Expert: Frederick R. Liewehr DDS, MS, FICD - 12/8/2009

Question
Hello- I submitted the below 3rd paragraph question in July of 2007.  A recent update to my condition is below

My front left tooth now has moved more and it is slighly starting to cover the front right tooth.  I still have no pain.  I have been going to Univ of Penn to see a specialist of Oral and Maxillofacial Surgery every 6 months the last 2 years for a checkup.  The Dr.recommended I come every 6 months for him to look at it and possibly to have a biopsy to know for sure what the mass is and to remove it. This Doctor has DMD,DMD, FACS after his name & is also the OMS Residency Program Director.  Dr. is sure it is nothing major like cancer.  He believed it was a condensing ostiitis because some older xrays do not show a shadow over the tooth and it is commom for Afrian Americans.  (There were exrays from the last approx 7 years that were dated before and after the xrays without shadows that show the shadow).

I have a 6 month appointment next Tuesday and he has time available to do a biopsy when I come in.  I really just want to have braces put on. I do not mind wearing a retainer forever after the braces are taken off if needed. I do not want to risk having a biopsy and then it results in a possible root canal and crown being needed on my front tooth. Another dr. at this hospital who saw my chart said that as we age teeth will move and that braces should be ok without the biopsy.  Can you give me your opinion regarding the need to have a biopsy?

Thanks a lot.

"Question from July 2009:I am 39 yrs old and ex-rays show a shadow/possible cyst over my top front tooth. I have seen an endodontist and oral surgeon once a year for 4 or 5 years to have the area mointored. I do not recall injury to my mouth, except one time I was sleep walking and hit the corner of a wall - but I can't say for sure that this happened prior to the shadow or cyst appearing on the ex-ray. The front two teeth are alive and both dentists indicated that they are not sure what the shadow is, althought they believe it is not cancer. However, after a recent visit, they talked to each other and thought since the shadow or possible cyst looked a little bigger than it did a few years ago; they decided that I should have a root canal, then a few weeks later a biopsy. I was told that the tooth will be compromised after this is done and that I will most likely need a crown on my front tooth. I have never had pain in this area, my right front tooth has shifted a slightly toward the left front tooth the last few years. Do you agree that I should have the root canal and biopsy. I am hesitate only because I really want to keep my natural front teeth and unless it is really necessary I do not want to have a crown on one of my front teeth. My endondist recommended that I call the University of Pennsylvania Patholoy dept for a second opinion. He could not recommnend anyone to make an appointment with. Can you give me an idea of what I should I should ask for when I call? For instance, the type of dentist etc. Is there any other testing that can be done that will not compromise my tooth that will determine what the shadow is on the x-ray?I also want to get Invisaline braces, to correct the slight shifting of my front teeth. Thanks so much for your opinion."

Answer
I can't help you unless you send me a copy of the radiograph. Your tooth does not need root canal therapy if the pulp is vital (alive). There are anatomical features that can be misinterpreted. Oral surgeons are not the best people to see for the diagnosis; try the endodontic department. Your tooth will not be "compromised" after endodontic treatment. Unless it is broken down you will not need a crown, either. None of that should interfere with your orthodontic treatment. Try to get a copy of the radiograph. If they have digital, then just send me the file. If not, it is a bit more difficult, but the film can be scanned like a slide if inserted into a slide holder.