Apex Cysts: Tooth Extraction and Treatment Options

Apicoectomy for tooth extraction?

Hello, when I was a child, the nerve of my lower right second molar was removed.
Over the past decade, I have occasionally experienced cysts in that area, but they usually resolved on their own after a few days, so I didn't pay much attention to them.
This week, I went for an X-ray due to an erupting wisdom tooth, and it turned out that there is a large cyst located beneath my second molar (although I haven't had any cysts on my gums in the past 3-5 years).
The doctor mentioned that it is unusual for a cyst to be this large and provided me with a referral to a larger hospital.
After researching online, I believe it may be an apical cyst.
I read that a microscope may be needed to determine if the tooth can be saved, but using this equipment seems to be quite expensive.
I would like to ask the doctor if I can choose not to use this equipment and simply have the tooth extracted.
Additionally, will the cyst disappear after the tooth is removed? Can I also get braces afterward, since I have already consulted about braces and I need to extract a tooth from the lower right side? Lastly, will the health insurance cover the cost of the tooth extraction? Thank you!

Xiao Lian, 20~29 year old female. Ask Date: 2020/07/15

Dr. Huang Tingfang reply Dentistry

Dear Miss Hsiao-Lien,
Hello! Your question is indeed challenging! Tooth extraction is not a problem! If the large cyst affects the mandibular nerve canal, it should be avoided.
If it does not affect the mandibular nerve canal, the cyst should be completely removed; otherwise, it will recur! Take care! Wishing you peace and smoothness in everything!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2020/07/15

More Info

Understanding apex cysts, particularly in the context of dental health, is crucial for making informed decisions about treatment options. Apex cysts, often referred to as periapical cysts or radicular cysts, typically develop at the root of a tooth that has undergone necrosis or has had its nerve removed, as in your case with the second lower premolar. These cysts are usually a response to chronic inflammation and can vary significantly in size.

In your situation, it’s understandable to feel concerned upon discovering a large cyst during an X-ray examination, especially after years of intermittent symptoms. The fact that you have not experienced any recent cyst formation in the gums is a positive sign, but the presence of a large cyst warrants further investigation. Your dentist's recommendation to see a specialist is prudent, as they can provide a more comprehensive evaluation and treatment plan.

Regarding your questions about treatment options, you do have a choice. If you opt not to undergo the microscopic examination (often referred to as an endodontic microscope evaluation), you can choose to have the tooth extracted. Extraction is a common procedure and can effectively remove the cyst along with the tooth, which may help alleviate any potential discomfort or complications associated with the cyst. However, it’s important to note that while the cyst may shrink or resolve after extraction, it might not disappear entirely if there are remnants left behind.
After the extraction, you can certainly discuss orthodontic options, such as braces, with your orthodontist. Many patients undergo orthodontic treatment after tooth extractions, especially if the extraction is part of a planned orthodontic strategy. The timing and specifics of your orthodontic treatment will depend on your overall dental health and the recommendations of your dental care team.

As for the costs associated with tooth extraction, in many healthcare systems, including the U.S., dental procedures may be partially covered by insurance, but this can vary widely based on your specific plan. It’s advisable to check with your insurance provider to understand what is covered regarding tooth extraction and any associated treatments.

In summary, while you can choose to have the tooth extracted without the microscopic evaluation, it’s essential to weigh the benefits and risks. Consulting with your dentist and possibly an oral surgeon will provide clarity on the best course of action. Additionally, discussing your orthodontic goals post-extraction will help ensure a comprehensive approach to your dental health. Always remember that maintaining open communication with your dental care providers will lead to the best outcomes for your oral health.

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