst most often removed from sin away, even without attempts at treatment, and how this procedure is carried out;
• Can a cyst remain after tooth extraction or suddenly form in the hole and what does it threaten for the future;
• What very unpleasant complications can happen when a tooth is removed with a cyst and what are the recommendations in postoperative period help to minimize undesirable consequences...

Today, even those who do not have medical education, are usually well aware that cysts can appear in the human body under certain conditions, which pose a considerable danger to health in general. So, with regard to teeth, this problem is especially relevant - on any tooth, whether anterior tooth, a wisdom tooth or any other, for a number of reasons, a so-called root cyst can form. Moreover, several such cysts can fall on one tooth at once.

What is a tooth cyst? The root cyst of the tooth is a neoplasm localized mainly at the top of the root and is a kind of capsule, inside the shell of which fluid is contained. Under certain pathological conditions, the cyst is able to grow over time, increasing in size.

The photo below shows an example of an extracted tooth with cysts on the roots:

In many cases, it is important to remove the tooth cyst in time to avoid the development of severe complications. Here you need to understand that the formation of a cyst is a kind of manifestation of the protective reaction of the body, which is trying to isolate the infection that has penetrated through the root canal of the tooth into the surrounding tissues. First, an inflammatory process occurs on the root of the tooth, which often turns into a cyst.

It would seem that there is nothing to worry about - a cyst has formed, the infection is reliably isolated. However, the problem is that such isolation of the infection from healthy tissues is not eternal: a carious or poorly treated tooth in the canals continues to constantly feed the neoplasm with bacteria, which creates a certain load on the immune system. And at some point in time, for example, after hypothermia, the body's immune system is no longer able to contain the onslaught of infection, and when this "time bomb" (that is, a cyst) breaks through, then we can talk about very serious consequences, including life threatening(eg, blood poisoning, phlegmon).

That is why it is important to remove a tooth cyst in time, or to cure it.

About what can happen if you leave a tooth with a cyst, whether it can be saved without surgery (without incisions in the gums with a scalpel) and what methods of saving teeth with cysts exist today - about all this, as well as about some other interesting points, we will continue and let's talk more...

What happens if the cyst on the root of the tooth is not treated in time?

As noted above, the main reasons for the formation of a tooth cyst are:

• Complications of caries (periodontitis);
• As well as non-professional canal treatment, turning into periodontitis.

In the process of its development, the tooth cyst goes through 2 stages of periodontitis, in which at first there is a rarefaction of the jaw bone tissue near the root apex with fuzzy boundaries, and only then, due to the intensive decay of healthy tissues, a granuloma, cystogranuloma and (or) a cyst with clear boundaries is formed.

Not a single dentist can say in advance when exactly the development of a cyst will reach such a climax that the body will no longer be able to localize the infection in the formed capsule. With an exacerbation of a chronic process, purulent exudate spreads far beyond the boundaries of the cyst, often leading to very dangerous complications.

Listed below are just a few possible consequences continuous growth and "rupture" of the cyst:

• Purulent- inflammatory diseases maxillofacial region(periostitis, osteomyelitis, abscess, phlegmon, sepsis);
• Odontogenic sinusitis;
• Germination of cyst tissue in the maxillary sinus;
• "Thinning" of the jawbone (up to possible fracture jaw while chewing solid food);
• Capturing a cyst of the roots of healthy teeth.

The photo below shows an example of a huge cyst that was not removed in a timely manner and, having increased in volume, has grown to the roots of an adjacent tooth:

Dentist's comment

In fact, a cyst is a time bomb, a kind of purulent sac that can bang so that at best the face will become twice as wide, and at worst the whole infection will rush along the maxillofacial region to the neck and pose a threat to normal breathing, until it stops, or death will occur from intoxication of the body due to the hematogenous (through the blood) spread of bacteria throughout the body.

When a tooth with a cyst is found in the upper jaw, purulent processes leading to a threat to life occur much less frequently than in the case of the lower jaw. However, due to the proximity of the maxillary sinus to the top of the diseased tooth in the upper jaw, sinusitis, incurable by classical methods, can develop as a complication. That is, an ENT doctor with no experience can prescribe cuckoo sessions to the patient indefinitely in order to free the maxillary sinuses from pus, antibiotics and other means, but success will be achieved only on a short time, since the infectious focus at the root of the tooth will continue to fuel the inflammatory process.

Today, more and more often you can hear that there is a definite connection between the presence of a cyst on the tooth and the development cardiovascular diseases. How is the situation really?

About 10-15 years ago, information about the influence of apical infectious foci on the development of cardiovascular diseases were attributed, rather, to theoretical conjectures, rather than to real facts. Today, however, the medical community is listening to data from a massive study of 508 people with an average age of 62 suffering from various types of heart disease. Acute coronary syndrome was noted in the group with multiple infectious foci on the roots of the teeth, and a small percentage of individuals with single foci had an unexpressed disease. coronary arteries. More than half of the "cores" (about 60%) had at least one inflammatory process on the root of the tooth.

Of course, from an evidence-based point of view, the study is not ideal, since the presence of cardiovascular diseases is also affected by such factors as obesity, smoking, diabetes, etc. Therefore, today experts consider the presence of root cysts on the teeth only as another risk factor for health of the heart and blood vessels.

Therapeutic (conservative) treatment of cysts

Based on the fact that a cyst can carry so many risks to human health, immediately after its discovery (usually from a picture), a completely logical question arises about the need to remove it. Often, a tooth is removed along with a cyst at the root.

But is there really no way to not only do without removing a tooth with a cyst, but in general - without any surgical intervention associated, for example, with cutting out a cyst? Maybe it can be somehow cured conservatively?

Before considering modern methods"removing" a cyst without surgery, let's first get acquainted with some of the features of neoplasms that may be present on the tops of the roots of the tooth:

1. A granuloma is an overgrown granulation tissue in the region of the apex of the tooth root, which appears in response to basal inflammation. There is an opinion that the granuloma is the initial stage of the cyst, and that, gradually increasing, the granuloma sooner or later becomes a full-fledged cyst. In practice, sometimes there are large (up to 10-12 mm in diameter) granulomas, although the pictures of the root of the tooth stubbornly show a cyst;
2. Cystogranuloma is a transitional stage between granuloma and cyst. It differs from the previous formation in some tissue features (although at the moment, not all experts believe that cystogranulomas should be distinguished as a separate type of neoplasm);
3. And, finally, a cyst - in its structure it looks like an egg, in which a certain amount of liquid (pus) is contained under the shell.

Generally speaking, it is not so important whether a granuloma or a cyst has formed on the roots of the tooth. A cyst differs from a granuloma, primarily in terms of histology, but in the practice of a dentist, there is no fundamental difference between these forms to obtain a positive result of treatment: the treatment is carried out by the same methods without taking tissue for a biopsy.

On a note

It is difficult to determine with 100% accuracy what form inflammatory process present on the root(s) of the tooth. Usually visible area of ​​enlightenment with clear contours, usually round or oval. This “circle” can be located not only at one root, but also capture 2-3 roots of one tooth and even pass in close proximity to the tops of the roots of adjacent teeth, hinting to the dentist at the scale of the tragedy.

The key moment that arises in practice is the decision: is it worth it, in general, to start treating a cyst, or is it worth resorting to removing part of the tooth root, or is it worth removing the tooth completely along with the cyst?

The following factors influence the final decision:

• There are protocols that regulate the possibility of saving a particular tooth;
• The qualifications and experience of the dentist greatly influence the final decision (an inexperienced doctor may have no other options but to simply remove the problematic tooth out of harm's way);
• The high level of equipment of the clinic creates the prerequisites for the possibility of conservative treatment of cysts with tooth preservation.

As for the protocols that doctors follow, it should be understood that the documentation in many respects does not keep pace with technical progress, and the compositions (pastes) developed today, which are placed in the canal in order to “remove” the cyst, often allow success even with huge granulomas and cysts.

Besides, in last years Increasingly, cases of conservative treatment of significant radicular cysts without the use of classical pastes based on calcium hydroxide are described. There is an opinion that it is enough to treat the canal system of the tooth with the use of sodium hypochlorite and ultrasound, after which, thanks to the sterile canals, the cyst simply ceases to be necessary for the body and disappears on its own within 4-15 months.

Conservative treatment of a tooth cyst (that is, its "removal" without surgery) is a long process, but today it does not necessarily look like a routine. A routine option for treating a cyst is a visit to the doctor almost every day to infuse new portions of calcium hydroxide into the channels.

When using modern techniques, the patient, after a single visit to the doctor, walks with sealed canals and temporary restoration, periodically visiting the dentist to analyze the current state of the cyst using a tooth image. The frequency of visits is chosen by the doctor, but usually the appointment is made after 2 weeks, a month, 3 months, 6 months, a year and two years.

A small summary: an experienced doctor, with the appropriate equipment, may well save a tooth from extraction even with a large cyst. However, it should be borne in mind that there can also be failures - sometimes, after numerous attempts at futile treatment, the tooth is simply removed along with the cyst.

The use of depophoresis and laser to remove a tooth cyst

One of modern ways removal of the root cyst with the preservation of the tooth is the use of depophoresis, as well as a laser. Let's see if these methods really allow you to "destroy" the cyst at the top of the tooth root once and for all.

The use of depophoresis in dentistry has its roots in Germany, but in Russia it has been actively exploited since about 1990. During this time, the technique has gathered around itself both fans and opponents, who even claimed that depophoresis for endodontic treatment is categorically unacceptable.

On a note

The meaning of depophoresis is to inject molecules and ions of strong anti-inflammatory and bone regenerating drugs under the influence of an electric current. In the case of tooth cyst treatment, one electrode is connected to the transitional fold of the oral cavity, and the other is placed in the canal together with copper-calcium hydroxide. The treatment involves three visits: at the last, alkaline atacamit cement is injected into the canal(s) up to the upper third.

One of the areas of application of depophoresis was the treatment of inflammatory processes on the tops of the roots of teeth with periodontitis (including radicular cysts). In fact, depophoresis with copper-calcium hydroxide is a kind of symbiosis of drug treatment and canal filling. And this is a kind of dream of any bad dentist: you don’t need to develop the entire canal, go along the most unpredictable curvature, fight difficult canals of a resorcinol-formalin tooth, it’s not necessary to try to introduce anti-inflammatory material as close to the apex as possible, and you can even accidentally break the tip of the instrument or make perforation - depophoresis, according to the authors, "will write off everything."

Thanks to this technique, the restoration of bone tissue in the focus of inflammation is slow but sure. According to some authors, the success rate of such treatment is about 90-95% with an average of 10 to 12 months.

At the same time, many experts are inclined to believe that depophoresis with copper-calcium hydroxide should be used only as a last option, when other conservative methods of tooth cyst removal are not useful. In general, depophoresis is not a common technique today, even with the conditions described in the literature. positive results treatment.

Unlike depophoresis, the use of a laser to remove a cyst flickers in the advertising offers of dentistry much more often. However, how justified is its use?

Speaking about laser treatment of cysts, they mean two directions of its use, namely:

• Additional antiseptic laser treatment of channels (sterilization);
• As well as transchannel laser dialysis.

As for the first direction: laser sterilization of dental canals has the same purpose as ultrasonic treatment of canals with sodium hypochlorite. A number of experts believe that the use of a laser for such canal treatment is not entirely justified, since the laser, in contrast to the method of scoring the canal with hypochlorite, cannot remove organics as effectively. The laser can bring much more benefit in surgical methods for removing a cyst, which will be discussed below.

As for transchannel laser dialysis, this technique involves the introduction of a laser light guide into the dental canals, under the radiation of which, according to the advertising materials of clinics, microbes die (literally evaporate), and the cyst cavity becomes sterile. Unfortunately, the use of a laser in the treatment of cysts is more of an advertising ploy than a real necessity, since in addition to the laser, this technique then necessarily uses all the same drugs for injection into the cyst cavity, which are used without the use of a laser.

But how fashionable, and easier to justify the increased cost of the procedure - this is a laser ...

What is useful to know about some tooth-preserving operations

Above, we talked about the conservative (therapeutic) treatment of a tooth cyst, that is, when the dentist does not perform an operation and does not cut out the cyst, but only creates certain conditions for its resorption. Typically, such treatment lasts an average of 6-12 months, sometimes more, but without surgery.

Removal of the cyst in the truest sense of the word is carried out surgical methods. Among them are:

1. Resection of the root apex with cystectomy (removal of the cyst);
2. hemisection;
3. Coronoradicular separation.

The last two tooth-preserving methods are used in the practice of doctors not so often, but it is the resection of the apex of the tooth root together with the cyst that is of leading importance.

Usually this operation is carried out as follows:

Professionals perform a resection of the tooth root with a cyst in about 20-30 minutes. This operation is today one of the most common and effective ways preservation of teeth, the roots of which are affected by a cyst (the cost of resection of the tooth root in clinics today is about 10,000 rubles)

The success of the event directly depends on the ideally carried out each stage. If, for example, the cyst is not completely removed, the area of ​​the removed cyst is not filled with special materials, or antibiotic therapy is not carried out after surgery, then with a high probability this can lead to a recurrence of the infectious process. In such cases, quite soon the tooth is again in danger of being removed.

“Five years ago, when I fell, I hit my face so hard that both upper front teeth moved inward. I didn’t go to the doctor then, I just waited until they stopped staggering. I think it was my big mistake. A couple of months later, when the teeth were no longer loose, a small pimple appeared above the left one, pus was flowing from it. I ran to the dentist, there was a cyst on the x-ray. At first they wanted to remove the tooth, but then they decided to perform an operation on the cyst and remove it. Before that, the nerves were removed from the front teeth and glued together with splinting. After the operation, the doctor said to come and do bone grafting, since the cyst was large. But I never came, because I was very afraid that they would cut me again. It's been 5 years now, everything is fine with the teeth ... "

Elena, St. Petersburg

In what cases are teeth with a cyst most often removed, and how is this implemented

If a tooth with a cyst cannot be cured, then it is assumed that it needs to be removed as soon as possible - it has already been said above how risky it is to continue to “grow” a cyst. Especially often, a tooth is removed in cases where, due to a cyst, an exacerbation has already occurred with swelling on the face, fever, difficulty opening the mouth, severe pain, etc.

However, the final decision whether to remove the tooth along with the cyst, or to try to treat it, is made by the dentist. At the same time, the doctor is guided not only by officially existing indications (protocols), but also relies on his many years of experience, and often on the opinions of colleagues from related medical specialties. These are not only dentists of other profiles (dentist-therapists, orthopedists, surgeons, periodontists, orthodontists), but also neurologists, cardiologists, otorhinolaryngologists, etc.

To better understand the situations, two typical examples are given below.

A 78-year-old patient (man) with a aggravated history was brought to the dentist-therapist regarding the treatment of a front tooth with a cyst. Namely, the patient is registered with the local therapist about coronary disease heart, the surgeon - about disorders of the musculoskeletal system. Simply put, it is not only difficult for a person to move around, but it can also be said in advance that he does not tolerate long-term treatment.

Is it worth it in this case to remove a tooth with a cyst, or is it better to prefer a conservative treatment option?

Formally, the picture shows a small cyst (2-3 mm), the front tooth is immobile, single-rooted, the root is even, but can a seriously ill person endure many months of canal therapy and frequent visits to the doctor? And how important is this tooth for the future for prosthetics? If you decide to remove a tooth with a cyst, then how high is the risk of serious heart problems in a patient right in the doctor's chair?

Today, dentists have many such patients, and each case is individual. As a result, the doctor himself often does not have any answers to all these questions, so common sense and advice from colleagues come to the rescue.

On a note

If a patient with a weak heart seeks emergency assistance(a tooth with a cyst went into exacerbation and led to facial asymmetry), then the dental surgeon must perform an urgent tooth extraction under the supervision of the attending physician (local therapist, cardiologist, ambulance team, etc.). Often the risk is so great that the removal is performed in a hospital and constant monitoring of the vital functions of the body.

At chronic course periodontitis with a cyst, when the symptoms are not so bright, and there are no serious risks to life and health, the dentist must weigh the pros and cons, find out the opinions of colleagues, and only then decide whether to treat or remove.

And now an example from another clinical situation, which occurs much more often (almost every other day). A patient, a 45-year-old man, came to us with a large number of missing teeth, who is going to get a prosthesis in the near future. There was no orthopedic consultation yet, but the patient decided to treat the lower right wisdom tooth with a cyst, as it is the last hope for a "bridge" as an end support.

Often people, turning to the dentist, with some feeling or special intuition, assume the importance of a certain tooth for the future and try in every possible way to convince the doctor of the need to save the tooth. If the doctor is inexperienced, then he will pay attention only to the picture of the tooth - and, for example, he will see only wide, even canals, non-curved roots and a small cyst (granuloma), as well as ease of access to the canals, since the patient can open his mouth wide. But the doctor can notice the 2-3 degree of tooth mobility only in the middle of treatment, when it is so hard to tell the patient: “You know, but the tooth turns out to be mobile.” It's like admitting your incompetence.

Therefore, it often happens that a young doctor successfully completes the treatment of a tooth with a cyst (in 2-4 months) and sends the patient for prosthetics, and the orthopedic dentist, after checking the tooth for mobility, states the need for its removal and absolute unsuitability as a support for a bridge prosthesis. Due to the heavy load on the “bridge”, in the coming months the front support, which was previously the most reliable, would also become movable.

That is, the first doctor who did not check the tooth for mobility and did not consult with a colleague did not clinical thinking, and one-sided decisions (out of inexperience or “on a piece of paper”) lead to the fact that the treatment of a tooth with a cyst becomes useless in the long term, to put it mildly.

What else can stop a competent doctor from treating a tooth with a cyst:

• Serious orthodontic anomalies (occlusion pathologies);
• Poor oral hygiene of the patient;
• Significant loss of the crown part of the tooth;
• Serious mistakes of previous doctors in the canal (canals) of the tooth, made during endodontic treatment;
• Prerequisites for tooth overload when chewing food;
• Pathological abrasion of severe enamel;
• The large size of the cyst, when it creates serious risks for the roots of adjacent teeth;
• The desire of the patient to remove the tooth without fail.

In general, we can say that there are many cases when persistent long-term treatment of a cyst turned out to be ineffective and carried a trail of disappointment for the patient (and the doctor).

On a note

By the way, about the patient's desire to remove a tooth at all costs. The dentist does not have the right to refuse the patient's request, but before that, a competent doctor, having assessed the clinical situation, must argue for the possibility of treating the tooth, if any. For many reasons (including psychological and financial), the patient cannot always afford long-term treatment of a tooth with a cyst, not to mention conservative treatment. surgical intervention(resection of the root apex). Therefore, his request has the right to be satisfied after he signs the document - "Informed voluntary consent to medical intervention."

Technically, the extraction of teeth with a cyst is almost the same as the extraction of teeth without a cyst. Most often, the procedure is implemented using forceps and elevators.

How is the cyst or granuloma itself removed?

When removed, the cyst is almost always evacuated along with the root of the tooth, but it also happens that it breaks off from the top of the root, or even the top of the root itself breaks off. When a cyst is torn off, the dentist-surgeon scrapes out the cavity with a curettage spoon or trowel. If the root is broken off, it can be removed with elevators, a curettage spoon, or by sawing out with a drill, followed by suturing the wound.

Is it possible to do without pain when removing a tooth with a cyst?

Before any surgical intervention, the dentist always conducts anesthesia. The result of the work largely depends on its quality, since only in a calm environment can a tooth with a cyst be removed qualitatively - carefully and with minimal trauma to the tissues surrounding the tooth root. That is why modern dentistry has a large arsenal of tools (anesthetics and components) that almost always allow any, even complex, tooth extraction to be performed without pain for the patient.

Can a cyst remain or form in the hole after tooth extraction, and what does it threaten?

Suppose that everything is left behind for the patient: the doctor safely removed the roots of the tooth with a cyst, stopped the bleeding and gave recommendations. But I did not check the quality of the cyst removal!

Is it possible, in principle, to understand that all the pathological tissue is scraped from the bottom of the hole and its walls, if the review is often closed due to increased bleeding? And what happens if part of the cyst remains in the hole?

The cyst that the dentist left in the hole after the extraction of the tooth is called residual. And this focus of infection does not bring anything good for the future. A residual cyst can freeze for many years, in order to “shoot” in the future in the form of swelling on the face (flux), abscess, phlegmon, sinusitis, or it will grow into the maxillary sinus, mandibular canal, etc. Or it will not initially allow the hole to heal normally in comfortable conditions - alveolitis will occur, which will be extremely difficult to cure without eliminating the underlying cause.

It does not happen that a cyst by itself, “out of nothing” is formed after a well-performed tooth extraction. If it formed, it means that not all the pathological tissue was removed from the hole, or even the top of the tooth root could break off during the removal procedure. A left cyst or granuloma tends to grow and develop complications - this is worth remembering.

“I went to our hospital a couple of months ago, where they removed my back upper tooth that had been tormenting me for a long time. During the removal, something cracked, but the doctor said that everything was fine. He gave me a list of medicines and sent him home quickly, as he had a full corridor of people. On the second day, I realized that I was dying: my face was swollen, the temperature was 39, and the pain was no longer relieved. I ran to this doctor, and he was almost on my doorstep: they say, it happens, get treated with what you have. I spat and went to a private trader, and there they took a picture of me. In the picture, they found a piece of root with a cyst. A small shard, but with a huge cyst, as the new doctor said. He made an injection and removed this dirty trick in 15 minutes. The pain disappeared, the temperature returned to normal and the swelling subsided. So in this case, the main thing is to find a good specialist and not really rely on butchers-butchers in clinics ... "

Vitaly S., Stary Oskol

Possible complications and methods of their prevention

In some cases, after the removal of a tooth with a cyst, patients are faced with incomprehensible (and very unpleasant) situations for them, which sometimes cause almost panic. In particular, no dentist's patient is fully insured against:

• Prolonged bleeding from the hole;
• Alveolitis;
• Perforation of the maxillary sinus;
• Jaw fracture (already at home, for example, while eating);
• Paresthesia (persistent numbness of a part of the face);

Fortunately, the last three complications after the extraction of a tooth with a cyst are quite rare.

Perforation of the maxillary sinus sometimes occurs due to the proximity to it of the roots of the teeth of the upper jaw (mainly the upper 4, 5, 6 and 7 teeth) - for example, with not very accurate work of the dental surgeon. In addition, it is possible for the cyst to grow into the maxillary sinus - in this case, after the removal of a tooth with a cyst, a message occurs between the sinus and the oral cavity.

A dentist can test for a maxillary sinus perforation after tooth extraction as follows:

1. The patient pinches his nose and try to exhale through it. When a sinus is perforated, air is evacuated from it into the mouth;
2. If the cheeks are inflated, then when the maxillary sinus is perforated, the air immediately exits into the nasal cavity (this technique should be used only as a last resort because of the risk of microflora being thrown into the sinus).

On a note

Sometimes perforation occurs when the technique of tooth extraction is incorrect: excessive pressure of the instrument on its root or root apex, or directly on the bottom of the sinus.

Paresthesia of the facial areas (numbness) is characteristic of cases when the cyst grows into the mandibular canal, where the nerve passes. Less often - with excessive trauma of the intervention, when nerve fiber damaged directly by the instrument or squeezed by a hematoma.

A fracture of the jaw after tooth extraction can occur due to significant loss of bone tissue, when the cyst occupied a significant volume of the jaw (more than 1 cm in diameter).

Prolonged bleeding from the hole and alveolitis occur in practice more often than other complications.

The causes of non-stop bleeding can be different: from damage to large vessels during tooth extraction to the patient taking drugs that “thinn” the blood, or against the background of increased blood pressure. The risk of deterioration in the general condition of the patient is possible with continuous loss of blood through the well for more than 6-12 hours. Therefore, in the case of prolonged bleeding, it makes no sense to wait for hours for the blood to stop itself - it is better to take timely measures.

Before visiting a doctor, you should:

1. Measure blood pressure and normalize it by taking drugs prescribed by the therapist;
2. Stop taking anticoagulant drugs;
3. Place a sterile gauze ball on the well and press it for 15-20 minutes. The main thing is the compression force (but without fanaticism), since the hemostatic effect depends on this factor;
4. If the previous method is ineffective, you can drop a little 3% hydrogen peroxide into the middle of a sterile gauze ball and also firmly clamp the swab between the hole and the opposite tooth (hydrogen peroxide has hemostatic properties);
5. In extreme cases (if there is no way to get to the doctor at all), you can buy a hemostatic sponge at the pharmacy and put it on the well or partially in the well, also pressing it on top for 10-15 minutes with a sterile gauze swab.

Alveolitis (inflammation of the hole after tooth extraction) may be the result of poor cleaning of the wound from the remnants of the cyst and tooth fragments. Often, the patient himself is to blame for the development of alveolitis - if the doctor's recommendations are not followed. The consequences of such misbehavior are different: severe pain in the hole, swelling, fever, putrid breath (and even more serious, up to osteomyelitis and abscess).

Now let's see what to do after removing a tooth with a cyst so that the hole does not hurt and heals faster. If the dentist's tactics during tooth extraction were correct, then further prevention of complications depends only on the patient, to whom the doctor must issue a list of recommendations.

Unfortunately, it often happens that the dentist does not inform the patient in any way about the actions after the removal of a tooth with a cyst (either forgets or simply does not want to spend time on this). This happens both in Moscow and in the regions - in ordinary hospitals, where every working day, exhausted by "kilometer" queues of patients, a dental surgeon removes teeth in batches, and the price of the issue can be ridiculous (200-300 rubles), or in general the service is provided free of charge .

1. 3 hours do not eat;
2. Apply a cold compress to the area of ​​removal from the side of the cheek for 15-20 minutes every 2 hours, avoiding hypothermia;
3. For 4 days, refrain from coarse, spicy and hot food;
4. Eliminate heavy physical exercise, hot shower, bath, sauna, steam room, etc.;
5. Do not disturb the wound (do not climb into it with your hand and toothpicks, keep it away from any irritants);
6. Maintain an adequate level of oral hygiene (use a soft toothbrush, do not neglect to brush the teeth near the socket).

These tips are maximally adapted for most patients. However, even if these recommendations are followed, there is no 100% guarantee that after the removal of a tooth with a cyst, the hole will heal without problems.

The likelihood of problems if these recommendations are followed will be minimized in the case of simple tooth extractions that are not in the acute stage. If the cyst was large, and pus literally oozes from the hole after tooth extraction, then we are talking about the need for the doctor to use an additional arsenal of drugs: antibiotics, antihistamines, painkillers and wound healing agents.

Be that as it may, it is useful to listen to your body and be guided by common sense. And if, for example, the hole hurts for a long time, or incomprehensible sharp fragments stick out of it, it is better to see the doctor once again, not embarrassed to disturb him.

An interesting video about the modern approach to the problem of tooth cysts

An example of removal of a cyst in the upper jaw, followed by bone grafting and suturing

Dental manipulations on the upper jaw are associated with an additional risk of complications due to the proximity of the maxillary sinus. In terms of volume, it is larger than all the other paranasal sinuses, so it is not uncommon for roots, instruments, and implants to be pushed into it. Especially difficult is the extraction of a tooth with a cyst in the maxillary sinus, because large cysts cause tissue displacement, disrupt blood flow, and require long-term rehabilitation. Early treatment and diagnosis allows for the most atraumatic intervention with a quick subsequent recovery.

Reasons for the formation of cysts on the root of the tooth

A healthy sinus is usually damaged during dental procedures (extraction of teeth, endodontic treatment, implant placement). Many more factors influence the development of the pathological process.

The formation of cysts may be due to the following factors:

• mechanical trauma to the tooth;
• infection due to poor-quality treatment;
• chronic infectious processes of the nasopharynx;
• pulpitis, periodontitis;
• inflammation of the tooth under the prosthesis;
• complicated eruption of the last molars.

A cyst can form in the maxillary sinus itself due to gross manipulations by a doctor or anatomical features- for example, the roots are inside the sinus.

What is odontogenic sinusitis?

Unlike rhinogenic, odontogenic sinusitis occurs due to a cause associated with the teeth. The floor of the maxillary sinus is very close to the roots of the upper teeth. So, the roots of the first and second molars, as well as the root of the second premolar, are located at a distance of 1-2 mm from the bottom. Often, the tops of the roots protrude into the sinus, delimiting from it only by the periosteum and mucous membrane.

Inflammation near the roots of "dangerous" teeth easily spreads to the sinus mucosa, which becomes thinner when the process becomes chronic. Purulent masses penetrate into the sinus cavity also with suppuration of dental cysts. Unremoved roots also serve as a focus of infection. Perforated sinusitis begins after tooth extraction, and the root or the entire tooth may be inside the sinus.

Symptoms of a hilar cyst in the maxillary sinus

In the initial stages, the disease may be asymptomatic. Over time, the cyst grows, causing a characteristic clinical picture:

• pressure on the side of the lesion;
• pain in an inflamed tooth;
• labored breathing;
• bad smell from the nose;
• the appearance of nasality;
• discharge from the nose (mucous, purulent);
• irradiation of pain upward (to the eyes);

Swelling (“ball”) on the gum is a sign of cortical bone melting, perforation can be determined with a probe.

Important! If the cystic formation grows to a large size, it presses on oculomotor nerve, there is diplopia - double vision. This is a very serious symptom requiring immediate medical attention. medical care and extraction of a tooth with a cyst.

Diagnostics

The most informative method for suspected tooth cyst in the maxillary sinus is computed tomography, which provides accurate information about the size and localization of the pathological formation.

X-ray examination provides only approximate information about the cyst. Three-dimensional diagnostics is good in that the doctor can correlate all the studied elements with each other, i.e. carefully plan the surgical intervention with minimal risk of injury nerve trunks, vessels, surrounding structures. An orthopantomogram is also done (an overview of both jaw rows) to assess both maxillary sinuses, as well as the condition of the periodontium. If necessary, special studies are carried out by an ophthalmologist and an ENT doctor.

Is it possible to do without surgery?

Cysts at the apex of the tooth root can be treated conservatively by introducing calcium-containing preparations into the canals or surgically by removing the root or the entire tooth. However, things take a different turn when the affected root is inside the maxillary sinus.

As a rule, such a cyst is found when the pathological process has already gone far enough and therapeutic treatment most likely to be ineffective. Most often, the doctor decides on a surgical intervention, prescribing a tooth-preserving operation or removing a tooth with a cyst to the patient. This tactic is justified by the fact that conservative treatment proceeds for a long time (3-4 months are required for the resorption of the cyst). During this time, an exacerbation or a complication may develop. Even if the root is encapsulated, there should be no foreign bodies in the air sinuses. There may be no obvious signs of inflammation, but the root sometimes becomes a substrate for fungi with the formation of the so-called "fungal ball", which then still has to be removed.

Therapeutic measures for a tooth cyst in the maxillary sinus pose the following tasks:

1. elimination of the cause of inflammation;
2. removal of the root of a tooth with a cyst or removal of the entire tooth;
3. sinus cleansing from pathologically altered tissues;
4. closure of the oro-antral fistula or perforation;
5. ensuring sufficient outflow of discharge after surgery through the lower nasal passage.

The final decision on the method of treatment is made after complete examination, including all types of necessary x-rays, as well as testing if necessary. The protocol for working with the maxillary sinus includes a consultation with an otorhinolaryngologist to clarify the patency of the osteomeatal complex and remove the inflammatory component.

Treatment features, perforation closure

Physician's tactics and perforation closure maxillary sinus depend on the clinical situation.

1. Removal of a tooth with a cyst entirely. In this case, it is necessary to strive to prevent infection of the formed blood clot. A gauze iodine turunda is placed in the lower part of the hole. It can self-fix in the wound, but sutures are applied to the gum to improve fixation. A week later, granulation tissues are formed, the defect is closed, the turunda is removed. Additionally, you can separate the oral cavity and sinus by applying a plastic plate to the defect, which is attached to adjacent teeth. This tactic speeds up the closure of the perforation. At the same time, the patient is given drug therapy of anti-inflammatory drugs and vasoconstrictors to minimize the occurrence of complications.
2. Removal of the root of the tooth from the maxillary sinus. It is carried out promptly through the anterior wall of the sinus. The doctor's goal is to make a trapezoidal incision in such a way that the top of the formed figure "captures" the problem tooth. Then a mucoperiosteal flap is cut out, the front wall of the sinus is exposed, a hole is made in the bone with a diameter of about 1.5 cm. Through it, the doctor removes the root with the cyst, pathological growths, polyps, extracts foreign bodies(if any), i.e. doing a full audit. The sinus is washed with an antiseptic solution. A direct communication between the maxillary sinus and the nasal cavity must then be created to allow aeration and drainage of the sinus. Iodoform turundas are excreted into the nasal passage. Through the created drainage, you can wash the sinus with antibiotic solutions. The perforation can be closed with a bone block graft. Access from the oral cavity is sutured. The whole operation takes about an hour and is performed under local anesthesia.

Preventive measures

A tooth with a cyst in the maxillary sinus can be called a time bomb. Even if it does not cause concern, it should be understood that there is a risk of complications - for example, if the sinus is accidentally opened during the treatment of other teeth.

Prevention of odontogenic diseases of the maxillary sinus includes:

• thorough diagnosis before any dental intervention;
• usage latest methods examinations, including 3d tomography and microscope;
• competent dental care, taking into account the individual anatomical structure teeth and sinuses;
• observance of hygiene of the oral cavity and nose, strengthening of immunity;
• complete treatment of pathologies of the upper respiratory tract.

Complex manipulations are best trusted by experienced doctors. A serious approach to your health is the key to a favorable prognosis. The Khoroshevskaya clinic has all the necessary equipment for a complete diagnosis of each patient, including computed tomography with minimal radiation exposure. A team of doctors will select the right treatment tactics with the most careful attitude to the body, the patient after sinusotomy is supervised by the attending physician for the entire rehabilitation period.

Rehabilitation, features of care

After the operation, the patient feels pain, discomfort, impaired sense of smell for about 2 weeks. Tampons are removed from the nasal cavity for 3-4 days, the doctor removes the stitches after 7 days. After removing the turunda, the nasal cavity must be washed with antiseptics, instilled vasoconstrictor drugs. Antibiotics are required. Swelling can be reduced by applying cold. Recovery is accelerated by the appointment of physiotherapy (UHF, electrophoresis).

• avoid active speech and facial expressions;
• sneezing and coughing with an open mouth;
• eat soft, liquid foods;
• rinsing should be carried out very carefully;
• exclude intense blowing;
• do not visit the bath / sauna;
• temporarily limit physical activity.

In order to avoid relapses, it is necessary to be observed by a dentist-surgeon once every 3 months during the year.

Possible Complications

A tooth cyst, regardless of its location, is not treated with home methods. Success largely depends on the time of treatment and the qualifications of the doctor. Incorrect or untimely treatment leads to serious consequences:

• the spread of the inflammatory process to other air sinuses;
• melting of bone tissue with pus with the development of osteomyelitis;
• forced removal of healthy teeth in the area of ​​open perforation;
• proliferation of a cyst with compression of the bones of the skull and asymmetry of the face;
• pathological fracture of the jaw due to weakening and compression of the bone tissue;
• vision problems, severe headaches.

Important! The infection can spread to the brain, which threatens the occurrence of life-threatening conditions due to inflammation of the meningeal membranes!

Untimely treatment of patients to a doctor for the treatment of caries, unfortunately, is still an acute problem. One of the extremely unpleasant complications of caries is considered to be a dental disease in which an infection from a carious tooth completely destroys the pulp (a nerve in the tooth) and goes beyond the root into the surrounding tissues (periodontium) and bone. A distinctive symptom of periodontitis is often the appearance of a rounded swollen formation on the gum. Not all patients understand that if a cyst has formed in the gum of the tooth, the consequences can be much more serious than they could have imagined.

Why does a cyst appear in the gum?

In fact, the formation, popularly referred to as a gingival cyst, is nothing more than a fistula, or a fistula. With the development of untreated caries, the infection penetrates through hard tissues tooth into the pulp, destroying and killing it, and then into the tissues surrounding the root of the tooth. The immune system of the body, reacting to the attack of pathogenic microorganisms, mobilizes protective blood cells to the site chronic infection(causal tooth). Thus, pus forms in the root of the tooth and around it, which is a kind of battlefield between bacteria and the body's defenses.

Cyst in the mouth - photo

Subsequently, the accumulation of pus spreads further, destroying the bone and forming a kind of cavity, which the dentist sees on the x-ray of the affected tooth. The resulting pus constantly strives to come out through the path of least resistance. If untreated, the infection, gradually dissolving the bone, will form a course from the root of the tooth into the oral cavity, passing through the bone and gum. On the gum, a convex formation will become noticeable, often filled with a reddish or white-yellow liquid. Then the gum wall will burst and the pus will pour out.

At this time most often pain are declining. However, this is far from being a reason to calm down and postpone treatment until later, since the pathogenic bacteria are still in the infected tooth and continue to infect the surrounding tissues more and more. Subsequently, a new portion of pus is formed, which will again bleed from the previously formed fistula.

What are fistulas (cysts) in the gums?

Table. Cyst in the gum of the tooth - the main varieties.

Type of fistula on the gum	Reason for education	How does it manifest
	The beginning of the formation of pus occurs inside the root of the tooth, passes to the tissues connecting the root to the bone, and then to the bone. As a result, pus penetrates through the bone into the gum and is emptied into the oral cavity.	The cause may be a carious tooth or a tooth that has already been treated (a filling was placed or a nerve was removed). It causes pain when chewing food, pressing and tapping. After the formation of a fistula, the pain usually subsides for a while.
	Initially, a pocket is formed in the gum, in which plaque and bacteria accumulate, then pus forms in the depth of the pocket, which can form a passage, reaching the surface of the gum in the form of a fistula.	The bulk of the symptoms will affect the gums - inflammation, bleeding, gum separation from the tooth, loosening of the teeth. Then, in the area of ​​​​one or more teeth, a fistula forms on the gum.
	The rarest of fistulas. It is formed with improper eruption of the wisdom tooth and infection of the mucous membrane above it.	Pain, redness and swelling in the far parts of the jaw behind the chewing teeth, accompanied by a fistula on the gums in the same area.

Risk factors for the formation of a fistula (cyst) in the gum

1. Delayed treatment of caries and its complications. The launch of diseases that destroy the tooth leads to their progression and the spread of bacteria in the oral cavity.

   

2. Poor personal oral hygiene. Promotes the accumulation of plaque, in which pathogenic microorganisms multiply. The gum becomes inflamed, periodontal pockets form, in which, among other things, food can get stuck, which will immediately cause the release of pus.

   

3. Bad habits. Smoking significantly accelerates the formation of microbial plaque and impairs blood circulation in the tissues of the oral cavity, preventing them from fully fighting the infection.

   

4. Weak immunity. May present as seasonal colds or serious illnesses caused by external or internal factors(sexual infections, blood diseases, autoimmune diseases, beriberi, exposure to severe conditions). In any case, the reactivity of the body and the ability to destroy pathogenic bacteria are sharply reduced.

   

5. Strong stress. In this case, the body focuses all its forces on fighting stress, not infection, and exacerbations of chronic diseases, including those associated with teeth, easily occur.

Signs of a fistula (cyst) in the gum

Signs and external manifestations will mostly depend on the cause of the fistula formation. Here are some of the symptoms:

• pain in the tooth when biting, chewing and tapping;
• the formation of a rounded element on the gum containing a yellowish or red liquid;
• swelling of the face on one side;
• swelling of the gums;
• pain in the gums or in the area where the fistula has formed;
• bad breath;

Bad breath is the cause of many problems

• gum irritation;
• tooth sensitivity to cold or hot;
• nausea;
• swelling of the tonsils;
• the appearance of painful rounded formations under the jaw (swollen lymph nodes);
• ear pain;
• bad feeling.

Diagnosis of a cyst in the gum

To make an accurate diagnosis, the dentist will clarify the order in which symptoms appear, conduct a careful examination of the oral cavity, determine the presence of caries, fillings, and plaque on the teeth. Assuming a causative tooth, the doctor will conduct an X-ray examination, in which, to check the direction of the fistula, he can insert a thin and elastic gutta-percha pin into it (the same one that seals the roots of the teeth). Thus, it will become immediately clear which of the adjacent teeth caused the appearance of pus.

A more advanced diagnostic method is computed tomography. It will allow not only to determine the direction of the fistula, but also to assess the integrity of the bone, the size and shape of the initial periradical purulent focus, its proximity to the important structures of the jaws.

How is a fistula (cyst) in the gums treated?

Treatment will never be effective until the original cause of the disease is removed. That is why the most important step in the event of a cyst in the gum is to contact a professional. No types of home treatment and expectant tactics will clear the causative tooth from infection, will not remove plaque accumulated above and below the gum, infected tissues. If pus appears in any part of the body, and in the oral cavity in particular, postponing treatment can lead to irreparable consequences.

So, what are the treatment options when visiting a dentist?

If the disease has appeared in a neglected carious tooth, the doctor will drill out the destroyed enamel and dentin, remove the dead pulp, thoroughly and for a long time wash the infection with effective antiseptics and seal the canal to close its lumen for bacteria.

When a tooth suppurates with an already removed nerve and a sealed root canal, the dentist removes the existing filling, re-processes the canal with instruments and antiseptics and seals. There are many reasons for inflammation around the roots of such teeth - from the initially poor-quality processing of the canal to the features of the anatomy of the tooth (hidden, highly branched canals) and the abilities of the body's defense systems.

So, for example, if a tooth has too thin and crooked root canals, its treatment may not be possible, and attempts to fill will only lead to an aggravation. In such a case, one should resort to surgical treatment fistula in the gum.

If the tooth is severely damaged, and the anatomy does not allow it to be cured, or there is a fracture in the root wall due to trauma, surgical methods of treatment are used, with or without tooth preservation.

Methods for preserving the tooth may include removal of one of the roots, cutting off one of the root tips, separation and removal of the causative root along with part of the crown. These operations are quite expensive, have their own risks and complications, and are not applicable in all teeth. Their effectiveness is not always sufficient.

With severe inflammation and suppuration, frequent exacerbations and unsuccessful attempts at filling, most often they resort to the removal of the entire tooth. Unfortunately, in some cases, this is the only way to rid the patient of a focus of chronic infection that affects not only the jawbone, but the entire body as a whole.

In the event that pus has arisen due to gum disease, the doctor will professional hygiene oral cavity, remove plaque above and below the gum, clean out infected tissues in periodontal pockets.

With any of the listed types of treatment, revision or excision of the fistula will be a mandatory step. At the same time, the newly formed tissues lining the passage through which the outflow of pus was performed are removed, which prevents the occurrence of re-inflammation and the development of complications.

Consequences and complications of a fistula (cyst) in the gum

It is extremely important to understand that any purulent inflammatory diseases must be treated without delay. What can happen if you don't see a doctor?

1. The most “harmless” outcome is the loss of a tooth. It will occur due to the progressive destruction of the bone by pus and bacteria. It will lose its stabilizing support in the form of surrounding bone tissue and begin to loosen until it completely falls out of the hole.

   

2. Penetration of infection into the maxillary sinuses. Thus, maxillary sinusitis (or, in other words, sinusitis) will develop. This disease is very difficult and long-term treatment, continuing to overcome the patient for years.

   

3. Formation of cysts in the jaw. A jaw cyst is a large cavity-like formation that requires major surgery. In this case, a lot of bone tissue is lost and it is necessary to replace the loss with various materials.

   

4. brain abscess. It can occur when bacteria spread through the bloodstream from a long-existing focus of infection.

   

5. Bacterial endocarditis. Serious illness heart, often fatal. The connection between the teeth and the heart, again, lies in the blood flow, carrying the infection, constantly accumulating in one place (tooth root, inflamed gums).

   

6. Abscesses and phlegmon in the face and neck. In this case, the purulent infection moves to nearby tissues - in the cheek area, under the jaw, in the area in front and behind auricles. These processes threaten the life of the patient, significantly worsening general state. At the same time, pus melts everything in its path - vessels going to the brain, nerves, muscles, bones, eyeballs. The cause in most cases is decayed teeth.

   

7. Blood poisoning or sepsis. In this case, pathogenic microorganisms enter from the purulent focus around the root of the tooth directly into the bloodstream, spreading throughout the body and often leading to the death of the patient.

Video - Treatment of a tooth cyst