Clinical Manifestations
Most radicular cysts are asymptomatic and discovered incidentally on routine periapical or panoramic radiographs.
When symptomatic: dull intermittent pain at the apex of the involved tooth, particularly if acute exacerbation (suppuration) occurs.
Large cysts cause jaw expansion — a slow-developing, smooth bony swelling, initially hard (bony expansion) and later fluctuant as the outer cortical plate is thinned or perforated.
Associated tooth tests negative to cold and electrical pulp testing (non-vital). Adjacent teeth may be displaced or lose vitality due to pressure.
Egg-shell crackling (crepitus) may be felt on palpation when the cortical plate is very thin.