Dental granuloma or cyst? How can you tell the difference?

Dental granulomas and dental cysts are two of the most common lesions affecting the root of a tooth, usually resulting from an infection of the dental pulp caused by deep caries, trauma or incomplete root canal treatment.

Bacteria reach the tip of the root and cause an inflammatory reaction in the bone.

The difference between a dental granuloma and a dental cyst can be difficult to understand, particularly as the symptoms may be similar or even absent. However, establishing a correct diagnosis influences the therapeutic approach. A dental granuloma can be treated conservatively, whereas a dental cyst may require surgical intervention.

A dental granuloma is a localised inflammation at the tip of a tooth’s root, which usually occurs as the body’s reaction to a persistent infection originating in the root canal.

The main cause of a dental granuloma, also known as a periapical granuloma, is the penetration of bacteria into the tooth and their spread to the bone. The granuloma consists of inflammatory tissue rich in immune cells, which attempt to limit the spread of bacteria originating from the infected dental pulp.

Causes of dental granuloma:

• untreated deep dental caries;
• necrosis of the dental pulp;
• incomplete root canal treatment;
• dental trauma;
• dental fractures.

Symptoms of a dental granuloma

In many cases, the granuloma does not cause any obvious symptoms, which is why it may go undetected for a long time. When symptoms do appear, they are usually mild:

• mild sensitivity;
• discomfort when chewing;
• possibly pain during acute phases.

“If left untreated, this apical lesion can grow to the size of a lentil and lead to complications such as pulpitis or necrosis of the affected tissues. Furthermore, if not treated in time, it can lead to tooth loss,” explains Dr. Roxana Chirică, a resident in Endodontics.

A dental cyst is a pathological formation consisting of a cavity lined by an epithelial membrane and filled with fluid or semi-solid material. The most common type is the radicular cyst, which occurs at the tip of the root of a tooth affected by a chronic infection, with the lesion measuring less than 1 cm.

In many cases, a dental cyst develops from an untreated dental granuloma.

“A radicular cyst is usually asymptomatic, which is why it is recommended to schedule regular check-ups with your dentist. If the radicular cyst has not yet spread, the tooth can be saved through root canal treatment. In certain situations, the cyst can be surgically removed or, in the most severe cases, the tooth is extracted,” explains Dr. Roxana Chirică.

An accurate diagnosis requires a clinical assessment and imaging investigations.

A dental X-ray is usually the first step in identifying an apical lesion.

In many cases, a computed tomography scan (CBCT) is required. This investigation provides a three-dimensional image of the area and allows for an accurate assessment of the lesion’s size, its relationship with anatomical structures, and the extent of bone involvement.

Treatment depends on the size of the lesion, the condition of the tooth and the progression of the infection.

Dental granuloma treatment 

In most cases, treatment consists of endodontic treatment (root canal treatment), which involves cleaning and disinfecting the root canals and sealing them properly.

Find out more about root canal treatment under a microscope.

Dental cyst treatment 

In the case of dental cysts, the approach may vary. Sometimes, endodontic treatment is supplemented by surgical procedures, such as cystectomy, to remove the cyst and prevent recurrence.

“At DENT ESTET clinics, the therapeutic approach in such situations involves establishing an accurate diagnosis through clinical and imaging assessment, followed by selecting the most conservative and effective solution to save the tooth and eliminate the infection,” explains Dr Roxana Chirică.
 

If left untreated, both the granuloma and the dental cyst can progress and lead to serious complications, such as:

• spread of infection;
• bone damage;
• tooth loss;
• more complex surgical procedures.

For this reason, regular check-ups and early diagnosis are essential for maintaining oral health.