Siobhan,
Thank you for providing more information.
Regarding the dental injection... please do not assume that if a dentist uses the "wand" infiltration system that the injection will be perfectly administered as the dentist can regulate the speed of the injection. I have worked with that system and there are times it fails to perform and/or it does not allow profound anesthesia because the injection may not be deep enough. That is not to say that it does not work okay most of the time .. .. it's just not a definitive fool proof system. Also, I have never personally known an oral surgeon who utilizes the system because they usually prefer full control over the injection and infiltration of the anesthetic. Irrelevant of how an injection is given, there are some areas of the mouth that are going to be more sensitive than others. The KEY to giving the least painful, safest and most effective dental injection is .... calculated and strategic position of the needle, administer the contents slow and steady and take a second to quickly pull back slightly on the plunger to make sure a vessel has not been hit. All dentists know to do these things but not all follow that protocol.
It is important that you speak to the oral surgeon if you are concerned about the type of anesthetic that he uses. Don't be shy to discuss this as many people who have allergies need to discuss this with him.
I think the CT would be helpful especially since there could be a sinus communication with this cyst. I think the os suggested that you see an ENT because he is not sure if the sinus is involved. As I mentioned before, the CT would give a deeper, clearer view of the location of the cyst. Without that "view" the os would have to estimate its location, depth and sinus involvement which could result in a larger incision and some otherwise unnecessary exploration.
So the os that you are going to have the surgery by did not take his own panorex xray? That is not ideal and here is why. A physical copy of a dental film is less diagnostic than a digital film that is sent directly from one dentist to another via the computer. A digital xray can be put into the imaging system of the computer and the dentist who is viewing it can temporarily alter the gray scale of that xray to give him an in depth view of certain areas. He can also zoom in on areas whereas on a physical copy he cannot do those things.
Prior to the advancement of multi slice CT scans, surgeons had to make an educated guess on the size, location and involvement of a cyst in the jaw bone or sinus area. Then they would make an incision based on that guess and feel around with various instruments for the right location. Thanks to the scans, that guesswork it taken out of it and the surgeries are less complicated.
Bryanna
Quote:
Originally Posted by Siobhan
Thank you again, Bryanna.
I see, I shouldn't really be very firm on the epi since I don't want him to refuse to treat me! Better stick with the speed of the injection. I read somewhere that wands deliver the injection automatically at the exact best speed - is that correct? If he does use them (he's a proper real oral surgeon), does it really mean I have less to worry about?
Yes, my general dentist removed this tooth. I've had a small partial made for me beforehand, which only has this tooth and another 2 teeth on the other side, which I've been missing for a long time. So I'm happy with this at the moment.
There's a bit more to the story and I thought it wasn't that important because there were no real conclusions, but here it is ...
The dentist was positive there was nothing up there or anywhere (I saw him a few times) ... but I kept asking and going back. He said there was no need for any further xrays. I even saw another (ie. different) oral surgeon who also said "hopefully there's nothing there ... you don't want me to go in there, it could make things worse". Why and how would it make things worse??? So again I got nowhere.
Then I spoke to my doctor and had a quick ultrasound of that maxillary sinus area and it confirmed "complex cyst / lesion with possible bone involvement". Pretty much the U/S confirmed what I've been saying all along, but it does not specify the exact location of the cyst, except for "immediately next to maxilla".
I saw the (first) OS again with that report, he then said he can almost feel the lump, and sent me to an ENT and for a CT.
I skipped all that and found another oral surgeon. He told me right away that he can see the tiny tiny 'pimple' / lump, even though it is all the way under the fold, high up above where the root apex was (I think there is a distance between this mini lump and where the apex was - WHY IS THAT, wouldn't the cyst/lump be where the tip of the root was??). You need to push your finger all the way to the very end (and a bit further) under the mucobuccosal fold to be able to feel it. The lump is not on the external/buccal/lips side but rather on the teeth side, high up under the nostril. Is that normal? Would he be able to reach it for surgery without cutting externally?
Anyhow, he said he needs to take it out. I asked him if I needed further imaging (as suggested in the U/Sound report), but he immediately said not really, he could do with plain xray of that area, or even nothing (he has my panorex). But later he still gave me a referral for CT, and we left it at that as I was a bit reluctant to have the CT on the day (and when I came home, even more so). He said cysts on anterior maxillary teeth are quite common and he removed some recently. Unfortunately, I left the radiograph with him for the time being.
By the way, this pimple/cyst/lump is quite firm to touch and does not move around. Is that of any significance? The first OS told me that this does not seem like a typical residual infection cyst. Would a CT really be able to differentiate between different types of cyst, would it have any extra diagnostic or treatment benefits??
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