Oral bleeding: first clinical manifestation of dentigerous cyst in geriatric patient with dabigatran therapy and systematic literature review

Background: Jaw cyst surgery is a common intervention in oral surgery. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts and commonly report no symptoms. Mandibular dentigerous cysts are common in children and adults, while rare in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with mandibular nerve, and/or the patient has medical history that may represent a relative or absolute contraindication.

Materials and Methods: the case of a dentigerous cyst in an elderly patient in treatment with dabigatran therapy is presented, with jaw cyst surgery and tooth extraction. A systematic literature review was performed to evaluate previous cases of dentigerous cyst in elderly patient.

Results: No complications, in particular excessive bleeding, occurred neither during the surgery nor in the week after. Mandibular sensitivity returned with the pass of the dental anesthesia. One year after the surgery, a new panoramic radiograph was performed, revealing the complete healing of the site. The systematic literature review reported two cases of previously documented cases, one treated with irrigation, the other one treated with cyst enucleation and tooth extraction.

Conclusions: This paper reports the first case of spontaneous oral bleeding as a first clinical sign of a dentigerous cyst in a geriatric patient, with one year of follow-up. Clinicians should consider the possibility of dentigerous cysts in elderly patients and, on the basis of multidisciplinary evaluation with cardiologists and geriatrician doctors, choose the most effective treatment to reduce the risks of surgery.