I just keep thinking about this dentist. The first thing he showed me looking at the ct scan pictures was the white spot you told me about ( the root canal material above the root of the extracted tooth ) while no any other dentist ever mentioned that to me. So I thought, he is a good one. Why would he say that he doesn't know what is that black cirle ? Even if he was a second opinion dr. for the tooth extraction site problem ( he didn't do the extraction ) this black circle is above a totally different tooth, not above the tooth that was extracted, so there is no connection to the previous dr's work. And it's actually an " accidental " finding. And he said he wouldn't go in to remove that white spot and he wouldn't remove the black circle, there is no reason for any of it, no infection, no reaction around them.
Can a cyst be visible on x-ray or just the ct scan ?
Thank you again ! I really respect and appreciate all of your answer, and I even recommended this site to my coworker , telling her who knowledgeable and nice are you, to take time and answer to all of us here on this site. And I know you are telling all the facts the way they are, while some of the dentists are not honest at all.

nyuszisue,

Do you remember me asking you after you posted the panorex xray if you had other dental work planned? If I recall correctly you said no, not at this time.

Well the reason I asked you that question was because your panorex shows that you have some other dental problems. Although the film is lighter than ideal it is still fairly diagnostic. Do you want me to tell you what I see on this film or would you rather not know right now?

The finding on your scan is not really accidental. It is an indication that there is a problem with tooth #5. To be honest dentists hesitate to offer too much information about "accidental findings" with a patient who indicates they are only interested in one particular area or one tooth. Do you think that could be part of the issue you are having with dentists in general?

Yes, I would like you to tell me what do you see on the panorex. Please.
Thank you !

And Yes I went to that second OS with the extraction site problem, but I would've think if he saw that problem with this other tooth that he would tell me what the problem is, I didn't tell him that I'm interested in one tooth only. And after I red all of your posts about root canaled teeth, I was thinking of pulling this tooth too ( # 5 ) but after the extraction problems I had with tooth #2 , I'm very very scared to do it.
I think that because I went to him as a second opinion, he was the way he was. But he was very nice and if he would've said something need to be done, I would go back to him and not the first OS.
I told you that I don't have other dental work planned, because at my last checkup in November I was told everything is ok.

nyuszisie,

Dental Radiographs are a two dimensional picture and depending on the angle that they were taken and the quality of the x-ray, x-rays can tell one aspect of the story while clinical examination gives an additional diagnostic view. Panoramic films are not intended to take the place of single periapical and bite wing films. It is important that all aspects of the mouth be evaluated and not just one or two.

The panoramic x-ray that you posted is lighter than ideal (that is due to the amount of exposure that was used to take it, not because it was copied) so it is not possible to see every tooth clearly on this film. With that said, I will share my radiographic findings based on the this film that you posted on this site. I am unable to move that film to this page...otherwise I would.

Over the years you have had several teeth removed which has caused your existing teeth to shift out of their anatomical position. So it makes it difficult for me to be accurate with posterior teeth numbers. It looks like the shifting and missing teeth have both contributed to a misaligned bite which is has caused some excessive wear on your teeth especially your upper front 6 teeth.

The upper right quadrant...........
You are already aware of the remaining remnants of the root canal material. The extraction site appears to have been somewhat cleaned out but not completely. This could be why you still have that puffy feeling in that area. This site may or may not heal completely. It is a judgement call as to whether a surgeon would be comfortable going in and debriding it at this point.

Also in the upper right quadrant it appears that you have some pocketing in between teeth #4 and 5 and 5 and 6. This could be due in part to the bacteria that resides on the inside and outside of tooth #5 the first pre molar. This tooth also appears to have some pathology at the apex of both roots. That could be the same dark circle that was seen on the ct scan and possibly a cyst forming. Again, the formation of a cyst is typically seen with root canaled teeth. But don't mistake typical to mean okay.... this is not a healthy tooth. It may even have decay but that is not clearly evident on this film.

The upper left quadrant....
Tooth #11 the lateral appears to have excessive wear on the lingual (back) portion of the tooth but it is vague on this film. Tooth #12 the first premolar appears to have some pathology going on surrounding the root structure of this tooth. Then you have a space where a tooth is missing. It appears that there is cystic and bacterial pathology in the bone partially in this space attached to the molar directly behind it. This molar I'll refer to as #14 and it has been root canaled. It has a very large area of radiographic pathology, possible decay and possible fracture of the root system. This tooth does not look healthy and definitely needs further evaluation. There appears to be a deep pocket between #14 and #15 the last molar in that quadrant. This last molar may have decay and pathology also.

The lower left quadrant...
The first molar #19 has a deep restoration and appears to have decay or a defect underneath the filling. There may also be radiographic pathology at the end of the distal (back) root of this tooth.

The lower right quadrant...
There could be recurrent decay underneath the filling on the first molar which I will call tooth #31.

Panoramic x-rays are diagnostic when looking at the upper and lower jaws in their entirety and when viewing the position of wisdom teeth along with some other anatomical structures like the partial sinus and jaw joint. However this x-ray is not intended to take the place of single periapical films and bite-wing films. Both of which are absolutely necessary to confirm various dental problems such a the ones that I have commented on here.

If your dentist has not mentioned any of these findings to you, then please seek a different general dentist for a full examination with all of the necessary x-rays.





[QUOTE=nyuszisue;1070701]Yes, I would like you to tell me what do you see on the panorex. Please.
Thank you !

Tooth #31 , I was at the dentist office 3 weeks ago for a pain I felt a few times, single tooth x ray didn't show anything wrong, actually it looked exactly the same like the last x ray of that tooth ( they showed me the two x rays on the screen one beside the other ) and the dr. did some kind a cold test on that tooth and the teeth next to it, they all reacted the same.
Tooth #14, the root canal was retreated last fall and I went for a follow up in March ( before the extraction story of this other tooth began ) and the root canal specialist said everything looks ok.
No, my general dentist didn't mentioned any of these thing to me at my last check up in November. She didn't see this panorex yet, it was the first OS who took this panoramic x ray in April of this year.
When you say pocketing and deep pocket ,what is that ?
And when I had the sinus ct scan, the dr. mentioned that on the upper left I have a tooth in the sinus ?

nyuszisie,

I will re-post some of your statements and answer them in bold type.

<<Tooth #31 , I was at the dentist office 3 weeks ago for a pain I felt a few times, single tooth x ray didn't show anything wrong, actually it looked exactly the same like the last x ray of that tooth ( they showed me the two x rays on the screen one beside the other ) and the dr. did some kind a cold test on that tooth and the teeth next to it, they all reacted the same>>

TOOTH #31 HAS A FEW ISSUES. ONE IS THE TOOTH HAS SHIFTED AND IS SEVERELY LEANING INTO THE EMPTY SPACE IN FRONT OF IT. THE ANGULATION HAS CAUSED THE BONE TO RECEDE ALONG THE MESIAL ASPECT OF THE TOOTH. THIS IS THE AREA WHERE THE FILLING HUGS THE SIDE OF THE TOOTH. FOOD WILL TEND TO PACK IN THAT AREA CAUSING THE GUM TO BECOME IRRITATED AND INFLAMED. YOU MAY NOTICE ON/OFF PAIN AND EVEN SOME BLEEDING WHEN YOU BRUSH OR FLOSS THERE FROM TIME TO TIME. SECONDLY WHEN YOU CHEW THE UPPER PRE MOLAR IS HITTING AGAINST THAT SAME MESIAL AREA. WHICH AGAIN CAN CAUSE INTERMITTENT PAIN OR INFLAMMATION. THIRDLY, IT APPEARS THAT THERE IS RECURRENT DECAY UNDERNEATH THAT FILLING.

<<Tooth #14, the root canal was retreated last fall and I went for a follow up in March ( before the extraction story of this other tooth began ) and the root canal specialist said everything looks ok.>>

TOOTH #14 DOES NOT LOOK AT ALL HEALTHY ON THE PANOREX. IT HAS SEVERAL PROBLEMS AS I HAD MENTIONED IN MY OTHER POST. RE TREATING A TOOTH WITH A SECOND, THIRD, FOURTH ROOT CANAL HAS NO POSITIVE EFFECT ON THE TOOTH AS THERE IS NO ACCESS TO THE MANY HUNDREDS OF MICROSCOPIC CANALS THAT WILL CONTINUE TO HARBOR NECROTIC INFECTED NERVE TISSUE. SO THE RETREATMENT HAS NOT ALTERED THE BACTERIAL STATUS OF THIS TOOTH IN A POSITIVE WAY.

<<When you say pocketing and deep pocket ,what is that ?>>

WHEN AN AREA BECOMES OVERWHELMED WITH BACTERIA THE BONE WILL RECEDE. THIS CAUSES THE DEPTH OF THE POCKET, THE AREA BETWEEN THE TOP OF THE GUM LINE DOWN ALONGSIDE THE TOOTH, TO BECOME DEEP. IF THE GUM TISSUE ALSO RECEDES ALONG WITH THE BONE THEN THE POCKET MAY NOT BE DEEP BUT A PORTION OF THE ROOT WILL BE EXPOSED. YOU CLEARLY HAVE EVIDENCE OF POCKETING/RECESSION ON THE UPPER LEFT AND UPPER RIGHT NEXT TO EACH OF THOSE ROOT CANALED TEETH.

<<And when I had the sinus ct scan, the dr. mentioned that on the upper left I have a tooth in the sinus ?>>

BOTH OF YOUR UPPER LEFT MOLARS ARE IN CLOSE PROXIMITY IF NOT IN COMMUNICATION WITH YOUR SINUS. FROM THE APPEARANCE OF THESE TEETH ON THE PANOREX, I WOULD NOT BE SURPRISED IF TOOTH #14 IS INFECTING #12 AND #15. TOOTH #13 HAS BEEN REMOVED.

Thank you very much for your answers.
Regarding tooth #14 i wouldn't be surprised if the root canal specialist say he did everything right and everything is ok, but wouldn't he see ( and tell me ) if there is decay and a root fracture, if there is one ? He took an x ray when I went for a follow up visit.
And couldn't the general dentist see on the x ray she took of the tooth #31, the recurring decay underneath the filling ?
It shouldn't be a sinus connection if the tooth #5 gets extracted ? or there is always a possibility for one with upper teeth ? And if there is a fracture of the root system ( tooth #14 ) plus the tooth is in a sinus or very close to it, how difficult is the extraction ? ( I was thinking to have that tooth extracted before the re treatment, but then I didn't know all of the bad things about root canal, so I thought I'll save the tooth ).