Introduction
Paradental cysts were first discovered in 1930. Hofrath, in 1930, was one of the first dental authors to report several cases of inflammatory jaw cysts that were occurring distally to the third mandibular or lower third molar. This inflammatory cyst became known later in 1976 in dental literature as the paradental cyst.
What Is a Paradental Cyst?
The paradental cyst is a dental-origin inflammatory cyst with histologic features similar to other inflammatory-origin dental cysts, like odontogenic cysts. The presence of reduced enamel epithelium and epithelial cell rests of Malassez that persist locally causes this cyst. This cyst is associated with the infection of the lower third molars (in the mandible), called pericoronitis. When the cyst occurs further to this infection around the lower first, second, or third molars, it would be termed a paradental cyst.
Where Do Paradental Cysts Occur?
Paradental cysts mainly occur around the mandibular first molars. It also occurs less frequently around the second molars. Most paradental cysts always occur with pericoronitis infections, which are more common around the lower third molars.
What Are the Clinical Features Seen in Paradental Cysts?
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The main clinical feature of this cyst is a recurring inflammation called pericoronitis which is seen in most cases. In addition, the cyst is quite localized, along with the presence of a third molar infection.
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This cyst is characterized by only a few clinical symptoms ranging from mild to moderate discomfort, tenderness, or pain in the region of the infected molar.
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The patient may also complain of food lodgement in or around this tooth, especially when it is a partially erupted molar.
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The food impaction would again depend upon the position and angulation of the lower molar in the arch.
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It is also not uncommon to see this local area inflamed along with features like suppuration or pus exudating in or around the third molar or, less commonly, around the first or second molar region.
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When the patient is asymptomatic, these cysts can be discovered through routine radiographic examination.
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However, these cysts can also be difficult to detect on a two-dimensional radiograph like intraoral periapical radiographs (IOPA) and orthopantomogram (OPG) because of the superimposition of other anatomic structures around the molar at this site.
What Is the Prevalence of Paradental Cysts?
The prevalence of this cyst would vary between one percent to five percent of all dental odontogenic cysts. Paradental cysts are unique and uncommon lesions compared to other common dental cysts. However, they are not considered common as several cases have been reported so far because they commonly get misdiagnosed by dentists with other cysts.
How Are Paradental Cysts Diagnosed?
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Because of its atypical features, the paradental cyst remains a clinically diagnostic challenge for dentists. It is also easily misdiagnosed for other dental cysts around the lower molars.
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The dental surgeon must always establish a confirmative diagnosis because the features of a paradental cyst are similar to a dentigerous cyst, lateral radicular cyst, pericoronitis, and other inflammatory conditions (these are the lesions for differential diagnosis) related to the dental follicle.
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Studying differential diagnoses with other lesions or common dental cysts around the tooth root is important before establishing a confirmed diagnosis of a paradental cyst.
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Paradental cysts should be assessed clinically in detail. They commonly occur on the buccal or mesial aspect only of the third molar, specifically, and even less in the first and second molars. They are also very rarely reported in the maxillary region.
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When this cyst is associated with a localized inflammation around the tooth like the wisdom tooth (especially in partially or fully erupted vital teeth), the dentist should suspect a paradental cyst.
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Other local anatomical factors, such as the shape of the crown, the fissure patterns on the tooth surface, the contact with adjacent teeth, or even the gingival architecture, tend to influence the location of these cysts.
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The dental surgeon would hence correlate the surgical, radiographic, and histologic findings to obtain a final diagnosis of this cyst.
How Are Paradental Cysts Managed?
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Management of the paradental cysts depends upon the classification of the paradental cyst.
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The dentist can classify it as a cyst associated with the permanent lower first and second molars or the paradental cyst associated with the lower third molars. This distinction is important in treating these lesions, as the permanent first and second molars are crucial for occlusion and mastication.
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The maxillofacial surgeon would recommend a complete surgical removal of the wisdom tooth or the third molar when the cyst is associated.
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When it uncommonly occurs around the first or second lower molars, enucleation of cysts would be the treatment of choice by the surgeon. This attempt to enucleate cysts only by preserving the lower first or second molar is crucial for the patient's dental health and functionality. The first and second molars are important permanent teeth in the mandibular arch for biting, chewing, and grinding.
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There are also fewer recurrence rates associated with the paradental cyst post removal or extraction of the third molar or cyst enucleation.
Conclusion
The paradental cyst is an inflammatory jaw cyst that occurs exclusively around the lower mandibular molars. Because of its similarity to other jaw conditions like a dentigerous cyst and lateral radicular cyst, it may be commonly misinterpreted or misdiagnosed. Therefore, dentists must establish a proper diagnosis so that the patient is relieved of the infection, inflammation, oral pain, or discomfort associated with these lesions. Paradental cysts are usually managed by surgically removing the tooth and the cyst.
