Do Asymptomatic Apical Cysts Require Treatment? A Dental Inquiry

Q: Do Asymptomatic Apical Cysts Require Treatment? A Dental Inquiry

Hello： Due to differing opinions from the two physicians, it is recommended that you visit the endodontics department at a medical center for further examination and to seek a third opinion. <br>Please inform the physician of your original condition and the sequence of events. <b

Does an asymptomatic periapical cyst require treatment?

Hello Doctor: About eight years ago, I had root canal treatment on two upper front teeth.
Approximately five to six years ago, my gums started to become red and swollen, with a bad odor, and it has progressively worsened.
I only began seeing a doctor for treatment this year because there was no pain, just a slight feeling of looseness in the teeth.
The doctor performed a series of treatments, including laser therapy on both front teeth and microscopic root canal treatment on one of them.
Three months later, the cyst on that tooth appeared smaller and less pronounced on the X-ray, but the doctor discovered a small cyst on the other tooth as well and mentioned that it also requires microscopic root canal treatment.
Later, I visited a large hospital, where the doctor noted that since I am not in pain and although there are shadows on the X-ray, it is similar to a scab forming on a skin injury and does not require additional treatment.
Therefore, I would like to ask the doctor if the absence of pain (and the swelling has subsided after the laser treatment) means that no intervention is necessary? If left untreated, could the small cyst develop into a larger one in a few years? Thank you, Doctor.
🙏

Yú lín, 30~39 year old female. Ask Date: 2023/11/01

Dr. Lin Jiayong reply Dentistry

Hello: Due to differing opinions from the two physicians, it is recommended that you visit the endodontics department at a medical center for further examination and to seek a third opinion.
Please inform the physician of your original condition and the sequence of events.
You can make your final decision afterward.

Reply Date: 2023/11/01

More Info

Asymptomatic apical cysts, also known as periapical cysts, are fluid-filled sacs that can develop at the root of a tooth, often as a result of chronic inflammation due to untreated dental issues, such as deep cavities or failed root canal treatments. Your situation, where you have experienced gum swelling, bad odor, and some tooth mobility, suggests that there has been an ongoing issue, even if you are not currently experiencing pain.

The management of asymptomatic apical cysts can vary based on several factors, including the size of the cyst, the presence of any symptoms, and the overall health of the surrounding tissues. In your case, since you have already undergone some treatments, including laser therapy and microscopic root canal treatment, it is encouraging that one of the cysts has shown improvement. However, the presence of a new cyst, even if asymptomatic, warrants careful consideration.

1. Observation vs. Treatment: The advice you received from the hospital regarding the asymptomatic cyst being similar to a scab on the skin is a valid perspective. In some cases, if a cyst is small, asymptomatic, and not causing any significant issues, a dentist may recommend a watchful waiting approach. However, it is essential to have regular follow-ups to monitor any changes in size or symptoms.
2. Potential for Growth: While it is true that not all asymptomatic cysts will grow or cause problems, there is a risk that they can enlarge over time, potentially leading to complications such as infection or tooth loss. If the cyst grows, it may eventually require surgical intervention, such as cyst enucleation or further root canal treatment.

3. Importance of Regular Monitoring: Given your history of dental issues, it is crucial to maintain regular dental check-ups. This will allow your dentist to monitor the cysts and any other potential problems. If you notice any changes, such as increased swelling, pain, or changes in the mobility of your teeth, you should seek immediate dental care.

4. Treatment Options: If the cyst does require treatment in the future, options may include retreatment of the root canal, surgical removal of the cyst, or even extraction of the affected tooth if it is deemed non-restorable. The decision will depend on the specific circumstances surrounding your dental health.

5. Maintaining Oral Health: In the meantime, maintaining excellent oral hygiene is critical. Regular brushing, flossing, and possibly using an antibacterial mouthwash can help reduce the risk of further complications. Additionally, avoiding sugary foods and beverages can help prevent new cavities from forming.

In summary, while asymptomatic apical cysts may not require immediate treatment, they should not be ignored. Regular monitoring and maintaining good oral hygiene are essential to prevent potential complications. If you have any concerns or notice changes in your symptoms, do not hesitate to consult your dentist for further evaluation and guidance.

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