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Epithelial cysts can be subdivided into?
- Odontogenic
- Non-odontogenic
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Odontogenic cysts originate from residues of tooth forming organ. Name 3 kinds:
- Epi rests of Serres e.g. Keratocyst
- Epi rests of Malassez e.g. Radicular cyst
- REE e.g. dentigerous cyst
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What are the most common cysts?
- Radicular 60-70
- Dentigerous 10-15
- Keratocyst 5-10
- Nasopalatine 5-10
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Odontogenic cysts can be inflammatory or developmental. Name the inflammatory cyst:
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Most radicular cyst are apical, what other types are there?
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Where do radicular cyst commonly occur and why?
- Maxilla
- Incisors, due to palatal invaginations, silicate restorations, trauma, small teeth
- Usually occur after pulp death (non vital tooth)
- Chronic infection may stimulate cell rests of Malassez to proliferate
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Clinical fts of radicular cyst?
- Slowly progressing painless swelling with no symptoms
- Round and hard
- Bone becomes thin, eggshell thickness, crackling sensation on pressure
- Part of wall fully resorbs away, leaving a soft fluctuant swelling.
- Can get infected
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Pathogenesis of radicular cyst?
- Infection from pulp - proliferation of epi rests of malassez
- Cyst fluid contains high conc of proteins - exert osmotic pressure
- Cyst tissues release bone resorbing factors
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Histopatho radicular cyst?
- SSE lining - with time lining becomes thinner
- Chronic inflammation
- Cholesterol clefts
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Treatment radicular cyst?
- Displace teeth, displace antrum
- Enucleate and extract/RCT tooth
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Who and where are Dentigerous cysts found?
- Upto age 40. Young adults
- Encloses crown of U/E tooth.
- Attached to CEJ
- L8, U3, L5
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Symptoms Dentigerous cyst?
- Painless enlargement
- Missing tooth
- Tilting teeth
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Radiographic fts dentigerous cysts?
- Round, uniloc
- Envelop crown, CEJ
- Lucent
- Corticated, well defined
- Resorb adj teeth
- Displace antrum
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Histopathology of dentigerous cysts?
- SSE lining, continuous with REE
- Fibrous wall similar to radicular, but less inflammatory changes visible.
- Fluid = clear yellow. Purulent if infected.
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What other lesions may envelop the crown of a tooth?
- Keratocyst
- Ameloblastoma
- Adenomatoid odontogenic cyst (anterior)
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Lateral Periodontal cyst are positioned where?
- Beside a tooth (vital), near crest of ridge.
- Small (<1cm)
- can extend into the gingivae
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Treatment of lateral periodontal cyst?
Enucleation. Tooth can be retained if healthy.
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Sialo-odontogenic cyst occurs in anterior mandible. Histological findings?
Small glands in epi lining that are lined by mucous cells and secrete mucin.
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Three things that help you differentiate a nasopalatine duct cyst from a large nasopalatine foramen?
- Over 6mm, cyst more likely
- Foramina are usually oval or irregular
- Cyst tends to be more lucent having resorbed bone.
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What times of primary bone cysts exist?
- Aneurysmal bone cyst
- Solitary bone cyst
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What does a solitary bone cyst contain?
- No epi lining
- Empty
- Or pale fluid.
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What radiographic fts may help you decide solitary bone cyst?
- Generally less well defined compared to odontogenic cysts.
- Cavity arches up between the roots of teeth, usually without expansion
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