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Authors: Dr. Tina Agarwal, Dr. Chanchal Singh, Dr. Sonal Gupta

Abstract:

Alveolar cysts of infant are a special form of odontogenic cyst which are derived from epithelial remnants of dental lamina during tooth development. These are present as small whitish multiple swellings on the alveolar ridge of the maxilla or mandible. These are self limiting and disappear spontaneously a few weeks or months after birth.

Key words:

Alveolar cysts of infant, Gingival cysts of newborn, Bohn nodules

Introduction

Kramer, 1974 described cyst as a pathological cavity having fluid, semifluid or gaseous contents and which is not created by the accumulation of pus; it is frequently but not always lined by epithelium1. Henirich Bohn and Alois Epstein were the first authors to describe the small palatal cysts of the foetuses and newborns in 1800’s. Thus “Epstein’s Pearls” and “Bohn’s nodules” were named after them2. According to location in the oral cavity and histological origin, Fromm et al. (1967) classified oral mucosal cysts as Epstein’s pearls, Bohn’s nodules, dental lamina cysts or alveolar cysts of the newborn3. Epstein’s pearls are cystic keratin filled nodules found along the mid palatine raphe along the fusion of the palatal halves4. Bohn’s nodules are also keratin filled cysts but scattered over the palate, most numerous along the junction of the hard and the soft palate and apparently derived from palatal salivary gland structure2 or on the buccal and lingual aspects of the alveolar ridges5. Dental lamina cysts of newborn / Alveolar cysts of newborn (keratin filled cysts) found on the edentulous ridges of the newborn / infant4.

Case report

A male infant of four months old was brought to the Department of Pedodontics and Preventive Dentistry, K. D. Dental College and Hospital, Mathura, Uttar Pradesh, India, by his father and grandmother, who complained of swelling over the upper gums of the infant. History revealed that the swellings were detected after fifteen days of birth. Parents also consulted Paediatrician who made the provisional diagnosis of oral candidiasis. The child was born full term with no complications during pregnancy or delivery. All the required vaccinations were started soon after birth and his medical history was noncontributory.

On intraoral examination, small whitish multiple swellings were seen on the alveolar ridge of the maxilla from canine to canine region, which were small, firm and sharp on palpation. A small white lesion was also present on the hard palate (Figure 1). The lesions were not scrapable. Thus, the provisional diagnosis made by paediatrician was ruled out as the lesions were not clinically significant as oral candidiasis. No other abnormality was seen in any other parts of the oral cavity. The swellings were painless. Based on the clinical presentation and characteristic finding, a diagnosis of alveolar cysts of the infant was made. Biopsy of the lesion could not be carried out as parents were not keen on it6 and the patient was not healthy. As the lesion is self limiting, the child is under observation after proper oral hygiene instructions.

Discussion

Alveolar cysts of infant is also termed as gingival cysts of newborn / infant and dental lamina cysts of newborn / infant7. These are multiple, occasionally solitary, superficial, raised nodules on edentulous alveolar ridges of infants or newborns derived from rests of the dental lamina and consisting of keratin producing epithelial lining4. It arises from epithelial remnants of the dental lamina during the bell stage of the tooth development. Usually these clusters degenerate and resorb. Sometimes, they persist as epithelial pearls or islands within the jaw as well as in the gingiva and called as the ‘Rests of Serres’3. These remnants proliferate to form small keratinised cysts8. It is important that these cysts should not be mistaken for natal / neonatal teeth or any other pathology in the newborn and no treatment should be rendered to the patient as these are transient in nature and disappear within two weeks to five months after birth9.

According to Rajendran R and Sivapathasundharam S, (2012), it is a special form of odontogenic cyst which is found in as many as 80% of the newborn infants4. Paula et al (2006) reported a prevalence of 28% in Parana, Brazil10. Friend et al (1990) reported the prevalence of about 25-53% in Memphis, Tennessee11. According to Flinck et al (1994), palatal cysts are formed during the foetal period and majority of them disappear soon after delivery. But the alveolar cysts are likely to appear during the neonatal period8. Donley and Nelson (2000) reported that these cysts are more commonly seen in the maxillary arch than in the mandibular arch and whenever they existed in mandible, they also appeared in the maxilla. In the maxilla, the most affected region was the labial aspect of the anterior region and in deciduous second molar region. 12

Conclusion

Alveolar cysts of infant are a special form of odontogenic cyst which is derived from epithelial remnants of dental lamina during tooth development and present as small whitish multiple swellings on the alveolar ridge of the maxilla or mandible in which no treatment is required as these cysts are very superficial and within weeks or 6 - 9 months will rupture harmlessly to spill their contents into the oral and pharyngeal environment and then fusing with the overlying mucosa and becoming a part of it.

Reference
  1. Kramer IRH. Changing views on oral disease. Proceedings of the Royal Society of Medicine 1974; 67: 271-276.
  2. Viswanathan R, Bharath KP. Alveolar cyst of the newborn: a case report. Arch Orofac Sci 2012; 7(2): 85-87.
  3. Fromm A. Epstein pearls, Bohn's nodules and inclusion cyst of the oral cavity. J Dent Child. 1967; 34: 275-287.
  4. Raajendran R, Shivapathasundharam B. Shafer's Textbook of Oral Pathology. In: Shafer, Hine, Levy, editors. 7th ed. Noida, India: Elsevier; 2012.
  5. Chaudhary SD and Chaudhary M. Essentials of Pediatric Oral Pathology. First edition. New Delhi, India: Jaypee Brothers Medical Publishers; 2011.
  6. Veena KM, Jagadishchandra H, Bhat SS, Rao PK. A Rare Case of Gingival Cyst of Infant occurring in a baby age four months. Pac J Med Sci. 2011; 9(1): 40 – 41.
  7. Benni DB, Sirur D. Gingival cyst of the newborn: A case report. International Dentistry – African Edition 2013; 3(2): 32 – 34.
  8. Kumar A, Grewal H, Verma M. Dental lamina cyst of newborn: a case report. J Indian Soc Pedod Prev Dent. 2008; 26(4): 175-176.
  9. Flinck A, Paludan A, Matsson L, Holm AK, Axelsson I. Oral findings in a group of newborn Swedish children. Int J Paediatr Dent. 1994; 4(2): 67-73.
  10. Paula JD, Dezan CC, Frossard WT, Walter LR, Pinto LM. Oral and facial inclusion cysts in newborns. J Clin Pediatr Dent. 2006; 31(2): 127-129.
  11. Friend GW, Harris EF, Mincer HH, Fong TL, Carruth KR. Oral anomalies in the neonate, by race and gender, in an urban setting. Pediatr Dent. 1990; 12(3): 157-161.
  12. Donley CL, Nelson LP. Comparison of palatal and alveolar cysts of the newborn in premature and full-term infants. Pediatr Dent. 2000; 22(4): 321–324.

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