It started innocently enough...

City House Menu

About 2 months ago, after a really good meal at City House here in Nashville, a couple of my teeth in my lower right jaw became a little sore. Not really painful...more just an ache. I thought to myself...you need to do a better job flossing. You probably have some retained meat from the awesome Pork Belly pizza the other night. Flossing, however, produced no offending porcine products, just a little blood between the two.  Are those teeth wiggly? Hmmm.

As it happened, my regularly scheduled dental appointment was the next week and when I talked to my hygienist, I mentioned that my chompers were still a bit sore. She found no sign of infection, no hidden foodstuffs, no pit or other dire finding. Whew, that would have been embarassing. We mentioned it to my dentist who decided to get some x-rays.

Something looks a little funny. More x-rays. These images showed a well circumscribed oval dark area around the roots of teeth #28 and #29. Hmmm. This was not there when they took x-rays 18 months ago. Hmmmmmmmmmmm.

"Does this ice on your tooth feel cold?" No "Well I think you might have internal resorption" (some form of internal deterioration with damage to the nerve going to the tooth.) my dentist tells me.  A sidewalk consult with one of his partners confirmed that I likely needed a root canal. Great. I've heard bad stories about those.

I was lucky enough to be able to get an appointment with a well regarded endodontist the next day. Good, I can get this over with and get on with life. Nice guy, modern office. The digital x-ray technology for dentistry is phenomenal...clear pictures and fast. Yep, there is a lytic lesion in my right jaw. "It really does not look like internal resorption, more like a bone cyst" he tells me. Cold test again clearly shows all of my teeth have normal sensation. "Good news...no root canal. Bad news...I need to send you to an oral surgeon because I dont know what that lesion is. It doesn't look bad, but we need to find out what it is." Now I was getting a little concerned.

Jargon Alert:
lytic /lyt·ic/ (lit´ik) - Having to do with destruction. It looks like a hole on x-ray.

Fortunately, he wanted to send me to Dr. W, an oral surgeon whom I know well and respect highly. We were both in residency at Vanderbilt University at the same time, me in Orthopaedic Surgery, he in Oral/Maxillofacial Surgery. Dr. W. is a very busy guy (as you would want the best guys to be) but luck had it that I could see him the next day...he had a cancellation. Thank you sir. I appreciate your insight.

Dr. W is a whirlwind of intelligence, dry sarcastic wit, and plain talk. I like him tremendously as he and I are cut from very similar cloth. First order of business is my history....2 weeks duration, not trauma, just sore...especially with biting down or pressure. Yes, they do throb with my heartbeat. No swelling, fever....etc. Next step the exam. A lot of fingers in my mouth with his scribe noting my occlusion (how my teeth fit together), my dental hygiene ("Good +"), "no masses" etc. "Does it hurt if I tap here on your jaw? Nope. How about tapping on these teeth?" Uh Huh (somewhat garbled because his fingers were still in my mouth) All the time relating stories about all the folks we trained with and under while in residency. Funny. Off to get a panorex.

Jargon Alert:
panorex - A panorex is a two-dimensional dental x-ray that displays both the upper and lower jaws and teeth, in the same film. 

Can you spot my new little friend?

There was clearly a lesion in the front half of the right side of my mandible (Jaw bone). It is well circumscribed (It has a definite outline), oval appearance without any evidence of tooth or root destruction. Good. It looked benign (meaning that it was not terribly destructive), but "it could be a problem". Okay, what now?

In order to determine the extent of the lesion, and it's specific location, we needed to get a CAT scan. This is an x-ray scan that "slices" the body up in multiple planes so that the anatomy of the bone can be more clearly and completely evaluated.

"Oh and have a Werther's candy on the way out. I'm not related, but they are really good. I'll see you next week."

And off I went...