Study puts dentigerous cyst prevalence at 33.3% in dogs: full analysis

A newly published cross-sectional radiographic study in the Journal of Small Animal Practice reports that one-third of unerupted teeth in adult dogs had associated dentigerous cysts, offering fresh prevalence data on a lesion veterinary dentists know can be easy to miss until damage is already underway. Across approximately 13,000 records reviewed from January 2017 through June 2023, the authors found 285 unerupted teeth in 206 dogs, with 95 cysts identified, for a prevalence of 33.3%. They also found higher odds of cysts in brachycephalic dogs and in neutered males versus intact females. (researchprofiles.ku.dk)

The findings land in the middle of an active clinical debate over how aggressively to manage unerupted teeth. Earlier veterinary studies have already shown that dentigerous cysts are common around unerupted teeth, especially mandibular first premolars, and that brachycephalic breeds are overrepresented. A 2016 study found radiographically apparent cystic lesions in 29.1% of 213 unerupted teeth, while a 2019 Frontiers series noted that many cases are discovered incidentally during routine intraoral imaging rather than because the pet parent noticed a missing tooth. (journals.sagepub.com)

This new study adds more detail on where risk appears to cluster. The highest frequency of unerupted teeth was found in mandibular first premolars, mandibular third molars, and mandibular central incisors. Still, prevalence per site stayed below 50% for all tooth positions except the mandibular second incisor. That matters because it supports a more nuanced message: unerupted teeth are clearly not benign, but neither do they all progress to cystic disease. The authors’ clinical significance statement reflects that distinction, suggesting that close monitoring of unerupted teeth without radiographic evidence of cyst formation may be an appropriate minimally invasive option instead of routine prophylactic extraction. (researchprofiles.ku.dk)

That conclusion stands in some tension with long-standing guidance from veterinary dentistry references and continuing education summaries. Merck Veterinary Manual states that any missing mandibular first premolar should be radiographed and that unerupted teeth should ideally be removed, or at minimum closely monitored with annual intraoral radiographs. A Clinician’s Brief summary of prior work similarly advised extraction of unerupted teeth, while also underscoring that brachycephalic breeds are at highest risk and that mandibular first premolars are the most common problem site. (merckvetmanual.com)

Recent pathology-focused work helps explain why some clinicians may remain cautious. A 2022 study comparing radiographic and histopathologic findings found that among unerupted mandibular first premolars without radiographic evidence of a cyst, 22.9% still had histologic evidence of epithelium consistent with a cyst lining. And a 2024 Frontiers review of 279 dentigerous cysts in 192 dogs reiterated that these lesions can vary from small, localized findings to large mandibular defects involving multiple teeth, while emphasizing that earlier detection likely makes treatment easier. (journals.sagepub.com)

Why it matters: For general practitioners, the practical takeaway is less about choosing one universal treatment rule and more about tightening the diagnostic workflow. Adult dogs with clinically missing teeth, especially brachycephalic dogs, warrant dental radiography rather than assumptions that the tooth is congenitally absent. For dentists and surgeons, this paper may support more individualized conversations with pet parents when an unerupted tooth is found incidentally and radiographs show no cystic change, particularly if extraction would be technically challenging. But the broader literature still argues for caution, because dentigerous cysts can be clinically silent while progressively damaging adjacent teeth and bone. (merckvetmanual.com)

What to watch: The next question is whether follow-up studies confirm that radiographically negative unerupted teeth can be safely monitored over time, and if so, which teeth, breeds, and imaging intervals define a low-risk surveillance protocol. Until then, this paper is more likely to refine case selection than to end the extraction-versus-monitoring debate. (researchprofiles.ku.dk)