Jaw cysts
Investigation and surgical treatment of benign cysts of the upper and lower jaw, from the small cyst found by chance on a dental X‑ray to larger cysts that need careful planning.
What a jaw cyst is
A cyst is a fluid‑filled sac. In the jaws they most commonly form around the root of a dead or infected tooth, or around the crown of a tooth that hasn't come through, such as an impacted wisdom tooth. They are almost always benign, and many cause no symptoms at all. They are usually discovered when a dentist notices a dark, well‑defined area on an X‑ray.
Left alone, a cyst tends to grow slowly, thinning the surrounding bone, displacing teeth or becoming infected. That is why even a symptomless cyst is normally treated once it is found.
Assessment
Chris will examine you and review your X‑rays. For anything other than a small cyst he will usually arrange a cone‑beam CT scan, which shows the cyst's size and its relationship to teeth, nerves and the sinus in three dimensions. Some cysts are sampled first, because a few conditions that look like cysts on an X‑ray need a different approach, and the plan depends on knowing exactly what is there.
Treatment
The usual treatment is enucleation: removing the cyst lining in its entirety through a small opening in the bone, often together with the tooth that caused it. The bone gradually fills in over the following months. For very large cysts, Chris may recommend a staged approach called marsupialisation or decompression, which shrinks the cyst before it is removed, to reduce the risk to nearby nerves and teeth.
Smaller cysts are treated under local anaesthetic, often with sedation. Larger ones are removed under general anaesthetic as a day case. The tissue removed is always sent for examination, and Chris will discuss the result with you.
Afterwards
Recovery is similar to a surgical tooth extraction: swelling and discomfort for a few days, dissolving stitches and a soft diet for a short while. Chris will review you in clinic and arrange a follow‑up X‑ray to confirm that the bone is healing, usually at around six months.
Do I definitely need treatment?
Not necessarily. Chris will first establish whether treatment is needed at all and whether there are reasonable alternatives to surgery. He may recommend leaving things alone when:
- a small, well‑defined area on an X‑ray is stable on a repeat film and causing no symptoms, and can be watched
- the "cyst" turns out to be a normal variation in the bone, which a scan can confirm
- the problem is an infected tooth, where root‑canal treatment or extraction alone will resolve it
What does the next week look like?
A typical recovery. Yours will be discussed with you individually before you decide to go ahead.
- That evening
- Numb, then aching. Painkillers before the numbness wears off, soft food, quiet evening. After a general anaesthetic you'll feel tired.
- Day one
- Swelling and stiffness. Gentle salt‑water rinses from 24 hours.
- Days 2 to 3
- Swelling peaks. Bruising of the cheek or under the jaw is common with larger cysts.
- By one week
- Settling well, stitches dissolving. The bone takes several months to fill in; you won't feel that happening.
- Practicalities
- Driving
- 24 hours after sedation, 48 after a general anaesthetic.
- Work
- 3 to 7 days depending on the size of the cyst.
- Eating
- Soft food for about a week.
Chris's view
"A cyst on an X‑ray sounds frightening and is almost never serious. What it does need is dealing with before it gets bigger, and a scan first so I know exactly what I'm dealing with."
Mr Christopher VinallWhen should I get advice?
Arrange an assessment if your dentist has seen a shadow or dark area on an X‑ray, if you have a painless swelling of the jaw, or if a tooth that has had root‑canal treatment has a persistent area at its root.