What could this be if not a cyst?

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David Nugent - 22 Jun 2006 22:25 GMT

I had a dental exam a few months back. After getting a Panoramic XRAY of my
teeth, my dentist asked me "Has anything changed in your medical history"..
I replied "No, why". He showed me the XRAY and around one tooth near the
front of my mouth on the bottom there appeared a dark area around the tooth.
He asked me if I had been hit in the jaw by a hockey puck or baseball.. I
told him not that I recall. He said it appears there is a large cyst
around/under the tooth. He said you will have to go for oral surgery to get
it removed. So about 4 months later I finally get to see the oral surgeon.
He looks at the xray and is scratching his head saying "I don't know what
that is". Maybe we should get a CT scan. He then proceeded to do a pulp
test of my teeth and found out I have no feeling in the tooth where the
"cyst" is. He is an experienced surgeon, so his puzzled look concerned me.
He ended up telling me "Maybe we should sent you to a root canal
specialist". I left his office feeling quite concerned. I didn't
originally notice until after the XRAY that there is a small lump on my gum
around the area of the tooth. He pressed on it, but it doesn't seem to hurt
much to the touch. If I press below it, it's mildly sore. Has anyone
experienced anything like this? He said it looks like it could be an
abcess, but he said it doesn't make sense because it's under a front tooth
and there has been no filling or dental work near the tooth?

Any suggestions? I'm afraid to let them "try" a root canal if it could be
something serious. Could exposing it make it worse? I apprecaite any
suggestions / thoughts.

Thanks,
Dave

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Mark & Steven Bornfeld - 22 Jun 2006 22:49 GMT

> I had a dental exam a few months back. After getting a Panoramic XRAY of my
> teeth, my dentist asked me "Has anything changed in your medical history"..
[quoted text clipped - 23 lines]
> Thanks,
> Dave

    Obviously there's no way to know--the obvious guess is that the tooth
is abscessed. Remember that these teeth probably erupted around age 6
to 8, so it's quite possible you suffered a fall and damaged the nerve
and can't even remember the event. Many dentists don't take full-mouth
x-rays in caries-free mouths, so it is quite possible that lesions like
these can escape detection indefinitely.
    The fact that the oral surgeon had a pulp tester certainly points this
way. I can't account for the puzzlement, since we see these kinds of
lesions all the time. The appropriate treatment if my surmisal is
correct is a root canal, which should be rather simple and painless in
this case.
    Some of these cases do become cystic--that is, the area of bone
destruction is lined more or less by epithelium (a layer of cells). But
this is not a primary area for cysts, and unless there is something
unusual about the appearance on x-ray that I'm not getting, I see no
reason for CATs, surgery, etc. at this time. Your surgeon would be the
one to ask if there is anything worthy of biopsy.

Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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David Nugent - 23 Jun 2006 00:16 GMT

Steve, thank you so much for your reply. You have calmed me down quite a
bit. I've been
nervous all day thinking about this. The only "positive" thing I remember
the surgeon saying
is "I don't think it's anything ominous". But he did seem quite puzzled.
He didn't seem to
think it couldn't be an abcess because it was near no fillings, or other
dental work. He also
seemed to think the location didn't seem consistent with being hit by
something. But perhaps
years ago something did happen that I don't recall. He did have an XRAY
from 16 years prior.
He mentioned the root canal? seems extremely wide (almost double what he
usually see's) but
he said my 16 year old XRAY showed almost the same size so it is probably
normal for me.
I didn't think to ask him at the time, but how can a root canal help?
(Unfortunately I had to
drive 5 hours just to see him). I thought a root canal was used to save a
tooth. Does the no
feeling mean my tooth is dead? If so, will they remove it?

I REALLY appreciate you taking the time to reply to me e-mail!
Dave

> > I had a dental exam a few months back. After getting a Panoramic XRAY of my
> > teeth, my dentist asked me "Has anything changed in your medical history"..
[quoted text clipped - 43 lines]
>
> Steve

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Steven Bornfeld - 23 Jun 2006 03:24 GMT

> Steve, thank you so much for your reply. You have calmed me down quite a
> bit. I've been
[quoted text clipped - 20 lines]
> I REALLY appreciate you taking the time to reply to me e-mail!
> Dave

I may be missing something here. You said this is a lower front tooth
IIRC, and this is a very common area for dental trauma. Furthermore, if
the root canal is very large (esp. compared with the same tooth on the
other side) this is consistant with trauma to the tooth at an early
age--perhaps even before root formation is completed. I have seen
nonvital teeth without history of cavities or fillings in this area
many, many times, and find it unusual that an oral surgeon would be at a
loss here. Again, I'm just going on what you're saying. If there's any
way to scan the x-ray image and post it somewhere, I think things would
be clearer.
Root canal treatment cleans out the root canal system and fills it with
an inert substance (usually gutta percha). If the root canal system is
very wide open and root formation is not complete sometimes a procedure
known as apexification is done. While some people refer to non-vital
teeth as "dead", in fact the root still receives blood supply from the
ligament that surrounds the root. Access to the root canal of the lower
front teeth is usually achieved from the tongue surface of the tooth.
It is quite likely that the opening can be closed with a small white
filling after the root canal has been completed. Most teeth that have
had root canal should be crowned afterward, but your tooth is most
likely one of the relatively few which shouldn't need this. The root
canal should be fairly easy and quite painless, since there is almost
certainly no living nerve remaining within the root canal system.

Good luck,
Steve

>>>I had a dental exam a few months back. After getting a Panoramic XRAY
>>
[quoted text clipped - 85 lines]
>>
>>Steve

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