Bryanna, what can a black circle be on a dental ct scan ?
 

I had a dental ct scan and the dr. showed me a black circle above one of my root canaled tooth. He said it's not an infection, but he doesn't know why is it there. This was actually the second opinion for my ( now ) 10 weeks of gum puffiness after the tooth extraction, and he said he doesn't see anything wrong with the extraction site and he wouldn't re open it. He said this black circle is maybe from a sinus connection if it was one, but this black circle ( he called it an air bubble ) is above the tooth #5, and the extraction was of the tooth #2 .

nyuszie,

A black circle can indicate several different things. It depends on where it is located.... upper or lower jaw .... near which teeth..... near or in the sinus.... near an infected or root canaled tooth.

Was this doctor an oral surgeon?

Yes, the dr. is an oral surgeon. He said in 27 years he did see something like this air bubble as he called it, only a couple of times. It's the upper jaw, above tooth #5, root canaled 20+ years ago. But he said he doesn't see anything to worry about, no infection. He said it can be felt in my mouth, where the gums and cheek meet as a little "bump". My sinuses and everything else looked ok.

nyuszisie,

Typically a round black radiographic area above a root canaled tooth indicates that the bacteria has proliferated beyond the tooth into the bone. The dark area is usually a cyst that has formed at the apex (root) of the tooth. This is not an unusual occurrence at all. So I really don't know why he would have told you that. I truly have no idea what he is talking about when he says an air bubble. You could have a sinus communication between the tooth and the sinus in which the bacteria has proliferated beyond the tooth into the sinus. That would also show as a black area above the tooth. But an air bubble??? I really don't know anything about that.

The fact that he can feel this "bump" in your mouth makes me lean towards the cyst possibility.

Based on extensive information that I have provided here on this site and that you could find if you were to search a little bit for it..... there is no denying that this root canaled tooth is not healthy. Bacteria has been residing in this tooth for many, many years and unfortunately it will travel beyond the tooth. I cannot tell you why your dentist told you he has never seen this before... perhaps you misunderstood him or he misspoke? I really don't know.

I wish I could offer you something more than I already have. But there really is no mystery here and I wish you could find the help that you need.




QUOTE=nyuszisue;1070590]Yes, the dr. is an oral surgeon. He said in 27 years he did see something like this air bubble as he called it, only a couple of times. It's the upper jaw, above tooth #5, root canaled 20+ years ago. But he said he doesn't see anything to worry about, no infection. He said it can be felt in my mouth, where the gums and cheek meet as a little "bump". My sinuses and everything else looked ok.[/QUOTE]

He said it will stay there forever or it will disappear slowly over time, but he didn't even mention a cyst, and he said it's not an infection. I didn't misunderstand him, he even said I'm one of the "lucky ones " to have something unusual ???????????
Do I really have this bad luck that I always choose a dentist who doesn't know what is he doing ?
If this is a cyst, what is need to be done ?
Thank you very much Bryanna for your time !

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 ).

nyuszisie,

Please let me try to clarify one more time about root canals...

It is irrelevant of how well the "flawed" procedure is done. There is no way to remove or eliminate the infected nerve tissue inside of a tooth as there is NO access to the microscopic canals that contain dead infected nerve tissue. You can have the procedure done 100 times and the outcome will not change. The ONLY reason root canals are performed is so a person can "retain" not "cure" their infected tooth for an undetermined amount of time.

I cannot answer why dentists do not inform their patients of this fact. Perhaps it is because it is the most profitable form of dentistry and can be done on one tooth many times over. So when someone does not want to remove their infected tooth this is the only "restorative" option. It is not the healthiest option for many, many reasons but it is the persons choice to have it or not to have it.

Why your endodontist is not telling you about the pathology surrounding tooth #14 ... again I cannot answer that question other than to assume that he sold you on the re treatment and the longer you retain this tooth the less likely he will feel obligated to reimburse you the money that you paid to have it done. I am also assuming that you told him you wanted to "save" this tooth which indicated to him that you did not want to remove it.

I have no idea if your general dentist is concerned about the dark area underneath the filling on #31. She had to see it if she looked at the x-ray. I worked for a dentist who had the mindset that if she put in a filling and an x-ray later on showed recurrent decay underneath her filling..... she did not inform the patient of that finding. Instead she may have written in the chart to "watch" it and then she waited until the patient complained about pain in that tooth. Yes, this is wrong to do but unfortunately it is done all of the time.

There is always a possibility of a sinus perforation or communication when an upper tooth is extracted. Especially one that has been root canaled as the bacteria spreads beyond the tooth and can travel into the sinus. The longer the tooth is present the further the bacteria will spread. I know this is not pleasant to hear and I understand the BS you are dealing with from your dentists. I wish I could make it better for you. However, the only thing I can do for you is to inform you of the truth and prompt you to read the articles that I have provided on this site so that you are able to make better informed decisions about your dental care.

Tooth #14 has several problems and they go beyond just the tooth. This will be a complicated extraction in that it will require a lot of surgical clean up to remove the pathology in the bone. This does not mean it will be painful, it just means that it is not a simple quick extraction.

I want to make something perfectly clear...
The term "saving" when pertaining to any procedure associated with an infected tooth means nothing more than "retaining".

Hi, I am going through a similar experience. Can you please update me with what your doctor found out ?