There is a paperclip icon above the text box, which opens a window called "Manage Attachments." That's how I tried to attach a couple of xrays on my first post (unsuccessfully). It seems to do the same thing as what you described.

I tried it again. In case it works, Bryanna, the first image is an xray the endodontist took before the tooth was extracted. The tooth on the left is number 19. The second image is the panorex taken a week later, and the third image is the dental xray taken in August showing the root channels filled in.

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Thanks to Chemar, I was able to finally post some images.

Bryanna, would you mind taking a look at them (see previous message) and rereading my first post? I would love to learn what you think.

Besides the root tip, do you see anything worrisome in the panorex, especially around the extraction site, but really anywhere in the image?

Do you see any evidence of a root or crown fracture in the first xray image, which was taken the day before the extraction? Do you see anything worrisome in that image?

Comparing the panorex to the last image, which was taken last August, almost a year after the root tip was removed, do you think it's likely that the jawbone is clear of infection?

Hi Parminides,

Thanks for posting the x-rays!!
Sorry for the delay.... I work varied hours throughout the week so I am not able to be here all of the time. A big thank you to Chemar for guiding you through the attachment process

I will re post your questions and answer in bold type.

<<<Besides the root tip, do you see anything worrisome in the panorex, especially around the extraction site, but really anywhere in the image?>>

THE ROOT TIP WAS NOT ACTUALLY AT THE SURFACE. IT WAS CAUGHT IN HIGH UP IN THE OPEN CHANNEL WHERE THE MESIAL ROOT USE TO BE. I'M GLAD IT WAS REMOVED.
I CAN SEE THAT YOU HAVE GENERALIZED BONE LOSS THROUGHOUT YOUR DENTITION. YOU HAVE SOME OVERCROWDING/CROOKED TEETH IN THE FRONT LOWER ARCH WHICH CAUSES AN OVERLAPPING OF TEETH ON THE X-RAY MAKING IT DIFFICULT OF DISTINGUISH ONE TOOTH FROM ANOTHER. HOWEVER IT DOES LOOK LIKE YOU HAVE MODERATE BONE LOSS ASSOCIATED WITH SEVERAL OF THOSE TEETH.
YOU ALSO HAVE SOMETHING IN THE LOWER RIGHT BONE BEHIND YOUR SECOND MOLAR. LOOKS LIKE A SMALL WISDOM TOOTH THAT NEVER FORMED COMPLETELY OR A REMNANT OF A WISDOM TOOTH. HAS ANYONE MENTIONED THAT AREA TO YOU?
THE UPPER FRONT AREA HAS A LOT OF SHADOWING IN PART DUE TO SOME OVERLAPPING/CROWDING OF TEETH THERE ALSO. SO IT IS DIFFICULT TO SEE THE ANATOMY CLEARLY. HOWEVER, TOOTH #7 ...AND POSSIBLY #9 MAY HAVE SOME HEALTH ISSUES DUE TO THE SPREAD OF INFECTION FROM TOOTH #8. IT WOULD BE WISE TO HAVE A FEW PERIAPICAL X-RAYS OF THE UPPER FRONT OF YOUR MOUTH TO SEE THE BONE MORE CLEARLY. HAS ANYONE MENTIONED ANYTHING ABOUT #7 AND 9?

<<Do you see any evidence of a root or crown fracture in the first xray image, which was taken the day before the extraction? Do you see anything worrisome in that image?>>

IT APPEARS TO ME THAT THE MESIAL ROOT (ROOT TO THE LEFT OF BOTH ROOTS) WAS FRACTURED FROM THE CROWN DOWN TO THE ROOT. THERE WAS DEFINITIVE PATHOLOGY IN THE BONE SURROUNDING THE MESIAL ROOT MOVING OVER TO THE DISTAL ROOT. SO IT WAS WISE TO HAVE THAT TOOTH REMOVED.

<<<Comparing the panorex to the last image, which was taken last August, almost a year after the root tip was removed, do you think it's likely that the jawbone is clear of infection?>>>

THE MAJORITY OF THE HEALED EXTRACTION SITE HAS FILLED IN AND LOOKS PRETTY GOOD IN THE LATEST X-RAY. HOWEVER, THERE IS A SMALL DARK AREA SHAPED LIKED A HALF MOON JUST BELOW THE GUM ON THE MESIAL (LEFT) SIDE OF THE EXTRACTION SITE. I WONDER IF THIS IS A RESIDUAL POCKET OF BACTERIA??? YOU SAID YOU WERE STILL GETTING SOME DRAINAGE ON THE BUCCAL AND THAT MIGHT EXPLAIN IT.

Bryanna

Bryanna, thank you for looking at the images.

Yes, other people have mentioned the wisdom tooth remnant, which has been interpreted as another root tip (although it looks too wide to me).

Other people have also mentioned that the bone loss associated with #8 has spread and will potentially affect other teeth. When I had #8 pulled in September 2012, they added a bone graft or some kind of filler. Other than that procedure, I've put #8 and its neighbors on the back burner until I have a handle on this leaky #19 extraction site.

You said that you think #19 had a crown to root fracture. Would you look at the attached image? Does the yellow line I added correspond to what you think might be the fracture?

You also mentioned a slightly darkened area just below the gumline on the most recent xray (from last August). That was a very interesting observation. I wonder if you're not on to something there!

There are three things on the panorex I'd like to ask you about. Do you see the dark area under the molar roots on the right side of my mouth (left side of the image)? Notice how much darker it is compared to the same area on the left side. Does that mean anything to you? Is it something to worry about? (It's not an artifact unique to this image. The right side is darker in all the panorexes I've had.)

Do you see how the root channels from the extraction site appear to actually enter the mandibular canal? (This is not an optical illusion. It is evident from the slices of the CT scans.) Why didn't the infection from the original dental abscess go into the canal and travel somewhere else, such as the neck? Do you think that the dentist who extracted #19 would have seen that the channels entered the canal visually after he pulled the tooth, or would everything have been too bloody? What are the possible complications of infected roots impinging on the nerve canal?

Lastly, do you think the panorex indicates that the roots in my upper arch teeth go into my sinuses? I seem to have been blessed (or cursed) with particularly long roots.

Sorry to ask so many questions, but you've finally seen the pictures!

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Parminides,

Do you recall if your lower right wisdom tooth was extracted and that is what was left behind? It looks like the crown portion (the top) of a wisdom tooth that is remaining in the bone.

Yea, I am concerned about the spread of bacteria and bone loss associated with tooth #8. I know you want to put that area on a back burner but that might not be such a wise thing to do. According to ancient chinese medicine, that area of the mouth is connected to the urinary and renal collecting system. Which means the bacteria from that area will likely travel to those other systems. I can tell you from my professional experience that I know of patients who had infections in the upper anterior teeth who also had bladder, prostate and/or renal problems.

The yellow line that you drew (nicely articulated by the way) could be where the fracture was or that could be your normal anatomy. I see a possibility more towards the center of the tooth, just left of the center that starts at the crown of the tooth and travels down through the pulp chamber into the distal portion (near the back) of the mesial root (first root). Did the dentist show you where the crack was? Do you know how you cracked that tooth?

Yea, there is a small void in the bone just below the gum line where tooth #19 was. Frequently a dentist will not pick up on this

The darkened areas on the panorex pertaining to your lower right side may be indicative of an infection. A periapical xray may be helpful in determining that. If it is, I would tend to think it could be linked to that odd wisdom tooth in that quadrant. You said that area has looked dark on other panorex films. Has the darkened area gotten larger? Is there any drainage or pain in that area? What have your dentists said about it? How did that area show up on your CT scan? If it has not been evaluated by an oral surgeon, I think it should be.

I'm not positive if the roots of your lower molars go directly into the mandibular canal. Keep in mind these are only 2 dimensional xrays. The CT scan may have showed something different as you said.

Regarding the travel of bacteria from an infected tooth to another area of the body... it depends on what area of the body shares the same meridian path with that tooth. Here is a chart that shows those paths....
http://toothbody.com/wp-content/uplo...v2.1_rehme.swf

The dentist who extracted #19 may have been able to tell if he was in the mandibular canal because that area feels different than bone when you touch it with an instrument the texture of the blood may be different also. But typically general dentists do not really look for these signs.

There are a variety of possible complications regarding infection and the mandibular canal. Each case would be different. Some people may have temporary or permanent numbness, others may have radiating nerve pain, some could have temporary or permanent facial paralysis, others may end up with further infection.

I think you definitely have long roots!!! It is very possible that the posterior teeth are either in or in close proximity to your sinuses. The pan is just a 2 dimensional xray.... so it can be deceiving when trying to view it from that perspective.

Bryanna






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Thank you so much for your detailed reply.

I remember that all four wisdom teeth were pulled at one time, and that the dentist had a lot of trouble with one. This was about twenty years ago, and I don't remember if he told me that he left a piece. But I haven't had any trouble from there.

I'm attaching an xray from last August of the #8 area of my mouth. See what you think about it.

I think I see what you suspect might be a crack in #19. It was an endodontist who said the tooth was cracked (after a general dentist said he suspected a crack). The endodontist did not show me on the xray. I was in pain and ready for some relief and wasn't too skeptical or interested in challenging him. If it was cracked, I have no idea how I got it.

I don't think the dark area on the right side of my mandible has gotten larger, although it's hard to say for sure since every x-ray has its own artifacts, etc. In September 2012, with the root tip still inside, the extraction site of #19 burst like a blister and drained completely. The swelling was gone and the area felt normal for the first time since the tooth had been pulled.

For a brief period it wasn't draining. During that period I noticed drainage coming from the dark area on the right side (which I've dubbed the mandibular swamp!). Apparently that drainagae source had been "drowned out" by the #19 drainage before then.

The general consensus is that the mandibular swamp is just a normal variation between my right side and left side. That seems strange to me, but that's what I've heard over and over. The way some people put it is that my nerve canal is wider on that side. It's very evident in the CT scans was well. It's like a cave on the right side.

One oral surgeon said the drainage I once perceived in that area might be discharge from a deep periodontal pocket. That same oral surgeon later said it might be a tumor or neoplasm and wanted to do a deep bone biopsy. I never let him do it because I lost confidence in that guy, who was really the only one who's seen me who ever thought that dark area might be bad.

Are you starting to understand that my mouth is a riddle wrapped in a mystery, surrounded by an enigma?

The track on the image of #19 pre-extraction (that I outlined in yellow) has bugged me to no end. Notice that there's overlapping bone to the left of it but none to the right. It just doesn't make any sense to me at all. Dentists have tried to explain to me that it's the angle of the camera, it's 3-D compressed to 2-D, etc. But no explanation convinces me that the overlapping bone should just abruptly stop like that.

When I was asking about the spread of infection, I just meant by the simple pathway of infection in #19 root channels spreading to mandibular canal and then traveling along the canal into the neck, just because there's a clear pathway. I've wondered why the infection didn't do that.

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Parminides,

I cannot enlarge this xray but it does look like tooth #9 and 10 have problems. It looks like there is an infection in the bone around both of those teeth. Tooth #7 is not on this x-ray. The root of #9 appears to be disintegrating. Surely you have been informed about these teeth by at least one of the dentists you have seen??

Yea, that piece of wisdom tooth on the lower right is not in a good place. If you had drainage on that side then that would indicate an infection and that could be why that area is so dark on the xray. I think this needs further evaluation as well as the upper front.

Bacteria from an abscessed tooth does not have to follow any particular pathway especially if it is draining out through the gum. So that could be why the infection from #19 didn't end up in your lymph nodes under your neck on that side.

Bryanna

Thanks for continuing to answer my questions. I really appreciate it.

I provided a side-by-side comparison of 3 xrays showing #8. The leftmost one was taken in May 2012, about a week after #19 had been pulled. (What in the world are those two dark, slanted lines at the top that seem to outline a small-scale version of Mt. Everest in my mouth?) The middle xray is from Aug 2012 and the last one is from Aug 2013.

After comparing them side-by-side myself for the first time this morning, I'm disappointed that there seems to be little if any bone regeneration since #8 was yanked.

I knew that the bone loss around #8 had endangered the adjacent teeth, but no one made it sound as dire as you do. The first oral surgeon thought an implant was possible if I had bone and soft tissue grafting when #8 was pulled, and possibly secondary grafting before the implant.

Another oral surgeon pulled #8 in Sep 2012. His records state that "Foundation graft placed 4-0 chromic gut." I'm almost certain that he didn't do a soft tissue graft.

What do you think needs to be done about the #8 vicinity after learning some more history and seeing a couple of more xrays?

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Parminides,

Thanks again for posting the xrays.

The two dark "Mt Everest" lines are an artifact indicating the film may have been bent during the exposure. It is not your anatomy

Yea, I think there is something brewing in the upper front quadrant of your mouth. Tooth #9 appears to have a cavity on the distal portion of the root surface. The root of this tooth is also misshapen indicating bacteria and/or lack of vitality.

The lack of bone regeneration is caused by the chronic bacteria that is still residing in the bone not just from the previously abscessed #8 but from your periodontal disease as well. In addition to that the adjacent teeth do not appear to be healthy which is also preventing the #8 site from heal properly.

The more xrays you post here the more obvious it becomes that your periodontal disease is not under control. I don't mean to sound so "dire"... I am just telling you as I see it. I am puzzled as to why a dentist has not informed you of the things that I have.... especially since it seems that you have seen various dentists. Or have you been informed and perhaps don't believe it or it scares you or......??

I can see without a doubt that tooth #8 was infected for quite some time. Whether you had symptoms or not, a tooth does not become that abscessed unless it has been brewing for possibly a few years or more.

If I had to prioritize I would say that your biggest dental problem is your periodontal disease..... second the infected teeth that you may have which need a clear diagnosis ...and third the generalized bone loss. The xrays indicate you have deep pocketing and/or various areas of gum recession.

What are your thoughts about the periodontal disease?

Also you asked me awhile back about oil pulling....
This is an ancient therapeutic method used to keep healthy gums healthy. It can also be beneficial in those with periodontal disease but cannot take the place of proper periodontal therapy or professional cleanings.
A simple version of this is.... place one tablespoon of melted coconut oil in your mouth and move it around coating your entire mouth, teeth and gums. Do this for at least 1-2 minutes or longer. Then spit it out. You can brush afterwards.

Bryanna