Panoramic radiographs (x-rays) provide a good view of the entire jaw and surrounding areas. With this radiograph we can detect and monitor various conditions, and is an important part in cancer screening as the jaw is a very common site for metastatic cancer. For most individuals this radiograph should be taken once every 5-6 years. For others, it may be taken more frequently to monitor various conditions. The following cases are some of the examples of things “not quite normal” found at our office through the routine taking of panoramic radiograph. Some are common, and some are much more rare. Ultimately, a panoramic radiograph is a very thorough way of helping to maintain and monitor your oral health. If you have not had one of these radiographs in the last five years, contact us today to book your complete evaluation with cancer screening.
A common condition found with teeth is Hypercementosis, and often can only be fully visualized with a panoramic radiograph. In the area highlighted you will notice a large whitish mass around the roots of a tooth. This mass is an increased number of cells that line the root surface of the tooth. This is quite common and is generally not treated as it is an increase in number of normal tissue cells and not cancerous. This does, however, pose a concern if the tooth ever requires extraction as this mass can make it very difficult to remove the tooth.
Radiopaque masses (white spots on a radiograph in the jaw are quite common and have many possible sources. Many are just random increases in bone density which are normal for that individual. Others, like this one highlighted for you, is a cyst full of malformed teeth. In some individuals a clump of cells destined to become teeth, branch off and develop into a cyst full of little malformed teeth or bits of teeth. In some cases these cysts are removed to prevent further growth of the cyst and damage to the jaw and other cases (if not caught soon enough), the risks of removal out weigh the risks of leaving it alone, and are monitored instead. This is such a case where the cyst is too large to risk its removal at this time, and could have been dealt with years prior if routine panoramic radiographs were done.
Florid Cemento-Osseous Dysplasia
This condition is rare one and of great importance to be aware of. This condition involves multiple cyst like growths at the base of the teeth. Some individuals have this with one or two teeth, while others, like this individual, have it associated with multiple teeth. One of the cysts is highlighted for you. This condition causes expansion of the jaw bone, and in some cases displacement of the teeth (making them crooked). This condition is sometimes related to various systemic diseases and testing for these diseases is recommended. When the cyst is associated with just one tooth, it can easily be mistaken for an abscess and mistreated. For this individual, the original diagnosis made 20 years prior was incorrect, and the condition has continued to progress since that time. Panoramic radiographs every 5 years would have caught this much earlier and allowed for better understanding of the rate of progression of this condition.
Calcified Lymph Node due to TB
Not all lesions will be found within the jaw bone, or associated with the teeth. As the panoramic radiograph shows much more than that, lesions in the sinus chambers, or neck can also be found. In this case, the mass highlighted on the radiograph is that of a calcified lymph node in the patient’s neck. The cause of this has been diagnosed as childhood exposure to TB (tuberculosis). Standard tests for TB include chest radiographs as that is the most common spot for TB to be located. Finding TB on a panoramic radiograph is very rare, but very important when it is found. This case is dormant and non-contagious, however, 10% of people who have asymptomatic TB will develop the active TB disease at some point later in their life, which has a 50% morbidity rate if left untreated. With this information, this patient can be diagnosed and treated appropriately if the inactive TB ever becomes active again.
Simple Bone Cyst
Although many different lesions affect older individuals, between ages 40 to 60, there are many that can also affect younger individuals, showing up in the late teens, or earlier. This case is a perfect example why at Schau Dental we take panoramic radiograph at age 6, 12, 18, and then every 5-6 years after that. This case is of a teenager who came in for her first evaluation at Schau Dental. A large radiolucency (dark area) showed up on the panoramic radiograph. To confirm this was not an artifact on the radiograph, a more detailed closeup radiograph was taken of the area. The closeup radiograph confirmed the presence of the radiolucency.
Due to the severity of what some of the possible conditions could be that would cause this, the patient was sent to see an Oral surgeon to have the cyst removed. One of the concerns with the cyst not being caught sooner was that its large size and removal could result in the loss of all the front teeth in contact with the cyst. In this case, the cyst ended up being what is termed a Simple Bone Cyst which is a hollow void in the bone. Once the cyst lining is cleaned out, the area generally heals normally. So far healing has progressed nicely, and the teeth have responded well to treatment.
Abnormal Tooth Development – Supernumerary Teeth
Radiographs are regularly used to help assess the growth and development of children in regards to determining orthodontic needs. Panoramic radiographs in particular are used to assess the presence and stage of development of the adult teeth. In some cases we find there are missing teeth, crooked teeth, or even extra teeth, all of which can complicate normal development. In such cases, knowing of these problems early on can help the dentist plan for these to help minimize any potential harmful affects. The radiographs to the right demonstrate a case with multiple extra teeth in the upper front jaw with a comparison of a person of similar age with normal tooth development.