Gingival Cyst
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Gingival cyst, also known as Epstein's pearl, is a type of
cysts of the jaws Cysts of the jaws are cysts—pathological epithelium, epithelial-lined cavities filled with fluid or soft material—occurring on the bones of the jaws, the human mandible, mandible and maxilla. Those are the bones with the highest prevalence of ...
that originates from the
dental lamina The dental lamina is a band of epithelial tissue seen in histologic sections of a developing tooth. The dental lamina is first evidence of tooth development and begins (in humans) at the sixth week in utero or three weeks after the rupture of t ...
and is found in the mouth parts. It is a superficial cyst in the
alveolar mucosa The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed ''lamina propria''. The oral cavity has sometimes been describ ...
. It can be seen inside the mouth as small and whitish bulge. Depending on the ages in which they develop, the cysts are classified into gingival cyst of newborn (or infant) and gingival cyst of adult. Structurally, the cyst is lined by thin epithelium and shows a lumen usually filled with desquamated
keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. It is the key structural material making up Scale (anatomy), scales, hair, Nail (anatomy), nails, feathers, horn (anatomy), horns, claws, Hoof, hoove ...
, occasionally containing inflammatory cells. The nodes are formed as a result of cystic degeneration of epithelial rests of the dental lamina (called the rests of Serres). Gingival cyst was first described by a Czech physician Alois Epstein in 1880. In 1886, a German physician Heinrich Bohn described another type of cyst. Alfred Fromm introduced the classification of gingival cysts in 1967. According to him, gingival cysts of newborns can be further classified based on their specific origin of the tissues as Epstein’s pearls, Bohn’s nodules and dental lamina cysts.


Babies

Gingival (alveolar) cysts of infants are mostly found in groups, but are frequently found as single nodules. They are present on the alveolar ridges. They are formed from fragments of dental lamina that remains within the alveolar ridge mucosa during tooth formation ( odontogenesis). Specifically, they emerge when the process of formation extends into the abnormal sites to form small keratinized cysts. They are generally harmless (asymptomatic) and do not cause discomfort, and they normally degenerate and involutes or rupture into the oral cavity within 2 weeks to 5 months after birth. Hence, they are not normally recognized and do not require medical treatment. It is estimated that the prevalence is higher than 50% in babies. Depending on their exact occurrence, the cysts can be classified into
palatal The palate () is the roof of the mouth in humans and other mammals. It separates the oral cavity from the nasal cavity. A similar structure is found in crocodilians, but in most other tetrapods, the oral and nasal cavities are not truly sepa ...
and alveolar cysts. Palatine cysts are those located at the mid-palatine raphe, while alveolar cysts are found on the buccal, lingual or crest of alveolar ridge.


Epstein’s pearl

Epstein’s pearls were discovered by Alois Epstein in 1880. They are palatal cysts found along the median palatal raphae and arise from the epithelium entangled along the line of fusion. They are small white or yellow cystic vesicles (1 to 3 mm in size) often seen in the median palatal raphe of the mouth of newborn infants (occur in 60-85% of newborns). They are typically seen on the roof of the mouth (palate) and are filled with keratin. They are caused by entrapped epithelium (fissural cyst) during the development of the palate.


Bohn’s nodules

Bohn’s nodules, described by Heinrich Bohn in 1886 as "mucous gland cysts", are distributed over the junction of the hard and soft palate. They are derived from minor
salivary glands The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of Duct (anatomy), ducts. Humans have three paired major salivary glands (Parotid gland, parotid, Submandibular gland, submandibula ...
. They are found at the junction of the
hard Hard means something that is difficult to do. It may also refer to: * Hardness, resistance of physical materials to deformation or fracture * Hard water, water with high mineral content Arts and entertainment * Hard (TV series), ''Hard'' (TV ser ...
and
soft palate The soft palate (also known as the velum, palatal velum, or muscular palate) is, in mammals, the soft biological tissue, tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is ...
, and along
lingual Lingual may refer to: * Tongue, a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication * Lingual, in palaeontology, the side of the teeth that faces the tongue * Lingual artery arises from the e ...
and buccal parts of the dental ridges, away from the midline. These nodules are 1–3 mm in size, and filled with keratin. Bohn also classified cysts in the alveolar ridges as mucous gland cysts. However, a century later it was shown that these cysts are microkeratocysts.


Adults

Gingival cyst of adult is a rare condition. The incidence is less than 0.5%. It is formed from the rests of dental lamina. It is found in the soft tissues on the buccal and labial portions of the jaw. It usually occurs on the facial gingiva as a single small flesh colored swelling, sometimes with a bluish hue due to the cystic fluid. Sometimes, it may occur in cluster, either unilaterally or bilaterally or on the lingual surface of the alveolar process. It is most commonly seen in the canine and premolar regions of the mandible, and are sometimes confused with lateral periodontal cysts. It is not normally problematic, but when it grows larger, it can cause some discomfort. It can be removed by simple surgical excision. They are developed late in life, generally up to the sixth decade of age.


References


External links

{{oral pathology Pediatrics Cysts of the oral and maxillofacial region Diseases of oral cavity, salivary glands and jaws