Clinical Presentation of Dentigerous Cysts: Systematic Review

Objective: To determine the principal features of dentigerous cysts by a systematic review. Materials and Methods: The relevant literature was identified by searching electronic databases, handsearching key journals, and reference list harvesting. The principal selection criterion was that the study should represent a complete collection of cases. Results: Searches using Medical Subject Heading terms identified more than 80% of systematic reviewincluded reports, but required review of nearly 10,000 Medline abstracts. Although the specific term ‘dentigerous cyst’ had the highest ‘precision’ of 1.48%, the non-specific term ‘odontogenic cyst’ had the highest ‘recall’ of 58.62%. Some reports displayed a fundamental misunderstanding of the taxonomy and/or histology of dentigerous cyst, even as recently as the 1980s. Five systematic review-included reports were identified by hand-searching relevant journals or by harvesting the reference lists of relevant reports. Thirty published series, covering 4324 cases, were included in the systematic review; 48% were not in the English language. The reports generally included little more than sex, mean age, age range, and site. The ‘number of cases of dentigerous cysts per hospital per year’ was significantly greater for Asians and Caucasians than for black Africans. The mean ages, given in 3 reports, were significantly older for Caucasians than for black South Africans. The mean age was 28.6 years. There was a 58:42 predilection for men and a 64:36 predilection for the mandible. For the latter, this predilection was significantly greater for Caucasians than for Asians. Among Asians, Chinese people had a significantly greater predilection for the maxilla. Three reports included clinical details and 3 reports included radiological details. Only 1 article reported pain and swelling; dentigerous cysts occurred as an incidental finding in 24% of reports. Conclusions: Medical Subject Heading searches should include a mix of specific and more general terms, and should be used in addition to hand-searches and reference list harvesting. Non-English language reports substantially contribute to the number of cases. There are significant differences in prevalence of various features between ethnic groups. Nevertheless, both lack of detailed reporting and the confusion about nomenclature and histology, until relatively recently, was unexpected for this hitherto supposedly well-understood lesion. The radiology component of the systematic review-included reports is almost non-existent in comparison to systematic reviews conducted for other lesions.