Dentigerous Cyst with an Impacted Wisdom Tooth

Patient: This was a 16 year old patient who presented to us from his Pediatric Dentist.  He had never received orthodontic treatment and neither his parents nor he could recall ever having a panoramic x-ray taken. His previous pediatric office did not have a panoramic machine.  His medical history indicated exercise-induced asthma. This patient came to my previous office before I opened my own dental practice in Orange, CT

Description:  Routine radiographs consistent for a 16 year old male were taken. These were 4 bitewing x-rays and a panoramic radiograph.  The two images are below:

Dentigerous Cyst or Follicular Cyst with an impacted wisdom tooth on a dental x-ray

Bitewing Dental X-ray showing hint of dentigerous or follicular cyst next to mandibular tooth

The panoramic radiograph shows a large radiolucency associated with an impacted and inferiorly displaced wisdom tooth. The radiolucency extends well beyond the angle of the mandible and into the ramus.  The bitewing dental x-ray shows a radiolucency distal to #18 but by itself is not conclusive for any pathology. On clinical exam, there was no pain on palpation on either lateral or medial aspects of the ramus. No asymmetry was noted on palpation between left and right ramus.  A tentative diagnosis of a dentigerous cyst was made but other pathologies could not be ruled out. The findings were explained to the patient and his family, and an immediate consultation with an oral surgeon was made.

The patient saw an oral surgeon who recommended immediate surgery.  The surgeon removed all 4 wisdom teeth and through enucleation excised the entire cyst.  The pathology report indicated a dentigerous or follicular cyst.

A follow-up panoramic x-ray was not able to be obtained from the oral surgeon. The patient returned 15 months later post surgery.  Routine bitewings were taken:

Bitewing dental x-ray after dentigerous cyst removal showing almost complete bone fill

Almost complete bone fill was observed in the area where the dentigerous cyst had been present.  The patient had only slight palpable thinning of the ramus of the left mandible intraorally but no functional deficits.

I present this case fairly routinely to parents in my office in Orange, CT who object to routine imaging for teenagers.  It goes a long way to show that there are numerous other pathologies we dentists are concerned with besides dental caries and periodontal disease.