Cyst or Granuloma on a Tooth Root: Symptoms, Treat or Extract

A cyst and a granuloma are a focus of chronic inflammation near the apex of a tooth root. The key thing to know: they can grow for years with almost no symptoms, and a “bump on the gum” or swelling is already a signal that the process has gone far. The second piece of good news: in most cases the tooth can be saved rather than removed. Here is how to spot them and what we do.

What it is and where it comes from

Both a cyst and a granuloma are the result of an infection in the tooth canal. Most often it is neglected decay that has reached the nerve, or canals treated poorly in the past. Bacteria from the canal escape beyond the root apex into the bone, and the body “walls off” the focus:

Granuloma

A small nodule of inflammatory tissue (usually up to 5 mm) near the root apex. This is an early stage — at this point the tooth is saved most easily.

Cyst

A cavity with a lining and fluid inside that slowly grows and resorbs the surrounding bone. It can grow to centimetres, press on neighbouring teeth and even on the nerve. It is the same granuloma that was not stopped in time.

Symptoms: how to notice

The insidious part is that for a long time there is nothing. The focus grows painlessly, and people learn about it by chance — on an image before implantation or orthodontics. But there are signs that mean you should see a doctor:

A “pimple” or fistula on the gum — a small white or red spot near the root that periodically discharges pus. It does not go away “on its own” and is not cured by rinsing. Periodic swelling of the gum or cheek that comes and goes. A darkened tooth compared with its neighbours — a sign of a dead nerve. Discomfort on biting on a specific tooth, a feeling that it is “taller”. A flare-up with pain and fever — when the focus turns into a gumboil.

How we make the diagnosis

An ordinary examination is not enough — the focus is inside the bone. An image is needed: a targeted X-ray or, for complex cases, a 3D CT scan. Only it reveals the true size of the focus, how much bone has already been lost, which canals are involved and whether the neighbouring roots and the nerve are affected. Based on it the doctor tells you the main thing: whether the tooth can be saved and by what route.

Treat or extract

In the vast majority of cases the tooth can be saved — extraction has long ceased to be the first solution. The approach depends on the size of the focus and the condition of the tooth.

The conservative route (without removing the tooth)

The main method is root canal treatment under a microscope. The doctor removes the infection from the canal, disinfects it and seals it hermetically; with the canal closed the focus is deprived of its “supply” and gradually heals, while the bone regenerates. For cysts a medicated material is additionally placed for a few weeks. It is the same protocol as in root canal treatment, but harder and longer. A follow-up image after a few months shows whether the focus is shrinking.

The surgical route (keeping the tooth)

If the canal is already well treated but the focus is large, an apicoectomy (root-end resection) is used: through a small access the apex itself, along with the focus, is removed, while the tooth stays in place. This is microsurgery, not extraction.

When the tooth has to be removed

Extraction is the last resort: the tooth is destroyed beyond restoration, the cyst has destroyed too much support, or the root has cracked. In that case the focus is removed together with the tooth, and the space is later restored with an implant. But even then the decision is made from an image, not “just in case”.

What it costs

The cost depends on the route and complexity: root canal treatment for a granuloma is counted as endodontics (a single-rooted tooth from UAH 6,600, a multi-rooted molar from UAH 11,500), while an apicoectomy and extraction are separate, and the figure is quoted after an image. A consultation with an assessment and plan is from UAH 590. All services are on the pages endodontics and surgery.

Frequently asked questions