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Case Report
Gingival Cysts in the Adult*
John L. Giunta
Background: Gingival cysts in the adult are
unusual cysts of odontogenic origin with less than
100 reported, including this series. Even rarer are
cases of multiple gingival cysts. This paper reports
the second largest retrospective study of biopsy cases
of adult gingival cysts with a spectrum of their fea-
tures and another case of multiple gingival cysts.
Methods: The files of a biopsy service were
reviewed for the most recent 10-year period. Data col-
lected included location, age, gender, clinical features,
clinical diagnosis, and histologic features. These were
compared to previous reports. There was also a case
report of multiple cysts.
Results: Twenty-two adult gingival cysts were
retrieved, 2 of which were multiple. They are uncom-
mon cysts of odontogenic origin, noted primarily in
the fifth and sixth decades with only a slight predilec-
tion for females. They occur more in the mandible on
the labial attached gingiva of the anterior teeth. His-
tology shows a very thin, uninflamed wall lined by
a very thin squamoid or cuboidal epithelium. Multi-
ple cysts are very rare.
Conclusions: Gingival cysts in the adult are
uncommon cysts that are diagnosed at the clinical
level about 50% of the time, with others being con-
fused with a mucocele. They may be bluish due to
the fluid and may cause pressure resorption of the
labial bone, yielding a radiolucency sometimes con-
fused with a lateral periodontal cyst. Treatment con-
sists of an excisional biopsy. J Periodontol 2002;73:
827-831.
KEY WORDS
Cysts, gingival; gingival cysts.
* Department of Oral & Maxillofacial Pathology, Tufts University School of
Dental Medicine, Boston, MA.
J Periodontol July 2002
Gingival cysts in the adult are uncommon soft tissue
cysts of odontogenic origin most likely arising from
rests of the dental lamina. They occur primarily on
the labial attached or free gingiva in the mandibular
incisor, canine, bicuspid area in adults in their 50s.
Usually singular and small, they appear as a slightly
raised lesion with apparent fluid within them, occa-
sionally with a bluish color and resembling a vesi-
cle.1-6 Rarely, they may be multiple, either as unilat-
eral or bilateral lesions.7-9 Very rarely, they may occur
on the lingual.4 The histopathology presents a non-
inflamed cyst wall with a very thin epithelial lining,
occasionally with thickenings. This paper will report
the second largest retrospective study of biopsy cases
of the gingival cyst in the adult, with a review of their
features and another case of multiple gingival cysts.
RETROSPECTIVE STUDY
The 22 cases, signed out as gingival cysts, were
retrieved from files of the Tufts University School of
Dental Medicine Biopsy Service between 1991 and
2001. They were all gingival, soft tissue swellings
and were not within bone (lateral periodontal cysts).
Data collected included location, age, gender, clini-
cal features, clinical diagnosis, and histologic fea-
tures. These results were compared to published
reports of other studies.1-6
RESULTS
Table 1 lists selected data from several clinico-
pathologic studies1-6 of gingival cysts in the adult,
including the present study. In the present study, all
of the 22 gingival cysts were located on the labial or
buccal. Of the 22, 18 listed the location. Sixteen
(89%) were located in the mandible anterior gingiva
incisor, canine, first premolar area. Two (11%) were
located in the anterior maxilla in the canine, lateral
incisor area. Two were multiple in the same patient
and are reported in this paper. The age at time of
excision ranged from 32 to 80 with a mean age of
52. Seventy-seven percent occurred in the fourth,
fifth, or sixth decade. Seventy-three percent were in
females and 27% in males, a ratio of 15 F:6 M.
Clinically, all of the cysts appeared as oval to round
elevated masses on the free and/or attached gingiva.
The size, as indicated by measurements of the fixed
specimen, was small. Utilizing the height and width
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Case Report
Table 1.
Data from Clinicopathological Studies of Gingival Cysts in the Adult

Reference N Cases Female Male Mandible Maxilla Mean Age Range

Bhaskar and Laskin1 (1955) 3 3 0 3 0 47 38-60

Reeve and Levy2 (1968) 4 3 1 4 0 61 55-67

Buchner and Hansen3 (1979) 33 19 14 24 9 48 7-77

Wysocki et al.4 (1980)* 10 4 5 7 1 51 41-75

Nxumalo and Shear5 (1992) 14 7 7 8 6 50 N/A

Bell et al.6 (1997) 8 7 1 7 1 51 35-65

Present (2001) 22 15 6 16 2 52 32-80

Totals 94 58 34 69 19 51 7-80
* Gender of one patient unknown; 2 sites unknown.
Two cases were in the same patient; 3 cases were not specified.

for measurements, the average was 0.6 0.3 cm.
The range of the larger dimension varied from 0.3 to
1.2 cm. None of the cysts showed any evidence of a
radiolucency on radiographs. The clinical diagnoses
of the submitted specimens varied. In 16 of the 22
cases with diagnoses, 8 were thought to be gingival
cysts. Other diagnoses were mucocele or mucous
cyst (31%), hemangioma, and lateral periodontal cyst.
Histologically, most of the cysts (19 of 22) demon-
strated an uninflamed wall with a thin or very thinned
lining of squamoid to cuboidal type epithelium (Fig.
1). Three cysts had minimal inflammation not nec-
essarily related to the cyst wall. A few cysts demon-
strated an island of odontogenic epithelium in their
wall. The epithelial lining consisted of 1 or 2 layers
of cells, and 8 of the 22 demonstrated plaques or
thickening of the lining in focal areas (Fig. 2).
REPORT OF CASE OF MULTIPLE GINGIVAL
CYSTS
Two of the 22 gingival cysts reported above were
multiple in the same patient. A 54-year-old African-
American female presented to the Graduate Peri-
odontal Clinic at Tufts University School of Dental
Medicine for periodontal care. Her history revealed an
allergy to pineapple, cysts of the breasts, no smok-
ing, and an occasional drink. She had had prior peri-
odontal surgery and had probing depths of 2 to 3
mm in the anterior regions and 4 to 6 mm in the pos-
terior regions. She was diagnosed with generalized
moderate chronic periodontitis. The intraoral exam-
ination also revealed 2 small, fluid-filled firm nodules
that appeared like large vesicles. Measuring 3 to 4
mm in diameter, they were on the attached and unat-
tached gingiva at the mucogingival line area between
the mandibular right canine (#27) and first premolar
(#28) and below the mandibular right lateral incisor
(#26) (Fig. 2). Probings of the gingiva in these areas
revealed 3 mm depths, but did not communicate to
the nodules. She had commented that she had
popped 2 vesicles 3 days before the appointment.
There was no evidence of a radiolucency on the radi-
ographs. The working diagnosis was multiple gingi-
val cysts in the adult.
Treatment of both cysts consisted of excisional
biopsy with local anesthesia. Histologically, both cysts
were similar. There was a zone of uninflamed colla-
gen beneath the overlying squamous epithelium and
a cystic space at the base of the lesion. The cysts
were lined by very thin squamoid to cuboidal type
epithelium with 1 to 2 layers and with occasional
thickenings or plaques of the lining (Fig. 2). The diag-
noses were gingival cysts in the adult. The areas
healed uneventfully.
DISCUSSION
Gingival cysts of the adult are uncommon lesions.
With this report, there are almost 100 reported in
various studies over a 46-year period. In this study,
spanning 10 years, the percentage of gingival cysts
in the biopsy service was 0.08%, a smaller percent-
age over a similar span in the study by Buchner and
Hansen who reported a percentage of 0.15%.3 How-
ever, despite this scarcity, clinicians make a correct

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Figure 1.
Typical histopathology of gingival cyst in the adult. Top, low-power
view showing gingival squamous epithelium overlying a thin
uninflamed cyst wall and a prominent lumen lined by a very thin
squamoid, single cell layer of epithelium; lower left, a closer view
showing the single squamoid cell layer (arrow) and lack of
inflammation in the immediately adjacent cyst wall; lower right, a
higher-power view showing an odontogenic epithelial rest in the wall
of the cyst with no inflammation.
clinical diagnosis 50% of the time. It is interesting to
note that mucocele is the second most common
working diagnosis despite the fact that mucoceles do
not occur on the attached gingiva. Due to the appear-
ance of fluid, it is understandable that mucocele is in
the differential diagnosis (Fig. 3).
When one compares the various studies, there is
remarkable agreement. The most common site is the
anterior segment of the mandible in the incisor, canine,
and first premolar region by a ratio of almost 4:1,
mandible more than maxilla. All of the cases of mul-
tiple gingival cysts have been in the mandible. The
mean age is 51, with the most common age at time
of biopsy being in the fifth or sixth decade. In the
present study, their occurrence was much more com-
J Periodontol July 2002
Case Report
Figure 2.
Multiple gingival cysts in the adult. Top, clinical picture case of
multiple gingival cysts (arrows) in the right mandible in the area of
the lateral incisor up to the first premolar tooth in a 5l-year-old
female; lower left, 2 medium-power views of the cyst between the
canine and premolar showing a few layers of epithelial cells, some
thickening of the epithelium, and no inflammation in the cyst wall.
Lower right, a medium-power view of a portion of the second cyst,
between the mandibular right lateral and canine teeth, showing only
a few layers of squamoid/cuboidal epithelium and no inflammation
in the wall.
mon in females than has been noted in other stud-
ies. However, when one looks at all of those reported
to date, the female to male ratio, 1.3:1 is not so dra-
matic, indicating only a slightly higher incidence in
females.
The histomorphology of the gingival cyst in the
adult is also very consistent. Most cases reported
show an uninflamed connective tissue surrounding a
lumen lined by a very thinned squamoid or cuboidal
epithelium, which can have some areas of thicken-
ing. The morphology is very much like the lateral
periodontal cyst within the bone such that most oral
pathologists think that the gingival cyst in the adult
is the soft tissue counterpart of the lateral periodon-
tal cyst, both arising from rests of the dental lamina.
Occasionally, odontogenic epithelial rests are noted
in the wall of the gingival cyst (Fig. 1). Tolson et al.10
reported on a lateral periodontal cyst and gingival
cyst occurring in the same patient. In those 2 cases,
both had radiographic evidence with a radiolucency,
with the gingival cyst having a more diffuse pattern
and the lateral cyst having a more well-defined pat-
tern. It has been recognized that the gingival cyst can
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Case Report
Figure 3.
Gingival cysts in the adult, showing a spectrum of features. Upper
left, clinical view of a firm, 1 cm rounded nodule in the attached
gingiva of the maxilla between the maxillary right lateral incisor and
canine teeth. At surgery, a cupped-out area of the labial bone was
noted. Upper right, radiograph of the same case showing a
rounded radiolucency surrounded by a thin opaque line (arrow) and
corresponding to the indentation from the gingival cyst. Lower left,
a small 4 to 5 mm slightly nodular swelling with a bluish tint from
the underlying fluid in the attached gingiva between the mandibular
right lateral and canine. Lower right, a radiograph of another
gingival cyst that had caused enough pressure resorption to create a
radiolucency that looks like a lateral periodontal cyst.
produce a radiographic radiolucency by pressure
resorption of the adjacent bone. In some cases, the
resorption can be so great as to create a lesion on
the radiograph that mimics a lateral periodontal cyst
with a more defined radiolucent lesion (Fig. 3). At
surgical removal, the gingival cyst would be against
the labial bone whereas the lateral periodontal cyst
would be within the bone.
Multiple gingival cysts in the adult are very rare
with only 4 reports, including this one, in the English-
speaking literature.7-9 Table 2 presents data on
reported multiple cysts. They are similar to their sin-
gular counterpart and appear in the mandibular ante-
rior region in individuals in the fifth and sixth decades.
The present case report was similar to that of Wescott
et al.7 and occurred almost in the same location in
the right mandible. Multiple cysts have occurred either
unilaterally or bilaterally. The report by Zerden11 on
multiple gingival cysts had only one gingival cyst of
the adult, the other being an intrabony hemorrhagic
bone cyst. The report by Fardal and Johannessen12
on keratin-producing multiple gingival cysts has been
recognized as a case of peripheral odontogenic ker-
atocysts, not adult gingival cysts, in a patient with
Gorlins syndrome. Thus, multiple gingival cysts
remain very rare with an approximate incidence of
only 3% or less of the total number of reported cases.
In summary, gingival cysts in the adult are uncom-
mon true cysts of odontogenic origin most probably
from the rests of the dental lamina (rests of Serres).
They occur usually as single, small, flesh-colored
nodules, sometimes with notable bluish hue due to the
cystic fluid in the labial of the attached gingiva. They
are rarely multiple. The mandible is the most com-
mon site in the areas of the incisor, canine, and pre-
molar teeth. There may be a radiolucency due to a
cupping out of the bone from pressure resorption.
The sexual predilection is about equal, with females

Table 2.
Data from Reports on Multiple Gingival Cysts in the Adult

Reference Female Male Mandible Maxilla Age Unilateral Bilateral

Wescott et al.7 (1984) 0 1 2 0 46 Yes

Shade et al.8 (1987) 0 1 2 0 47 Yes

Present (2001) 1 0 2 54 Yes

Totals 1 2 4 2 49

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Case Report
having a slightly higher incidence than males. The 11. Zerden E. Multiple gingival cysts. Report of a case.
age of discovery at time of biopsy is older, being in Oral Surg Oral Med Oral Pathol 1966;22:536-544.
12. Fardal O, Johannessen AC. Rare case of keratin-pro-
the fifth or sixth decade with a mean age of 51. The ducing multiple gingival cysts. Oral Surg Oral Med Oral
usual clinical diagnosis is gingival cyst followed most Pathol 1994;77:498-500.
commonly by mucocele. Histologically, they usually
have a non-inflamed cyst wall with a very thin Correspondence: Dr. John L. Giunta, Department of Oral
squamoid or cuboidal lining, sometimes with thick- & Maxillofacial Pathology, Tufts University School of Den-
tal Medicine, 1 Kneeland Street, Boston, MA 02111. Fax:
enings and rests in the wall. Treatment is simple sur- 617/636-6780.
gical excision with no evidence of recurrence.
Accepted for publication January 31, 2002.
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3. Buchner A, Hansen LS. The histomorphologic spec-
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Oral Pathol 1979;48:532-539.
4. Wysocki GP, Brannon RB, Gardner DG, Sapp P. Histo-
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