DENTAL SPEAK : A cyst is uncovered but, fortunately, nothing serious

Liza Gochuti arrived in the morning at around 10am. She braced herself for the dental surgeon’s diagnosis and ultimate treatment. She told the dental assistant (DA) to stand by her side and hold her hands.

Instead of the DA holding her hands Liza clasped hers around the DA’s outstretched arm. This was her attempt to allay her nervousness and to use the DA as a leaning prop. The dental surgeon (DS) mollified her, “Please try to relax. If you are less tense your facial muscles will not be stretched. This will make things easy for you and the operator.”

Upon examining the upper right posterior teeth, the area of her discomfiture, the DS noticed that the patient had a blackish grey silver amalgam restoration.

DS: “How long has the silver amalgam filling been there in your mouth?”

Liza: “I had that placed about eight years ago when I was in Moshi.” The DS percussed the second molar with the handle of the mirror. There was no pain elicited. On knocking the last molar Liza immediately responded, “That is exactly the type of pain I have been having for the past five days.” DS: “After removal of the filling there would be a more clearer view of the state of the pulp.” The DS went about his task of removing the silver amalgam chunk. After scrutinizing the spot the DS told Liza, “With the silver amalgam out, you need to know that the filling was literally resting on the gums. Also, the pulp of the tooth is exposed. It is the upper last molar and as there is no lower protagonist of the tooth you are advised to have the molar out. Root canal treatment will not be possible.

A cartridge of 1.8ml lignocaine with 1:1000 epinephrine was injected around the mucosa of the molar. After five minutes a molar forceps was inserted to remove the molar. The DS gave a buccal tilt to the forceps. There was a sound. The crown of the tooth came out leaving behind the three roots. The roots were fused to the overlying bone.

A round surgical bur in a slow straight hand piece was used to cut and clear the bone around the roots. A periosteal elevator and a bayonet forceps came in very handy in having the three roots out.

As the DS cleared the socket of the bone debris, his eyes fell on the tissue that was yellowish with elongated thread-like sac coming out of the spot around which the silver amalgam had entrenched itself on the gums. Holding the thread-like yellowish mass with the ends of a tweezer, the DS pulled out the sac.

The cyst was carefully separated from the socket site and cleaved off from the area it had arisen from. That end was gently cauterized, care was exercised not to leave behind any cystic material. The cystic sac was put in a bottle of formalin and shown to Liza. This was sent for histopathological examination. The report confirmed later that the lesion was indeed an odontogenic cyst. An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues.

Eliza was instructed to rinse with hot saline mouthwash after six hours. She had a nagging doubt, “Doctor, do I have some kind of a disease?” The DS said, “Did you have a headache?” She said, “A splitting one.” DS: “With your cyst out you will discover the gradual subsidence of pain and distress you were having on the right side of your upper jaw.

You will have more freedom of movement of the jaws on the right. You will begin to enjoy eating on both sides. Please disassociate yourself of the notion that you had some kind of a disease. It was unfortunate that the silver amalgam that was placed several years ago had continued to vex and nettle the periodontium (the specialised tissues that both surround and support the teeth).

The constant irritation of the tissue around the filling had caused the formation of a cyst. You are fortunate that the cyst was localised and not spread out. You are healthier and better now without the cyst.”

In a lighter vein, sophistication may be described as the ability to yawn without opening your mouth. When it comes to dental treatment such sophistication may be construed as refusal to cooperate with the dental surgeon.