Dr. Robert Axelrad Dental Office

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Can You See What I See You? A Case Study

Posted on by Dr. Axelrad

Panoramic dental X-Ray the human skull and Teeth

Panoramic dental X-Ray the human skull and Teeth

This will be our last in the series of blogs devoted to different dental entities that can be seen on a panorex x-ray film.

Let’s start from the upper left area of the mouth (the patient’s right) and go clockwise.

1) Upper Left (patient’s right)

The root canal treated tooth – There is a tooth that has a root canal and a crown. It is the second to last tooth right before the gap. The root canal is evident by the vertical opaque lines: there is a crown on it as well.

Why was a crown placed?

Because the tooth was weakened by the root canal and there most probably was a large filling, which is usually the case with a root canal treated tooth. For more information on crowns and their indications, please see the blogs ‘Dental Crowns,’ a four part series, posted on August 2nd, 3rd, 10th and 19th of 2012.

The gap – To the right of the root canal treated tooth is a gap (an empty space). This may be a good time to read the blog “Options to Replace a Missing Tooth,” posted on October 2nd, 2011. Ideally the best scenario is to place an Implant into the gap…Please see blog “Dental implants – A Great Solution for a Missing Tooth,” posted on October 9th, 2011.

2) Upper Right (patient’s left)
Another root canal treated tooth (third to last tooth). This tooth is not protected by a crown; instead it has a large filling…you have to wonder why a crown wasn’t placed. Another Interesting Point: Notice that this root canal treated tooth is ‘lower down’ than the others. The reason for this is that there is no tooth opposing it. Teeth like to contact other teeth. Since there is a gap present in the opposing arch, as opposed to a tooth, the upper tooth tends to want to grow downwards. In extreme cases, an unopposed tooth can even grow down as far as the opposing gum tissue…ouch!

3) Lower left (patient’s lower right)

The terminal (last tooth) molar tooth is in a sorry state… There are two roots associated with this molar tooth: One of the roots has a large infection associated with it. This is seen as a large dark area enveloping the root that is closer to the second to last molar tooth. This is known as a periodontal infection i.e. periodontal disease. This tooth has a poor prognosis, and will probably need to be extracted sooner rather than later. For more information on periodontal disease, please see the blog “Periodontal disease….What exactly is it?” posted on March 2nd, 2012.

Do you also notice that the ‘terminal’ molar tooth is tipped forward? The tooth in front of it is also tipped. The reason for these two tipped teeth is that there is a gap in front of both of these molar teeth. As in the case of ‘no. 2 ‘ above where the upper tooth erupted downwards to contact the gum, these two molar teeth are tipping forward (mesial) to try to contact ‘something.’ Teeth want to contact other teeth, so they may tend to move around in an attempt to do so.

4) Lower right (patient’s lower left)

It looks like there is nothing more here than a molar tooth that is tipped forward (the forward direction is known as mesial). In front of this is a large gap…an empty space. You would think that this space isn’t a big deal, but it is. The tipping of the molar tooth inwards has a way of throwing off the individual’s bite quite a bit…the teeth above the gap want to move downwards, which can lead to subtle movement of the other teeth as well. If you remember (no.3) this happened on the patient’s lower right too. The result is a posterior bite collapse and a subsequent loss of vertical dimension.

We discussed this concept in a previous blog, “What happens when a tooth is removed,”posted on September 24th 2011.

In Conclusion
In this blog we were able to see quite a few things:
-What a tooth with a root canal looks like on an x-ray and why it needs a crown.

– What happens when there are missing teeth (gaps) and the associated repercussions.

Most important, if for whatever reason you lose a tooth, it’s best to replace it to avoid any unwanted movement of other teeth in the mouth…check this out, “Dental implants … A great solution for a missing tooth,” posted on October 9th, 2011.

Dental Questions or Concerns? Give Us a Call!

Based in Brampton, Ontario, Brampton Dentist Dr. Robert Axelrad has been practicing gentle and pain-free dentistry for over two decades. During this time, he has helped to improve the dental health of countless satisfied patients in Peel Region, Brampton and beyond! Feel free to call us today at (905) 791-3867 for any dental health question you may have, as we are always happy to hear from you.

Our office is now open. We are taking the following precautions to combat COVID-19;

  • A plexiglass barrier stands on the front desk in the waiting room.
  • All patients have their temperature taken with a non-touch digital infra-red thermometer.
  • All staff wear mask, gloves, gown, bonnet, goggles and face shield.
  • Hand sanitizers are readily available for staff and patient use.
  • Patients will wait outside or in their car until their appointment time.
  • No visitors are permitted in the office.
  • Social distancing will remain in effect in the office.
  • Patients experiencing influenza-like-illness (fever with a cough, sore throat or muscle aches) should not come to the office.
  • Air purifiers with hepa filters have been installed in each operatory and waiting room.
  • All COVID-19 precautions put forth by both the dental and hygiene boards have been put into force in the office.

We look forward to seeing you soon. 
Dr Axelrad and Staff