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Case Report
Eruption cyst: A literature review and four case reports
Nagaveni NB, Umashankara KV1, Radhika NB2, Maj Satisha TS3

Departments of Pedodontics &

Preventive Dentistry, 1Oral &
Maxillofacial Surgery, College
of Dental Sciences, Davangere,
Karnataka, 2Orthodontist, Pune,
3
Department of Dental Surgery,
Armed Forces Medical College,
Pune, Maharashtra, India

ABSTRACT

Received
: 07-12-09
Review completed : 16-02-10
Accepted
: 25-02-10

Eruption cyst is a benign cyst associated with a primary or permanent tooth in its soft tissue
phase after erupting through the bone. It is most prevalent in the Caucasian race. Intraoral
examination of four patients revealed eruption cyst. Among these, in three patients it occurred
in the maxillary arch and one had it in the mandibular arch. All were associated with permanent
tooth. Surgical treatment was done in three cases and in one case the cyst disappeared gradually
and tooth erupted in normal pattern. Four cases of eruption cyst from India are presented and
literature on this condition is reviewed. It is clinically significant in that knowledge among
general dentists is very essential regarding this developmental disturbance to reach the correct
diagnosis and to provide proper treatment.
Key words: Benign cyst, eruption cyst, eruption hematoma, simple excision

The eruption cyst is a form of soft tissue benign cyst

accompanying with an erupting primary or permanent teeth
and appears shortly before appearance of these teeth in the
oral cavity.[1,2] Eruption cyst is the soft tissue analogue of the
dentigerous cyst, but recognized as a separate clinical entity.[1-4]
Although there are a number of theories about their origin,[5]
both seem to arise from the separation of the epithelium from
the enamel of the crown of the tooth due to an accumulation
of fluid or blood in a dilated follicular space.[6] Because of this
common origin, some authors do not classify the eruption
cyst separately from the dentigerous cyst.[7]
Literature shows small number of reported cases of eruption
cysts and they appear to be more prevalent in the Caucasian
race.[1,5,6] The aim of the present article is to report four cases
of eruption cysts from India and to review the literature
regarding this condition.

CASE REPORTS
This paper presents four patients of Indian origin with
Address for correspondence:
Dr. Nagaveni NB
E-mail: nagavenianurag@gmail.com
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DOI:
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Indian Journal of Dental Research, 22(1), 2011

eruption cysts who reported to the Department of

Pedodontics and Preventive dentistry, College of Dental
Sciences, Davangere, India. Table 1 shows age, sex, tooth
involved, history and chief complaints, clinical features and
the treatment rendered in four cases.

DISCUSSION
Prevalence

Prevalence of eruption cyst has not been thoroughly studied.

Extensive review of literature revealed low prevalence of
these cysts.[1,3,5] This may be due to the fact that many authors
classify them among the dentigerous cysts. In addition, since
they are benign, there are a few studies in which the authors
have done a definitive diagnosis using biopsy.[1,3] This may
also suggest that either the eruption cyst is an unusual lesion
or it is an accepted local disturbance that is associated with
the eruption of many teeth. The clinical impression of low
prevalence may also be due to the fact most often the dentist
sees only symptomatic eruption cysts and the majority
resolve unnoticed.[1,6,8,9] Anderson[1] reported on 54 cases
over 16 years, which were histologically confirmed. Aguilo
et al.[3] reported on 36 cases in their retrospective study of 15
years. Later, Bodner[5] found a prevalence of eruption cysts of
22% among various maxillary cystic lesions in 69 children.
Recently, in 2004, Bodner et al.[10] once again presented 24
new cases of eruption cysts.

Clinical features

Reports[1,3,5,11] show that most eruption cysts occur in

an age range of 69 years, a period coinciding with the
eruption of permanent first molars and incisors. However,
recently, occurrence of eruption cyst in a neonate has
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Nagaveni, et al.

Eruption cysts
Table 1: Characteristics of eruption cysts and associated treatment
Case no.
1.

Age
(years)
8

Sex
Male

2.

Male

3.

11

Male

4.

11

Male

Tooth Chief complaints and history

involved
21
Swelling in the upper front tooth
region
Appeared 4 months back and
gradually increased in size
Difficulty in chewing food and
ugly looking
History of previous trauma in
that area
11
Presence of swelling in upper
front tooth region since 2
months
Increasing in size
Unaesthetic appearance
History of previous trauma in
that region
13
Presence of swelling in upper
right back tooth region since 2
months
Difficulty with brushing and
mastication
44

Swelling in lower right back

tooth region since 15 days
No signs and symptoms

been reported. [12] Aguilo et al ., [3] in their study, have

shown that 2.8% of eruption cysts occurred in the incisal
and molar areas, the remaining 17.2% occurred in the
canine-premolar areas. In our cases, two eruption cysts
were found associated with incisors, one with canine and
the other one with premolar tooth. Other reports have
also suggested that majority of eruption cysts occur in the
incisal and molar areas, followed by canine and premolar
areas, and the preference for the incisal rather than the
molar area in a ratio of 2:1 could be based on their greater
visibility in the incisal area.[1,10]
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.[1,3,5,11] The color of the cyst ranged from
reddish black to bluish black in all the four cases presented
here. Sometimes, the cyst occupies the whole or part of an
unerupted crown area including the lingual area [Figure 1].
It has been reported that approximately it measures about 0.6
cm in diameter.[11] However, the size depends on whether
it is associated with a primary or permanent tooth and the
number of teeth involved. In one of the four patients, the
cyst was larger in size, measuring about 1 1cm in diameter.
They can occur unilateraly or bilateraly, and are either
single or even multiple.[3,6] Boj and Garcia-Godoy[6] reported
a case of simultaneous occurrence of six eruption cysts in a
15-month old child.
Eruption cyst occurs most frequently on the right side than
149

Clinical features

Diagnosis and treatment

rendered
1 1 cm in diameter, bluish
Eruption cyst
black color
Partial excision of soft tissue
Swelling covered both labial and and cyst compressed to drain its
lingual area of tooth crown
content
Soft consistency

0.7 0.6 in diameter

Bluish color
Soft consistency

Eruption cyst
Incision and crown exposure

0.7 0.5 cm in diameter

Bluish color
Soft consistency

Eruption cyst
Extraction of 53 followed by
compression of cyst to drain its
content
Tooth 13 erupted after 2 months
in normal pattern
Eruption cyst
No treatment given
Follow-up visit
Cyst gradually disappeared and
tooth (44) erupted in normal
pattern

0.5 0.6 in diameter

Reddish black color

left and among males than in females.[1] In this report, three

cysts occurred on the right side and one on the left side,
and all the four cysts were found in males. This was in line
with other reports.[3,5]
These cysts are most frequently found in the permanent
dentition and the preference for the permanent dentition
could partly be due to the fact that eruption cysts in the
primary dentition may be dealt with by pediatricians.[1]
They appear to be more prevalent in the maxillary arch
[Figure 2].[1] Three cases presented in this report occurred in
the maxillary arch and one case in mandibular arch and all
were found in relation to the permanent tooth. This finding
was also in agreement with other reports.[3,5]
On radiographic examination, it is difficult to distinguish the
cystic space of eruption cyst because both the cyst and tooth
are directly in the soft tissue of the alveolar crest and no
bone involvement is seen 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 [Figure 3].[1,13] Histologically, this cyst presents the
same microscopic characteristics as the dentigerous cyst,
with connective fibrous tissue covered with a fine layer of
non-keratinized cellular epithelium.[1]

Histopathologic features

Microscopically, eruption cysts show surface oral epithelium

on the superior aspect. The underlying lamina propria shows
a variable inflammatory cell infiltrate. The deep portion of
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Nagaveni, et al.

Eruption cysts

the specimen, which represents the roof of the cyst, shows

a thin layer of non-keratinizing squamous epithelium.[8]

Etiology

Clinical symptoms

Most of the time, eruption cysts are found to be asymptomatic

but there can be pain on palpation due to secondary factors such

The exact etiology of occurrence of eruption cyst is not

clear. Aguilo et al.,[3] in their retrospective clinical study
of 36 cases, found early caries, trauma, infection and the
deficient space for eruption as possible causative factors.

Figure 1: Large eruption cyst involving 21 labial view (left) and lingual
view (right)

Figure 2: Eruption cyst associated with 11

Figure 3: Periapical radiograph showing erupting 11. Cystic cavity

not visible

Figure 4: Exposure of 11 crown

Figure 5: Eruption cyst (arrow) involving 13

Figure 6: Eruption cyst (arrow) associated with 44

Indian Journal of Dental Research, 22(1), 2011

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Nagaveni, et al.

Eruption cysts

as trauma or infection.[3,5,6] Literature search on clinical histories

for symptoms shows that the main reason to visit a dentist for
the first time is appearance of the cysts along with missing of
tooth in that area.[1,3,6] Pain was reported as a secondary factor.[1,11]

Eruption cyst associated with other abnormalities

Most of the time eruption cyst occurs as an isolated

phenomenon. However, a case has been reported showing
other associated anomalies like hamartomas, natal tooth and
epstein pearls in a premature newborn baby.[14] Recently, a
case of eruption cyst has been published in a patient medicated
with cyclosporin-A.[15] Nomura et al[16] have reported a rare
case of Kinky hair disease with multiple eruption cysts. Also,
two cases of eruption cysts associated with natal teeth have
been reported by Bodner et al.[10] Rushton[17] has reported a
malformed tooth associated with an eruption cyst.

Differential diagnosis

Differential diagnosis should be considered before delivering

any treatment and varies from granuloma, amalgam tattoo
and Bohns nodule to eruption hematoma.[3] The eruption
hematoma occurs because of bleeding from the gum tissue
during eruption and the accumulation of blood is external to
the epithelium of the enamel.[5] While in the eruption cyst,
it is the cystic fluid that mixes with the blood. The exact
difference between the two is still unknown. The eruption
cyst glows under transillumination but the hematoma does
not glow.[3,11] Other authors[1,8, 9,18] reported that if bleeding
occurs within the cyst, due to trauma or local infection, the
eruption cyst becomes bluish in color and is then known as
an eruption hematoma, or a blue stain, which may be the first
sign of a follicular cyst.

Treatment

Mostly, the eruption cysts do not require treatment and

majority of them disappear on their own.[6,8,9] Surgical
intervention is required when they hurt, bleed, are infected,
or esthetic problems arise.[1,5] Treatment has to be performed
in order for the child to lead a healthy and comfortable life.
The relatively high rate of such cysts and the fact that they
occur in an area of rapid developmental change suggests the
need for a conservative management in the young patient
population. Interventional treatment may not be necessary
because the cyst ruptures spontaneously, thus permitting
the tooth to erupt.[5] If this does not occur, simple excision
of the roof of the cyst generally permits speedy eruption of
the tooth [Figure 4].[5] Simple incision or partial excision
of the overlying tissue to expose the crown and drain the
fluid is indicated when the underlying tooth is not erupting
or the cyst is enlarging.[7] A novel treatment modality has
been suggested by Boj et al.,[19] which consists of use of Er,
Cr-YSGG laser for treatment of eruption cysts. It has certain
advantages over conventional lancing with scalpel. They
can be listed as non-requirement of anesthesia, no excessive
operative bleeding, does not produce heat or friction and
151

patient will be comfortable. It is bactericidal and has

coagulative effects, tissue healing is better and faster, and
it is not associated with postoperative pain.[19]
In case 1, partial excision of soft tissue followed by compression
of cyst was done as the cyst was larger in size. In case 2, incision
and exposure of the crown was performed [Figure 4]. For case
3, primary canine was extracted and compression of cyst was
done to drain its content [Figure 5]. In fourth case, the cyst
disappeared spontaneously with the eruption of the tooth and
without surgical treatment [Figure 6].

Clinical significance

Knowledge among clinicians is very essential regarding this

clinical entity to provide appropriate treatment.

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How to cite this article: Nagaveni NB, Umashankara KV, Radhika NB, Maj
Satisha TS. Eruption cyst: A literature review and four case reports. Indian J
Dent Res 2011;22:148-51.
Source of Support: Nil, Conflict of Interest: None declared.

Indian Journal of Dental Research, 22(1), 2011