Gingival cyst of newborn /orthodontic courses by Indian dental academy

GINGIVAL CYST OF
NEWBORNS AND ADULTS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacdemy.com

REFERENCES
 Textbook of cysts of the oral and maxillofacial
regions – Mervyn Shear
 Essentials of Oral Pathology and Medicine- Cawson
 Textbook of Oral Pathology- Shafers
 Textbook of Oral & Maxillofacial Pathology-
Neville
 Textbook of Oral Pathology - Regezi

 Gingival Cyst of newborn ; JMRP March 2012 ; Volume
no 1 Issue 3.
 Gingival Cyst of Newborn - A Case Report ; JIDA, Vol. 6,
No. 1, January 2012
 Dental lamina cyst of newborn: A case report ; J Indian Soc
Pedod Prevent Dent - December 2008.
 Bohn’s nodules, Epstein’s pearls, and gingival cysts of the
newborn: A new etiology and classification ; ODA
JOURNAL March/April 2010.

 Cyst of Newborn ; Aman Moda ; International Journal of
Clinical Pediatric Dentistry, January-April 2011;4(1):83-84
 Diagnosis and management of oral lesions and conditions in
the newborn; SA Fam Pract 2010;52(6):489-491.
 Gingival cyst in adults T, N, Nxumalo and Shear M;
Gingival cyst in adults, J Oral Pathol Med 1992; 21; 309-
13.
 A Rare Lesion of the Periodontium: The Gingival Cyst of
the Adult - A Report of Three Cases ; The International
Journal of Periodontics & Restorative Dentistry; Volume 22,
Number 1, 2002

LEARNING OBJECTIVES
 At the end of the seminar, the learner should be able to –
 Define cyst
 Classify cysts
 Describe the frequency, pathogenesis, clinical features ,
histology and treatment of gingival cyst of newborns
and adults.

DEFINITION
 Cyst is defined as a pathologic epithelium lined
cavity usually containing fluid or semisolid material
-Shafer

• A cyst is a pathological cavity having fluid, semi
fluid, or gaseous contents and which is not created by
accumulation of pus. It is frequently, but not always
lined by epithelium.
-Kramer

CYST
True Cyst Pseudocyst
Lined by epithelium Not lined by epithelium

CLASSIFICATION
 Cysts of the jaws
 Cysts associated with maxillary antrum
 Cysts of the soft tissues of the mouth, face and neck

I. CYSTS OF THE JAWS
Epithelial Non-Epithelial
(True) (Pseudo)
Odontogenic Non-Odontogenic
Developmental Inflammatory

Odontogenic Developmental Epithelial
(True) Cyst
i. Odontogenic Keratocyst (Primordial Cyst)
ii. Dentigerous Cyst (Follicular Cyst)
iii. Eruption Cyst
iv. Lateral Periodontal Cyst
v. Gingival Cysts of Infants
vi. Gingival Cysts of Adults
vii. Calcifying odontogenic cyst
viii. Botryoid odontogenic cyst

Non-Odontogenic Epithelial (Fissural) Cyst
i. Nasopalatine duct (incisive canal) cyst
ii. Mid palatal raphe cyst
iii. Nasolabial (Nasoalveolar) cyst

Inflammatory Epithelial (True) Cyst
i. Radicular Cyst
ii. Residual Cyst
iii. Paradental Cyst

Non-epithelial lined Cyst
i. Solitary bone Cyst
ii. Aneurysmal bone cyst

II. CYST ASSOCIATED WITH THE
MAXILLARYANTRUM
i. Mucocele
ii. Retention cyst
iii. Pseudocyst
iv. Postoperative maxillary cyst

CYST OF THE SOFT TISSUES OF THE
MOUTH, FACE AND NECK
i. Dermoid and Epidermoid Cysts
ii. Branchial Cleft (Lympho-epithelial) Cyst
iii. Thyroglossal duct Cyst
iv. Anterior Median Lingual Cyst
v. Oral Cysts with gastric or intestinal epithelium
vi. Cystic Hygroma
vii. Nasopharyngeal Cysts
viii. Thymic Cysts
ix. Cysts of the Salivary Gland – Mucocele, Ranula
x. Parasitic Cysts

CLASSIFICATION BY TISSUE OF
ORIGIN
 DERIVED FROM RESTS OF MALASSEZ
 DERIVED FROM REE
 DERIVED FROM DENTAL LAMINA (SERRE)
 UNCLASSIFIED

DERIVED FROM RESTS OF MALASSEZ
 PERIAPICAL
 RESIDUAL CYST

DERIVED FROM REE
 DENTIGEROUS CYST
 ERUPTION CYST

DERIVED FROM DENTAL LAMINA
 OKC
 GC OF NEWBORN
 GC OF ADULT
 LPC

INTRODUCTION
 Some benign oral mucosal conditions are frequently found
in newborns, which are transient in nature.
 Based on histological origin and location in the oral cavity,
Fromm classified oral mucosal cysts as Epstein’s pearls,
Bohn’s nodules and dental laminal cysts.

 Epstein’s pearls are cystic, keratin-filled nodules found
along the midpalatine raphe, probably derived from
entrapped epithelial remnants along the line of fusion.

 Bohn’s nodules are also keratin-filled cysts but found o
the buccal or lingual aspects of the dental ridges.

 Dental lamina cysts are found on alveolar ridge
of newborns or very young infants which
represent cysts originating from remnants of the
dental lamina

FREQUENCY
 The frequency of gingival cysts is high in newborn
infants but they are rarely seen after 3months of age.
 It is apparent that most of them undergo involution and
disappear, or rupture through the surface epithelium and
exfoliate, as very few are submitted for pathological
examination.

 Ikemura et al. (1983) reported a frequency of 89% in
541 Japanese neonates examined in the the first 8days
after birth.
 Another high frequency was found in a Taiwanese study
in which the mouths of 420 neonates were examined
within 3days of birth.

 Oral cysts, palatal or gingival, were found in 94% of the
infants (Liu and Huang, 2004).
 There was no association between the frequency of the cysts
and gender, body weight or gestation age.
 In a review article intended for physicians, Dilley et al.
(1991) pointed out that congenital lesions such as palatal
and alveolar cysts occurred in almost 50% of newborns.

 Stout et al. believed that the epithelial remnants of the
dental lamina have the capacity, from as early a stage in
development as 10 weeks in utero, to proliferate,
keratinize and form small cysts.
 Some of the gingival cysts degenerate and disappear, the
keratin and debris being digested by giant cells.
PATHOGENESIS

 After birth, the epithelial inclusions usually atrophy and
become resorbed.
 However, some may produce keratin-containing
microcysts, which extend to the surface and rupture during
the first few months after birth.

 The limited growth potential of the gingival cyst of
infants compared with the OKC, which is also of
dental lamina origin, is that the former arises from
postfunctional cells of the dental lamina whereas the
latter presumably arises from that part of the dental
lamina still possessing marked growth potential.

CLINICAL FEATURES
 Small discrete white swellings of the alveolar ridge,
sometimes appearing blanched as though from the
internal pressure.
 These lesions appear to be asymptomatic and donot seem
to produce discomfort in the infants.

HISTOLOGY
 The cysts are round or ovoid and may have a smooth or an
undulating outline in histological sections.
 There is a thin lining of stratified squamous epithelium
with a parakeratotic surface and keratin fills the cyst
cavity, usually in concentric laminations containing
flattened cell nuclei.

 The basal cells are flat, unlike those in the keratocyst.
 As a result of pressure from the cyst, the oral epithelium
may be atrophic

TREATMENT
 No treatment is required in as much as these lesions almost
invariably will disappear by opening onto the surface of
the mucosa or through disruption by erupting teeth.

GINGIVAL CYSTS OF
ADULTS

GINGIVAL CYSTS OF ADULTS
 Gingival cyst of adult is an
uncommon, small, non
inflammatory,
developmental cyst of
gingiva arising from the
rests of dental lamina.

CLINICAL FEATURES
 ETIOLOGY : GCAs are developmental and non
inflammatory, as well as rather uncommon with reports
ranging from .5 to 1% of reported odontogenic cysts.
 The cyst usually occurs in the fourth through sixth decade of
life, although a wide age range from 14 to 84 has been
reported.

 The mandible is affected 60% of the time, and some have
reported a slight female predilection (Kelsey, 2009).
 The lesion is usually less than 1.0 cm in diameter
(Wysocki et al. 1980).
 The favored location is the mandibular canine-premolar
region.

CLINICAL PRESENTATION
 The patient may give a history of a slowly enlarging,
painless swelling.
 The cysts are round to oval, wellcircumscribed swellings,
usually less then 1cm in diameter and may occur in the
attached gingiva or the interdental papilla, invariably on
the facial aspect.

 The surface is smooth and may be the colour of normal
gingiva or bluish.

 The lesions are soft and fluctuant and the adjacent teeth
are usually vital.
 During surgical exploration, slight erosion of the surface
of the bone may be observed without extension into the
periodontium.
 Rarely, more than one gingival cyst may be found in a
patient.

RADIOLOGICAL FEATURES
 There may be no radiographic change or only a faint
round shadow indicative of superficial bone erosion.

PATHOGENESIS
 A number of suggestions have been made about the
pathogenesis of the gingival cyst in adults.
 It was originally proposed that they may arise from
odontogenic epithelial cell rests; or by traumatic
implantation of surface epithelium; or by cystic
degeneration of deep projections of surface epithelium
(Ritchey and Orban, 1953).
 It has also been postulated that, very rarely, they may be
derived from glandular elements (Traeger, 1961).

 The most favoured theory of origin is from odontogenic
epithelial cell rests derived from the dental lamina,
although Shafer et al. (1983) felt that cysts arising from
traumatic implantation of surface epithelium may occur.

 According to Buchner & Hansen (1979) and
Wysocki et al. (1980), there are similarities between
the gingival cyst of adults and the lateral periodontal
cyst, both clinically and histologically.

 This theory postulates that the lateral periodontal cyst
develops from REE before eruption of the tooth and
the gingival cyst of adults from REE after eruption of
the tooth.

HISTOLOGY
 Some have an extremely thin epithelium, closely
resembling reduced enamel epithelium, with 1–3 layers of
flat to cuboidal cells containing darkly staining nuclei.

 The attachment
of the epithelium
to the underlying
connective tissue is
tenuous and easily
peels off, leaving
epithelial
discontinuities.

 Occasionally, low columnar cells have been observed on
the surface of the epithelium, suggesting origin from
ameloblasts and reinforcing the impression that the
lining may be derived from reduced enamel epithelium.

 In a number of instances, the epithelial lining could be
traced to, or close to, the junctional epithelium in serial
sections.

 The fibrous connective tissue wall is usually relatively
uninflamed except close to the junctional epithelium
where a chronic inflammatory cell infiltrate may occur;
and rarely may contain small epithelial islands.
 The lesion is usually unicystic, but occasional multicystic
variants are encountered.

TREATMENT
 The gingival cyst is removed by local surgical excision
and in the majority of cases there is no tendency for
recurrence.

CONCLUSION
 The gingival cyst of adult is a unique pathologic lesion
of the oral cavity, typically localized in the mandibular
canine and premolar region, appearing in adults in their
fourth to fifth decades of life. Associated osseous
involvement occurs <50% of the time and is often
undetectable radiographically.

THANK YOU !!!

Gingival cyst of newborn /orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Gingival cyst of newborn /orthodontic courses by Indian dental academy

Similar to Gingival cyst of newborn /orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Gingival cyst of newborn /orthodontic courses by Indian dental academy