Eruption Cyst Not Uncommon: Report of Two Cases in Indian Pediatric Patients

Aim: Presentation of two clinical cases with an eruption cyst. 

Background: Eruption cysts are benign cysts that appear on the mucosa of a tooth shortly before its eruption. 

Case description: In two patients, eruption cyst occurred in the maxillary arch. All were associated with permanent teeth. Surgical treatment was done in all two cases and tooth erupted in normal pattern. 

Conclusion: Eruption cyst requires surgical intervention when they hurt, bleed, are infected or esthetic problems arise. Treatment has to be performed in order to relive the child from discomfort. 

Clinical significance: Knowledge about occurrence of eruption cyst, a rare developmental eruption disturbance is very essential to provide the correct diagnosis and treatment.

A12-year-old male child along with his parents reported with the chief complaint of bluish black swelling on the gums in the front region of the upper jaw [Figure 1-A]. History of the case revealed lesion started appearing 2 weeks back as translucent swelling over normal mucosa and it slowly increased to its present size. The color of the lesion also slowly changed from its normal red mucosa to the present bluish black color one week back. No fluid discharge or any other associated symptoms were associated. The general physical examination of the child showed no abnormalities. Examination of the oral cavity revealed that the child was in the mixed dentition stage. Soft tissue examination did not show any abnormalities except, the presence of swelling on the buccal gingiva with respect to unerupted 11, not extending to palatal surface. Clinically the lesion appeared as bluish-black, circumscribed, fluctuant swelling that measured approximately 1 × 1.5 cm in diameter and was very soft in consistency. The overlying mucosa was smooth and no ulceration or bleeding was present. On periapical radiographic examination, the permanent tooth was found covered by soft tissue with no definite cystic space surrounding the tooth. 

Figure 1: A-Preoperative photograph showing eruption cyst involving permanent maxillary right central incisor (yellow arrow), B-after surgery, C-after six month follow up.

An 8-year-old female patient reported with the chief complaint of non-erupting upper front tooth along with a swelling in upper anterior region [Figure 2 - A]. Lesion started appearing 6 weeks back as translucent swelling over normal mucosa and it slowly increased to reach present size. It was associated with dull aching pain on mastication. The general physical examination of the child showed no abnormalities. Examination of the oral cavity showed that the child was in the mixed dentition stage. All the permanent 1st molars had completely erupted and all central incisors except 21 were erupted. Swelling measured approximately 1 × 1 cm in diameter and was very soft and fluctuant and slightly pinkish in color. The overlying mucosa was smooth with no ulceration or bleeding. 

Figure 2: A-Preoperative photograph showing eruption cyst involving permanent maxillary left central incisor (Yellow arrow), B-Immediate post-surgical photograph, C-six months follow up.

Radiographic Examination

On radiographic examination, case 1 showed presence of 11, and case 2 showed presence of 21, in the stage of eruption and there were no signs of bone involvement or any radiolucency surrounding this tooth. Based on clinical and radiographic examination, the lesions were diagnosed as eruption cyst associated with 11 and 21.

Treatment

The clinical condition was explained to the parents and they were advised to observe the swellings for another 2 weeks as it may rupture on its own and may not require any surgical intervention. Patients reported after 15-20 days. In all three cases, the swelling was not resolved and patients complained of discomfort associated with swelling while chewing food. The surgical procedure was explained to the parents and consent was obtained for the same. A blood investigation was carried out before the procedure. In first two patients, the treatment included incising the eruption cyst with BP blade no. 15 and draining the contents of the cyst. A window was cut leading to the exposure of 11 and 21 (Figure 1, B and 2 B). Post-operative instructions were given in all patients. The case 1 and case 2 was reviewed after few months and a normal eruption pattern was observed (Figure 1 C, and 2 C). 

In day today clinical practice, dental practitioner can encounter different types of cysts and tumors occurring in the oral cavity in both children and adults [11-17]. Clinically, eruption cyst appears as a dome shaped raised swelling in the mucosa of the alveolar ridge, which is soft to touch and the color ranges from transparent, bluish, purple to blue-black [2]. In all three presented cases here, the color of the cyst ranged from reddish black to bluish. Eruption cyst found to be more prevalent in the maxillary arch involving anterior teeth. Eruption cyst associated with molars and premolars is very rare. Nagaveni et al., [5] reported development of this cyst in relation to mandibular first premolar which is a rare finding. It is difficult to distinguish the cystic space of eruption cyst on radiograph because both the cyst and tooth are directly in the soft tissue in contrast to dentigerous cyst in which a well-defined unilocular radiolucent area is observed in the form of a half-moon on the crown of a non-erupted tooth [2].Histologically, the eruption cyst presents the same microscopic characteristics as the dentigerous cyst, with connective fibrous tissue covered with a fine layer of non-keratinized cellular epithelium [2]. 

Mostly, the eruption cysts do not require treatment and majority of them disappear on their own [4,7]. Surgical intervention is required when they hurt, bleed, are infected, or esthetic problems arise [2,8]. Treatment has to be performed in order for the child to be relived from discomfort arising from lesion. Simple incision or partial excision of the overlying tissue to expose the crown and draining the fluid is indicated when the underlying tooth is not erupting or the cyst is enlarging [5]. The diode laser system is an excellent tool for management of eruption cyst, since it eliminates the need for local anesthesia in most cases; Painless character of laser has been attributed to its transitory anesthetic effect due to the blocking of the nerve conduction in Na/K pump [9]. The patient is comfortable, not noticing the sensation of vibration or observing the contact of the laser handpiece with the mucosa [4]. As of local anesthesia is not used, the possibility of complications, toxicity and allergic reactions are eliminated. The diode laser has bactericidal and coagulative effects also. Compared with conventional scalpel there is mild bleeding and better visibility of working area with use of laser [10]. In the presented two cases, we used scalpel for incising or excising the lesion as we did not have access to the laser therapy in our institution.

Eruption cyst requires surgical intervention when they hurt, bleed, are infected, or esthetic problems arise. Treatment has to be performed in order to relive the child from discomfort. 

Clinical significance

Knowledge about occurrence of eruption cyst among clinicians is very essential to provide the correct diagnosis and treatment.