As dental hygienists, we are the frontline of oral health screening. During a routine prophylaxis, we often see things that patients aren’t even aware of. While tonsil stones and common canker sores are frequent findings, occasionally we encounter something that requires a more discerning eye: oral cysts, including those on the tonsils and the common mucus retention cyst.
A dental hygienist’s role in oral lesions is primarily to understand these entities, as this helps us to educate patients and guide them from concern to appropriate care.
The Common Mucus Retention Cyst
One of the most frequent benign findings we see is the mucus retention cyst,1 also known as a mucocele. These are not true cysts but rather pseudocysts caused by a backup of saliva.
What it is: When a minor salivary gland duct is traumatized or blocked (often from a bite to the lip or cheek), mucus spills into the surrounding tissue, forming a soft, bluish, fluid-filled sac.
Where it’s found: Most commonly on the lower lip, but also on the floor of the mouth (where it’s called a ranula2), the buccal mucosa, and the palate.
Is it serious? Almost always, no. These are benign and painless. However, they can be bothersome, recurring, or large enough to interfere with speech or chewing.
From our perspective, a small, classic oral mucocele on the lip is often a simple “watch and wait” situation. If it persists or grows, the standard treatment is minor surgical excision, often by an oral surgeon, who will remove the cyst along with the associated salivary gland to prevent recurrence.
Demystifying Tonsillar Cysts
During an oral cancer screening, we visually inspect the oropharynx and palatine tonsils.3 It’s not uncommon to notice a smooth, yellow, or whitish bump on the tonsil itself. This is often a tonsillar cyst.
What it is: Retention cysts4 typically form when a duct in the tonsillar crypt becomes blocked, causing mucus and debris to accumulate. They are lined with the same epithelium as the tonsil’s surface.
Is it serious? In the vast majority of cases, a tonsillar cyst is a benign, asymptomatic finding. They are often discovered incidentally. As noted in radiology literature, including a review in the American Journal of Roentgenology, the key is to distinguish these common benign lesions5 from more serious pathology.
Differentiating from Other Conditions:
Our role is to observe and refer, not to diagnose or treat. Recently, I saw a new pathology in a patient’s throat. They were unaware of any problems, but I found a few lesions down their throat. What I love about this is that I saw it, took an intra-oral photo, and emailed it to the patient, suggesting that I would also be happy to email this and more details to her primary care physician. On my advice, she uploaded it to her medical chart and asked her PCP for guidance.
Note that this case is an excellent example of how telehealth can be used to improve outcomes for our patients. Using electronic medical records and the ability to communicate with providers without going in for an exam is the standard I hope all medical and dental professionals are living up to in 2026.
In this case, the PCP said she wasn’t sure what the lesions were and referred to an ENT, who said it was a mucus retention cyst; specifically, what I saw during her dental check-up was a tonsillar cyst. My spotting it, noting its characteristics, and flagging it for the patient helped a specialist make a more informed diagnosis. So what are some differences? Here are some of the most common ones:
Tonsil Cysts vs. Tonsil Stones (Tonsilloliths): Stones are hard, calcified, and often cause halitosis. Cysts are soft and fluid-filled.
Tonsillar Cysts vs. Peritonsillar Abscess:6 This is a severe, painful infection that causes fever, difficulty swallowing, and a “hot potato” voice. A cyst is typically painless.
Oral Cysts vs. Tonsillitis: This is a generalized inflammation and infection of the tonsils, leading to redness, swelling, and soreness.
Cysts vs. Cancer: As per the National Institutes of Health's MedGen database, while tonsillar cancer can present as an asymmetry or mass, it is often associated with risk factors like HPV or tobacco use,7 and may include symptoms like pain, earache, a persistent sore throat, or a neck mass. A simple cyst lacks these red flags.
The Critical Role of the Dental Hygienist Clinical Assessment
This is where our clinical duty becomes paramount. When we see a persistent, unusual lesion, whether that is a mucus retention cyst that seems atypical or a tonsillar mass we cannot classify, our protocol is clear:
1. Document Meticulously: Note the location, size, color, and consistency8 in the patient’s chart.
2. Ask Key Questions: “Have you noticed this before? Is it painful? Have you had any changes in your voice, swallowing, or noticed a lump in your neck?”
3. Initiate the Referral: We do not manage these lesions. Our critical role is to recognize the limits of our scope and to make an ENT referral to the appropriate specialist, such as an Oral Surgeon or an Otolaryngologist (ENT).
These specialists possess the necessary tools, including endoscopes and imaging equipment, to make a definitive diagnosis. In many cases, especially with symptomatic or recurrent cysts, the treatment is as simple as an easy surgical removal (excision), which also provides a tissue sample for biopsy, confirming the benign nature of the lesion and providing everyone with peace of mind.
Key Takeaways for Our Patients
When a patient is anxious about a new bump, we can reassure them with this knowledge:
1. Most oral cysts are harmless. Mucus retention cysts and tonsillar cysts are common benign conditions.
2. They are not cancer. While any new mass should be evaluated to rule out serious disease, the overwhelming majority of these cysts are not malignant.
3. Treatment is straightforward. If necessary, simple surgical removal is highly effective.
4. Your dental team is your ally. Our comprehensive oral screening is designed to detect these issues early and guide you to the appropriate care.
Why It Matters for Practice
Early recognition of oral cysts is a crucial component of comprehensive dental hygiene patient care. Hygienists are often the first to notice subtle soft-tissue changes during routine exams, making their vigilance crucial in distinguishing harmless lesions from those that require an ENT referral.
Understanding the appearance and behavior of common cysts, such as an oral mucocele and a tonsillar cyst, further empowers clinicians to document accurately, educate patients confidently, and ensure timely specialist evaluation when warranted. This proactive approach not only supports patient safety but also strengthens the hygienist’s role as a vital partner in the early detection of oral diseases.
By understanding the landscape of oral soft tissue lesions, we can move beyond simply cleaning teeth and become integral players in our patients' overall health, ensuring that a small, strange bump leads not to fear but to informed, timely action.
References
1. Bal M, Berkiten G, Uyanık E. Mucous retention cysts of the paranasal sinuses. Hippokratia. 2014 Oct-Dec;18(4):379.
2. Baurmash HD. Mucoceles and ranulas. Abstract: J Oral Maxillofac Surg. 61:369-378, 2003. https://doi.org/10.1053/joms.2003.50074.
3. IARC Working Group on the Evaluation of Cancer-Preventive Interventions. Oral Cancer Prevention. Lyon (FR): International Agency for Research on Cancer; 2023. (IARC Handbooks of Cancer Prevention, No. 19.) 4., Screening and Early Diagnosis of Oral Cancer. Available from: https://www.ncbi.nlm.nih.gov/books/NBK611816/. Accessed December 30, 2025.
4. Yetman D. How to Tell the Difference Between Tonsil Cysts and Tonsil Cancer. Healhline. https://www.healthline.com/health/tonsil-cyst-vs-cancer. Updated August 19, 2025. Accessed December 30, 2025.
5. Pattamapaspong N, Peh WC. Benign incidental do-not-touch bone lesions. Br J Radiol. 2023 Feb;96(1142):20211334. doi: 10.1259/bjr.20211334.
6. Castagnini LA, Goyal M, Ongkasuwan J. Tonsillitis and Peritonsillar Abscess. Infectious Diseases in Pediatric Otolaryngology. 2015 Jul 14:137-50. doi: 10.1007/978-3-319-21744-4_10.
7. Williamson AJ, Mullangi S, Gajra A. Tonsil Cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan. https://www.ncbi.nlm.nih.gov/books/NBK537238/. Updated September 4, 2023. Accessed December 30, 2025.
8.General and Oral Pathology for Dental Hygiene Practice. First Edition. ISBN 0803625774 , 978-0803625778 on Scribd: https://www.scribd.com/document/756240723/General-and-Oral-Pathology-for-Dental-Hygiene-Practice-First-Edition-ISBN-0803625774-978-0803625778. Accessed December 30, 2025.
