In addition to routine surgical procedures that are performed by our practice on a daily basis we also treat pathology of the mouth and jaws. Often times during a routine dental evaluation dark or bright white spots will appear on dental x-rays. Impacted teeth such as third molars or wisdom teeth can lead to the formation of cysts and tumors. Impacted teeth can also result from the presence of a mass or growth preventing the tooth from taking its place in the mouth. Any growth that is not a normal part of the anatomy is considered a tumor. These tumors can be either benign or malignant and may or may not be give the patient symptoms such as pain, swelling or numbness. Your general dentist will then refer you to a specialist for evaluation of these areas or lesions on the x-ray. And while most often these areas are nothing to be concerned over, being vigilant and fully investigating the possible issues is certainly warranted.
When you arrive at our practice our doctors and staff will review all the relevant medical information and discuss these issues with you. The initial step in treatment of these possible jaw tumors is confirming that they exist with a three dimensional image or CT scan. Our office is equipped with a Cone Beam 3D scanner and panoramic x-ray which can be used to distinguish radiographic anomalies from true cysts and tumors. Repeating the x-ray from your dentist can help distinguish shadows or other positional issues from true problems. The doctors at our practice will then review these images with you and explain what is found and then discuss recommendations for treatment. While the x-rays help confirm the presence of a cyst or tumor there is no definitive way to tell what type of tumor it is by x-ray alone.
Most dark lesions on an x-ray are cystic in nature and should be surgically treated with biopsy. Removal of the cyst and evaluation microscopically will determine if further intervention is necessary. The reasoning behind these recommendations is that while statistically most cysts are benign, (not cancerous) most will continue to grow over time and be destructive to the surrounding bone and teeth. Leaving a benign cyst untreated can lead to significant deformity, fractures of the jaw bone, loss of teeth and gums, and malocclusion. Some larger or more aggressive tumors may need to be treated more radically with a procedure called resection. This entails removing a large section of the jaw involved to prevent the tumor from reoccurring. This is only necessary in a small fraction of cysts and will be discussed and planned out well after the initial diagnosis is made.
White or bright areas on the x-rays are less often associated with a need for surgical intervention. The vast majority of these lesions are simple areas of rapid bone growth called condensing osteitis. This is a benign condition and surgical treatment is not required. What makes the white lesions more concerning is that a small number of these areas may be a form of bone cancer. This is usually easy to distinguish on early images and CT scans but as with all forms of cancer, the treatment is more urgent.
If your general dentist or primary care physician has recommended a consultation with a specialist for a growth or tumor the doctors and staff of Pottstown Oral and Maxillofacial Surgery can help guide you through this process. Please contact our office for a consultation appointment for assistance.