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I would like some answers because I am extremely worried

Hello, I would like some...
Hello, I would like some answers because I am extremely worried about my panoramic x rays which show a lesion near the wisdom tooth bone. The dentist flagged it for concern because it looked slightly different from a previous pano from 5 months ago at a different office with a different dentist. There is a dark spot from the old pano that is higher than the recent pano which shows the dark spot overlapping with the tooth. My tooth does not feel any pain or exhibit any other symptoms. The gum and tooth all look normal and there is no pocketing. What can cause this lesion and should I be worried about it? Could the dark spot from the old pano have just shifted due to distortion since it is a pano? I can attach my 2 panos for review.
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3/31/2017
Just Dental Truths!
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Yes, please do send picture of the old and new, if you would please for comparison. Thanks you!

Dr. Rampton

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Customer reply replied 7 months ago
Attached are my two panoramic x-rays. The first was taken 10/29/2016. The second was taken 3/29/2017.

Thank you for the pictures.

I'm NOT at all worried. The dark spot/s are loosely called in Dentistry "dead air spaces." You could look that term up on Google, and you'll see panoramic x-rays with that dark look. Yes, there could have been some shifting/different angles, etc. No two x-rays will ever look alike. The dead air spaces (dark areas) generally show up as dark, well defined/bilateral on the x-rays. However, as you mentioned, on this 2017 x-ray it appears admittedly more unilateral and not as square, but more of an odd shape. I do not think you have an abscess, although it is a 5% chance or less that you could. Just watch & observe, if pain, see your Dentist... I think more likely though, even though it is unilateral and not as boxed shaped as 2016, that it still is 95% chance of being "dead air space." Which really means, with all of the angles that there is some of the panoramic x-ray that just ends up with some more opaque and/or radiolucent (dark).

But summarizing: I see nothing that I would deem troubling. I hope this helps you. Personally, I'd without any ill symptoms, just keep an eye on it, and get another pano. next year. It likely will not be there then, or will look more similar to the earlier 2016 panoramic x-ray.

Dr. Rampton

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Customer reply replied 7 months ago
Upon recommendation from the dentist, today I went to a periodontist who performed a CBCT and my dentist thought that there might need to be a biopsy done. Is this overkill?
Customer reply replied 7 months ago
I'm just trying to figure out how one office thinks I'm fine, and the other office thinks I have something serious.

Well, it's hard to read the minds of those whom you've never met. More than likely, your Dentist is just looking out for your best interests... The difficult to swallow part is that the scan you had, will cost somewhere between $300-700. I hope your insurance pays well.

So, if it were me as your Dentist, I might have done the same?? But I'd also want to ascertain that your back molar, being all alone in the back is assymptomatic (showing you no pain or troubles). If it is causing no troubles, good. Now, once you have this extra CBCT scan, coupled with no symptoms, a more clear "leave it alone & check it out in the future" Dental visits assessment can be made (Likely). Or, a decision that it may be an abscess. But if no pain or troubles, it is likely no abscess! Just a dead air space. And if dead air space, another panoramic x-ray could be taken tomorrow, and it would look like the 2016 (Older x-ray).

Am I making sense?

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Customer reply replied 7 months ago
I think I understand. So no cancer? I'm just worried since I'm a former smoker that quit a few years ago.
Customer reply replied 7 months ago
Also I'm a little unclear on the additional insight the CBCT provides.

NO., no, no! NO CANCER !!!

You have no "C" word going on - you can dismiss that one. Likely dead air space (Or nothing at all going on - just artifact), or a slim chance of an abscess (Unlikely). And you'll know more when the CBCT comes back, or another Panoramic x-ray is taken!

NO C!!!

The extra CBCT you are referring to, provides more of a 3 Dimensional image. They are great for some things, and sometimes a bit oversold for use of everything. Much like everything in life.

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When did your Dentist suggest coming back to hear of the CBCT scan results?

My suggestion:

1) Get the result from the extra CBCT today. Likely there will be no evidence of trouble.

"if" concerns still exist

2) Have your Dentist take another March 2017 panoramic x-ray. I'll bet 95% chance that the x-ray will look much like the 2016 x-ray, with bilateral dark spots (dead air spaces). And story over. You'll feel good again!!!

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Customer reply replied 7 months ago
I find out the results of the CBCT next week, as they said it takes a few days for the radiologist to come back with the report.I'm just surprised that the dead air space overlapped well with my wisdom tooth, which caused this new dentist to want all these tests done to make sure it was nothing.They also said that there was potential infection in my bottom front teeth due to going a couple extra months without a cleaning (I usually get them every 3 months). Is that really evident from the recent pano?

Did you say the Dentist is fairly new, meaning younger?

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Customer reply replied 7 months ago
No she is my new dentist. she has been practicing for 20 years now.I made an appointment with my previous dentist to re-check again my pano since I have been going there for few years now.
Customer reply replied 7 months ago
You think there is no cyst either?

Good. I'd generally speaking, always go with someone who has been practicing for 10-15 years, as a general rule. They usually have more experience, and less debt, and not likely to be ordering additional tests, cleanings, CBCT's etc., if you know what I mean?!?!

________________

Let me just reiterate, I think (and it's too late tonight now) that if you were to take another panoramic x-ray tonight - it would look more like the 2016 one...!

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Customer reply replied 7 months ago
Thank you very much for everything. You were very helpful and provided much more explanations than both the dentist and the perio. They'll call me when they get the CBCT report. You're right -- it did cost me $350 but if it helps give me peace of mind...I'll also ask my previous dentist to retake a pano tomorrow. I'm hoping that will also look more similar because it's the same machine and not a different one.

Oh I think you are wise! It very well could be "and likely is" the angles your previous Dental personnel took the panoramic x-ray from. Tell your previous Dentist, if they don't already know the story - and they'll likely not charge you much if any for the additional panoramic...

One last thing: You can comment back to me for 7 days. Just Answer won't charge you any additional. And of course, I'll be happy to also address any additional concerns you have, should you have any after tomorrows x-rays - OK? So let me know... I'd like to help, if I can. Tomorrow should be enlightening.

Dr. Rampton

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Customer reply replied 7 months ago
I will definitely let you know. Again thank you so much and I hope to have good news tomorrow.

I think you likely will. And for certain receive more clarification.

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Customer reply replied 7 months ago
Oh sorry one more question. How many Implant do you think I should have so I can chew again?

Totally a judgement call, person to person. Dentist to Dentist. You may want to have 7 more, but they are costly. Have you ever considered going to a nearby Dental School for implants? Sure, they are slower... but much much cheaper (~50-60% less).

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Customer reply replied 7 months ago
Would recommend the removal of this wisdom teeth?

Well... maybe, but likely NO if you within the next year or two get the space filled in, directly in front of the lower wisdom tooth. That way you can avoid the wisdom tilting more so forwardly/ it's called "mesial drift". And assuming there is not an abscess. But I don't think you do have an abscess, as discussed earlier.

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Customer reply replied 7 months ago
How you know you have oral cancer? I heard it was a very rare but could happen.
Customer reply replied 7 months ago
Are dead air space considered lesions? I think the dentist terminology get me confused.
Customer reply replied 7 months ago
How do you know the dark space is a dead air space VS something else (cyst, infection, etc)

Dead air space is slang for essentially artifact. Or false readings due to attempting to reproduce images that are two or three dimensional from a singular one dimensional source - the x-ray machine.

I don't KNOW 100% certainty to almost anything, nor does anyone else. That is why I give my opinions and suggest and give approximate value such as 95% or similar examples.

Oral cancer, in the bone, is rare. It does happen, but rare. But it's rarely seen on an x-ray first. It is generally almost always first noticed due to signs & symptoms of the patient, symptoms & signs of pain, growth, color changes and obtuse changes.

___________________

As I mentioned earlier, a new panoramic x-ray will most likely (Say 95%) show the x-ray to look like the 2016 x-ray. 5% chance that the wisdom tooth has an abscess (Not likely). And almost 0% chance of being some type of cancer.

I hope you can rate my answer when you have read this. And please DO let me know how tomorrows x-ray turns out - alright?

Best wishes to you Lili.

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Customer reply replied 7 months ago
Hello. I had the second pano done with my original dentist and everything looked good like even better than the 2016. He also did a bitewing x ray of that tooth and again nothing there. You were right it was dead air space. I am just suprised that the last dentist didn't think of doing a bitewing x ray or even a cold test on my tooth to check the nerve. I am speechless because it could have saved me from spending for the cbct. Still no report from it yet.

I am so pleased with the results you now have obtained...

One thing you may want to try: Explain to the Dr. who took the CBCT, about the new panoramic x-ray, and how it now, in retrospect, was NOT at all needed. And how you wish the charge could be rescinded, or minimally ask the Dr. if he/she can work with you to abte the cosy impediment. Ask really nice. You'll "likely" benefit and pay less and possibly none.

I'm happy for you, and kindly wish you all the best!!!

Dr. Rampton

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Customer reply replied 7 months ago
I am still nervous because i haven't received the result from the CBCT. I am not completely reassured quite frankly. I am completely traumatized by this entire experience.

But did they not take another Panoramic x-ray and it looked more like the 2016 film? That should confirm, at least to me, that your wisdom tooth doesn't have a problem!

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Customer reply replied 7 months ago
Of course no problem. They took another pano and a bitewing x ray. It's jsut that i havent received my cbct results yet and i am anxious still.

I understand. I presuming they'll be explaining such to you this week though - correct?

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Customer reply replied 7 months ago
Right. I am still very anxious becaue I don't know what else they can find.

All I will say is the CBCT will NOT show anything derogatory. You may want to see if they can adjust some of the cost for you, as the second panoramic x-ray pretty much cleared things up and the CBCT was thus not really needed. It's up to you. But I would make an adjustment if you were my patient.

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Customer reply replied 7 months ago
Ok. I trust you. I don't think they will because I went in that office to get checked by a perio and I don't think they will adjust it. I am so mad at the situation really. I wish that dentist who scared me could have done a bitwing x ray and a cold test on my tooth instead of just wondering if my pano was normal or suspicious. I had to go to my former dentist and got other x rayss like you recommended. Anyway My new pano seemed more clear yes and didn't show any lesion. In one hand i am reassured but on the other hand now I am traumatized thinking what else are they gonna find.

I'm confused? What else are they gonna find? My answer is, nothing.

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And, if you explain the story to them. Then, ask very nicely if they would consider "working with you" on the price of the CBCT (Cone beam x-ray), I KNOW most Dentist/Periodontist, etc., will all tend to work with people. But you have to ask!

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Customer reply replied 7 months ago
I don't know. I never had a cbct done before. I don't even know what they look for quite frankly. Maybe that is why I am nervous. I will try to ask them tomorrow if they can work with me :)

OK, good. Everything will work out...! ( -:

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Customer reply replied 7 months ago
Report attached. Could you give me your impression

This Dr. Bechara's assessment is that everything about your mouth and sinus and other areas senn is "WITHIN NORMAL LIMITS"!!!

It's all very good Lili... I'd be pleased. Congratulations ( -:

Dr. Rampton

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Sorry, other areas seen is within normal limits

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Customer reply replied 7 months ago
the wisdom tooth is not an area for concern? It says high density. What is that mean?
Customer reply replied 7 months ago
Also what is going on with tooth n25?

Dr. Bechara only commented specifically about those areas because of your Dentist's specific concerns for such. But good question

He's saying that the wisdom tooth (#32) has some more dense bone below it and to the rear (back of the mouth) to it. This is actually "good" news. Strong bone. Dense meaning strong. And #25, he's saying it has periapical osseous dysplasia and is normal & has no concerns about either tooth or any other teeth. Periapical (around the tooth root area), osseous (bone), dysplasia is slightly untypical from what is normally seen cells or boney area.

I'm just being a straight shooter with you, you have NO worries, honestly.

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Oh, did they reduce the fee for the Cone Beam x-ray?

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Customer reply replied 7 months ago
Nope. I asked and they say we asked you if you wanted to have a CT scan and I said yes :(. Therefore I have to pay. I am sorry that I am asking you all of those questions. I feel that they don't really spend time explaining anything and I get confused all the time. Thank God for those services online. I got my cleaning this morning. I need to focus on implant now. It was a nightmare really. I am gonna try to enjoy the rest of my week now. Hopefully. Thank you so much for everything. I wish you were my dentist :)

OK, but "you" didn't ask for the CT scan, your Dentist did.

If you want to let this go, we can do so. But if you'd like I can attempt to contact this periodontist (Bechara) if you'd like?

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Customer reply replied 7 months ago
I am sorry but I would like to ask you again about tooth n25. Should I get a root canal for it? I am still confused on what it means bone change? I have bone recession in this area. It is genetic.

NO! In fact Dr. Bechara, who gave feed back about the Cone Beam x-ray said that he had no recommendations for any treatment for tooth #25! I agree.

No need to be worried when there is nothing that any of your Dental personnel think should be done - right?

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Does this make sense?

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