DENTAL SPEAK : Was this an ENT case of simply a dental issue?

Ahsante Paulo (AP) had carried out root canal treatment (RCT) in connection with lower left first and second molars. This was in 2006 in the US. Incidentally, RCT deals with the expertise of removing the living portion of the tooth, the pulp. Pulp contains tiny nerve filaments and blood vessels. Both the molars were strong.

They had become badly decayed.

The decay had proceeded toward the root ends. With the exposure of pulp the dentist in the US had ultimately carried out RCT and fitted these molars with ceramic crowns. AP had sent an email to the dental surgeon (DS) in Dar for an appointment. Two weeks had passed. AP conveyed to the DS that he was from Singida and having pain in the molars in which RCT was carried out.

The pain was radiating to the left ear. The DS tested the tenderness around both the molars by percussing (gently tapping the grinding surfaces of molars with the tip of the handle of a mouth mirror). There was no pain inferred. The DS had noticed stains and hardened deposits (tartar) around the margins of posterior teeth – upper and lower. He told AP to carry out cleaning and polishing of his teeth at a later date.

The DS’s mirror surveyed the inter-dental territory of the two upper molars. The DS said, “You have a hole in the distal surface of the first upper molar. This causes retention of food. This has to receive a permanent filling.” The food debris was disentangled. A hybrid glass ionomer filling was ultimately placed. The bite was adjusted.

AP did not have the presence of third molar. The DS said, “Just to make sure there are no teeth lurking in that portion of the lower part of the jaw you should take an orthopantomogram (OPG).” The OPG is also referred as ‘panorex’. It is a panoramic (wider unbroken view) dental x-ray picture of the upper and lower jaws offering a two-dimensional feature.

AP: “Because of the tingling pain around the left ear I had two sittings with the ENT (ear, nose and throat) specialist. I was prescribed eardrops, which I am afraid did not help. What you have suggested makes sense to me.”

The OPG shows all the teeth of the lower and upper jaws in a single film. It is a diagnostic tool for the number, position and growth of all teeth including those which are yet to erupt.

The OPG revealed a third molar that was submerged and surrounded by bone. It was also tilted and exerting pressure on the second molar.

The OPG established beyond any iota of doubt that AP had a dental issue and not anything to do with his ear, nose or throat. The OPG seen here with this feature has L on the right side at the bottom. L depicts the left side of the patient. The left side shows the third molar which is slanted and unable to come out. It is impacted, surrounded by bone. The upper third molar is also enclosed by bone. AP is 64 years old today. Both these teeth have continued to remain where they are.

The DS instructed AP: “The upper third molar, as long as it does not bother you, can be left where it is. The two molars in the OPG ahead of the impacted molar have had RCT done. The canals of the roots have been filled up. The opacity is well defined to convey that RCT had been complete. The impacted molar is adjacent to the second molar. It may exert pressure on the root of that molar. Since the impacted molar is very close to the canal that carries the inferior alveolar nerve (responsible for sensation of the lower half of the area of the mouth on the left) there could be injury to the underlying nerve when the impacted molar is surgically removed. This would mean loss of sensation of the left side of the mouth for quite a period.”

AP was kept on analgesics and anti-inflammatory agents. He has gone back to Singida. When contacted a few days ago he said, “Touch wood. I have no pain. I am bracing myself for the surgery. I will come back with my wife, for the ultimate and the necessary surgical intervention after Christmas. A very salubrious 2017 to you.”

A teacher was discussing the wonders of modern science and in particular various kinds of machines. Asking the nine year olds in her class to name the most wonderful machines they had ever seen, she got all the stock answers- aeroplanes, televisions, rockets, robots, etc – until one thoughtful little girl answered, “A hen!”

“Why, Asha”, said the teacher, whatever makes you think a hen is a wonderful machine?”

“Well”, said Asha, “do you know anything else that will take all our leavings and turn them into fresh egs?”

For the dental professionals a panoramic radiography machine that delivers orthopantomograms of quality is a wondrous machine.