On the contrary, Toiler suggested that the breakdown of proliferating cells of the follicle after impeded eruption is likely to be the origin of the dentigerous cyst. The breakdown products may result in increased osmotic tension, resulting in cyst formation. The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. In 1928, Bloch-Jorgensen suggested that the overlying necrotic deciduous tooth is the origin of all dentigerous cysts. The resultant periapical inflammation might spread to involve the follicle of the unerupted permanent successor, an inflammatory exudate ensued with resultant dentigerous cyst formation. He reported 22 cases of follicular cysts and stated that in each case a deciduous tooth or the remnants thereof was found in direct contact with the cyst cavity and that the related deciduous tooth always was diseased. Azaz and Shteyer similarly suggested that the persistent and prolonged periapical inflammation caused chronic irritation to the follicle of the successors. This may trigger and hasten the formation of a dentigerous cyst developing around the permanent teeth. They reported five cases of dentigerous cysts which involved the second mandibular premolar in four children aged 8 to 11 years old. These children were referred for extraction of carious, nonvital primary molars with swelling of the surrounding soft tissue. Occlusal radiographs showed buccal expansion of bone at the affected site. The primary teeth were not in direct contact with the underlying dentigerous cyst. It has been suggested that dentigerous cysts may be either extrafollicular or intrafollicular in origin.
In the maxilla, these teeth are often displaced into the maxillary sinus. Classic symptoms of sinus disease such as headache, facial pain, purulent nasal discharge or nasolacrimal obstruction may occur when maxillary sinus is involved. According to a study, 45.7 percent of dentigerous cysts involved mandibular third molar. On the other hand, only 2.7 percent of dentigerous cysts involved the maxillary premolar. Mourshed stated that the incidence of dentigerous cyst has been reported as 1.44 in every 100 unerupted teeth, so dentigerous cysts involving the premolars are rare. Dentigerous cysts most commonly occur in the 2nd and 3rd decades of life. Males have been reported to be more prevalent than females with a ratio of 1.8:1. These cysts can also be found in young children and adolescents. The age of presentation of these cysts range from 3 years to 57 years with a mean of 22.5 years. These cysts are commonly single lesions. Bilateral and multiple dentigerous cysts are very rare although they have been reported. Bilateral or multiple dentigerous cysts have been reported in Maroteaux-Lamy syndrome, cleidocranial dysplasia and Gardners syndrome In the absence of these syndromes, the occurrence of multiple dentigerous cysts is rare. Sometimes multiple dentigerous cysts are suggested to be induced by prescribed drugs. The combined effect of cyclosporine and a calcium channel blocker is reported to cause bilateral dentigerous cyst
Dentigerous cyst is potentially capable of becoming an aggressive lesion.