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Oral Surgery/possible periapical cemtifying osseos dysplasia

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I am a 27 year old female Caucasian. I recently went to the dentist for a routine cleaning and screening. During that visit she brought to my attention a growth under my 18-19 teeth.I have noted a dull ache in that area of my jaw for about 2 years or so (intermittently) and I had what I thought were TMJ problems last year to the extent of not being able to eat solid foods for 3 months. I followed up with an oral surgeon. The oral surgeon said that the white areas of the x-ray were just cementum growths and are very common but to get a ct-scan to have a definitive diagnosis. I had the ct-scan done and in the meanwhile did a lot of my own research. The ct-scan revealed another lesion missed by the original x-ray. I met with her to review the results of the ct and she seemed confident but unknowing of the results at the same time. She said it seems to be classic PCOD but she is uncertain about the cause of a second lesion in the front of my jaw as well. There seem to be small black areas she is also uncertain of not knowing why they would appear where they are. She did not recommend a biopsy at this time but to watch the growths over time. I would just like to have a second pair of eyes to look at the x-rays to ease my mind.my research showed that PCOD usually starts as a radiolucent area then over time turns radiopaque with a radiolucent rim and is connected to the root apex typically in the front teeth. The one in the front is not connected to teeth at all. She just said it could be any number of reasons for it for example maybe earlier trauma or normal bone growth. I thought the only way to rule out cancer is to biopsy. Should I push for a biopsy? I would really appreciate any advice you have in the matter. I am including a few of the ct pictures for you to review if you need more I can attach more.

Answer
Christy - from the trays alone, the dark areas appear very circumscribed and do not appear very pathologic. Does it require a biopsy? That is a difficult question to answer because of the appearance of the dark areas. I think observing the areas for a few months on a monthly basis to determine size change may not be a bad idea.

If you have continued questions, seek a second  opinion from a board certified oral and multiracial surgeon associated with  a dental school or an oral and maxillofacial surgery residency. If you wish, get back to me and tell me where you live and I will send you appropriate facilities and surgeon s to help diagnose your situation near you.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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