Dentigerous Cyst: Understanding Your Pathology Report

by Jason Wasserman MD PhD FRCPC
March 2, 2026

A dentigerous cyst is a noncancerous (benign), fluid-filled sac that forms around the crown of an unerupted tooth. An unerupted tooth is a tooth that remains inside the jawbone and has not come through the gum into the mouth.

Dentigerous cysts are a type of odontogenic cyst, which means they develop from cells involved in normal tooth formation. Because they form from tissue surrounding a developing tooth, they are sometimes called follicular cysts.

Dentigerous cysts most commonly occur in the lower jaw and are often associated with impacted wisdom teeth, although they can form around other unerupted teeth as well.

What are the symptoms of a dentigerous cyst?

Many dentigerous cysts are small and do not cause symptoms. They are often discovered incidentally when an X-ray is performed for another reason, such as evaluation of an impacted tooth.

When the cyst becomes larger, it may slowly expand and cause thinning or erosion of the surrounding jawbone. This can lead to visible jaw swelling or a feeling of fullness in the area. If the cyst becomes infected or ruptures, it may cause pain, redness, or swelling.

In some cases, a large cyst can displace nearby teeth or interfere with normal tooth eruption.

What causes a dentigerous cyst?

A dentigerous cyst develops when fluid accumulates between the crown of an unerupted tooth and the surrounding tissue known as the dental follicle. The exact reason this fluid builds up is not always clear, but it is related to the normal process of tooth development.

These cysts are not caused by poor oral hygiene and are not contagious.

Can a dentigerous cyst become cancerous?

Dentigerous cysts are benign and do not behave like cancer.

Although very rare cases of cancer developing within a dentigerous cyst have been reported in the medical literature, this is extremely uncommon. For most patients, dentigerous cysts do not have malignant potential.

How is this diagnosis made?

The diagnosis of a dentigerous cyst often begins with imaging, such as a dental X-ray, which shows a well-defined, fluid-filled space surrounding the crown of an unerupted tooth.

The final diagnosis is made after the cyst is removed and examined under the microscope by a pathologist. Microscopic examination confirms the cyst type and helps rule out other jaw lesions that may appear similar on imaging.

What does a dentigerous cyst look like under the microscope?

Under the microscope, the inner surface of a dentigerous cyst is typically lined by a thin layer of stratified squamous epithelium. The word stratified means the cells are arranged in layers, like bricks in a wall.

The lining is usually thin and uniform. In some areas, the cells may appear cuboidal (box-shaped), columnar (taller than they are wide), or occasionally ciliated, meaning they have tiny hair-like projections on their surface.

Beneath the epithelial lining is a layer of fibrous connective tissue, which appears pink under the microscope and forms the wall of the cyst.

Importantly, the lining cells in a typical dentigerous cyst do not show significant atypia (abnormal cellular changes), which helps confirm that the lesion is benign.

What is an inflamed dentigerous cyst?

A dentigerous cyst is described as inflamed when inflammatory cells are present within the cyst wall.

Inflammation may occur if the cyst becomes infected or ruptures. Under the microscope, the pathologist may see inflammatory cells such as lymphocytes, histiocytes, or multinucleated giant cells. Small empty spaces called cholesterol clefts may also be present. These represent areas where cholesterol crystals were previously located before tissue processing.

Inflammation can make the cyst lining thicker and less uniform, but this does not mean the cyst has become cancerous.

How is a dentigerous cyst treated?

Treatment usually involves surgical removal of the cyst along with the associated unerupted tooth. Removal prevents further growth, bone damage, or infection. After complete removal, recurrence is uncommon.

Questions you may want to ask your doctor

• Which tooth is associated with the cyst?

• Has the cyst caused any bone damage?

• Was the entire cyst removed?

• Is there any sign of recurrence?

• Do I need follow-up imaging?