Need help! Hospital and dentist saying different things. Who is right?

[Lalwen]

Hi.
I apologise in advance for how much text there is in this post, and also if anything in it is against forum rules. But I really am desperate for some advice/guidance.

I have severe dental phobia (as well as social anxiety, and PTSD, which makes everything 100x more difficult for me), but after recently ending up in A&E in August, in agony, with a face so swollen I didn’t even look like me/cellulitis in my top lip/an abscess up where the top lip and gum join/labial-frenum area (which I assumed was originating from my upper right incisor, which had been slightly discoloured for some time, but not painful), I was forced into taking what was, for me, the terrifying step of going to the dentist again after more than 20 years of being too scared to go anywhere near one.

Anyway, about two weeks after the hospital treatment, I finally had an appointment with my local NHS dentist, who looked at my teeth, and told me that my problem was that my upper right front incisor had been struck and injured at some point in the past, and had subsequently died. I would therefore need either a root canal on it or an extraction. Because of my extreme anxiety though, she referred me to a private sedation clinic to try and make things easier for me.

Since then, I have had two appointments with the private sedation dentist, who, on the first appointment, took some more bitewing x-rays of my mouth, and promptly told me that I needed not only a root canal on the front right incisor (which had, he agreed with the previous dentist, been physically damaged by an injury at some stage), but, to my horror, also one on my left upper second premolar too, because he said he could see a dark area around both of them on the x-rays he’d taken. Anyway, I reluctantly agreed to these root canals initially. But a couple of days later, I had a complete meltdown and got myself into such a state of panic that I eventually contacted the dentist and told him that I'd changed my mind and decided that, because of my extreme anxiety, and the sheer amount of other work I also need doing, I would prefer to just have both teeth extracted instead.

To cut a long story short, I am now scheduled to have the two extractions, plus a couple of fillings/reconstructions, and an immediate partial denture fitted, under i.v. sedation in two weeks’ time, and to say that I'm terrified is an understatement. But just when I had started to resign myself to the inevitable and try to mentally prepare as best I could for what needed to be done, I received a copy of the panoramic OPG x-ray I had done by the hospital during my treatment there back in August (because the sedation dentist asked me to try to get hold of a copy of them for him), along with the accompanying report from the advanced practitioner reporting radiographer... and now things have suddenly got even more complicated. Because this report states that there is "No significant focal lucency or convincing radiographic evidence of dental abscess demonstrated".

So now I am both totally confused, and even more panicky than I was before. The dentist and the radiologist are obviously both professionals in their respective fields, yet they seem to be telling me totally contradictory things. So now I don’t know what to believe. Are there dental abscesses visible in my OPG? And if not, is there any reason why they wouldn’t show up on that x-ray (even though I actually had significant physical symptoms at the time it was taken), yet would show up on the bitewing x-ray that the dentist took (when I had no physical symptoms at all)? I know I should broach the subject with my dentist before it’s too late, but because of my anxiety, I just can’t do it. I’m so terrified of offending/alienating him and making him think I'm questioning his expertise, and therefore making things even harder/worse for myself when I have to see him next (and for all the other treatment I’ve been told I’m going to need to have done eventually).

Please, can any dentist here offer me any sort of advice or give me their opinion? I'm worrying myself silly over this. I am still prepared to have the two teeth extracted if the only other option for them is root canals (which I have already decided that I definitely don’t want). But I obviously don't want to go through that if there is any chance that the private dentist’s diagnosis could be wrong and there are other potential treatment options. I have already had my partial denture impressions made with him, and things seem to be moving so fast now, I feel like I’m running out of time. I really don’t know what to do.

Here is a copy of the hospital OPG:

 

[Enarete]

Hi Lalwen,

not a dentist and can't give you an answer, but my first thought was that a bitewing and an opg are two different things. As you see, an opg has all teeth and the bone on it and it's great to see the big picture while an bitewing shows details around the single teeth and better to detect details. It's not rare that certain things are only visible on a bitewing and not on opg. Maybe the bitewings showed something that on the opg is not that clear?

All the best wishes

 

[Lalwen]

Thank you so much for replying Enarete. I really do appreciate it. What you said makes sense to me, and does help to allay my worries a bit. But I have to admit, I'm now a bit confused as to why the hospital decided to even do a full OPG on me while I was with them, instead of just a localised/bitewing x-ray on the specific problem area, if OPG's aren't much good for showing details around specific teeth (since a localised area was all they were treating me for at the time)? Hmmm.

The other thing that confused me, but that I didn't mention in my original post, is that both the doctors that treated me at the hospital also assured me that I did not need a root canal on that front tooth. I specifically asked them about that when I was there, because I was so worried about the prospect of the procedure, and they both insisted that I didn't need to worry, because it wouldn't be necessary in my case, and that the only procedure I needed was an incision in the gum. That seemed very odd to me at the time, and totally contrary to everything I'd previously read online. But they were adamant, and I was pleased to hear it. On top of this, the NHS dentist I saw after that (the one that referred me to the private sedation clinic) didn't do any x-ray on the front tooth in question. She just referred me for the root canal (or extraction as I ultimately decided) based on visual examination of the tooth. She did, however, take a bitewing x-ray of the second premolar, and told me that that only needed a filling. But then the private dentists did his own x-rays and told me I needed root canals on both. So I hope you can understand why, as such an already anxious and dental-phobic person, I've been left so confused/worried about all these seemingly conflicting opinions.

 

[MountainMama]

I am not a dentist either, but I had an abscess on my front incisor from a childhood injury. I never knew the tooth had died as it didn’t turn dark, just slightly yellowish and it never hurt. Mine went undetected for quite some time (endodontist thinks about two years or more), even though I had regular x rays once a year at the dentist. My dental fear is not about going to the dentist but about having procedures done. My oral surgeon who eventually extracted the tooth told me that the “big picture” x rays don’t always show issues, especially if they are in a different than usual location. Mine was mostly behind my front tooth. I don’t know if it is common practice but my dental x rays were always bite wings of the molars not the front teeth.
Anyway, I first had a root canal at the dentist, but my abscess ended up being too large. The endodontist did a 3D x ray and found that it extended back farther than showed up on the regular x ray. So they can “hide” sometimes. I never had swelling at all with mine either. It just started hurting one day. I was told that they can drain the infection but if you don’t remove the source of the infection, it will never truly go away. That is what the root canal can do. It removes the dead/dying pulp from the tooth.
I can tell you that having a root canal on a front tooth is a much easier procedure thanI had imagined. I was terrified but it went quicker than I had thought and was not painful at all. I ultimately had to have mine removed but now have an implant in place.
If you have any questions about the process of a root canal, don’t hesitate to ask.

 

[Gordon]

1: OPGs are useless for showing up periapical infections, they give a quick once over of all the teeth, but they don't give enough detail compared to an intra-oral film. Most hospitals don't have the equipment to take intra-oral films but do have OPG machines...
2: Radiographers aren't dentists and aren't trained in dental diagnosis
3: The doctors at the hospital are mistaken, if there is a dead nerve present, which has got infected, then the treatment is either root canal or extraction. Incising the gum is not treatment
4: It's entirely possible that the abscess on the premolar wasn't big enough to show up on your dentist's film but had grown enough to show up on the next one.

Hope this helps a bit.

 

[Lalwen]

Thanks so much for your input, Gordon. I really appreciate it. It's has definitely helped clarify things and to clear up the confusion I had. I feel much more reasurred that I'm doing the right thing again now.

Thank you also MountainMama for your kind reply.

You've all been a great help, and it means a lot.

 

[Lalwen]

One more thing.
Is there any way I can remove the image of my OPG from my initial post now? Or otherwise, if an mod/admin can do it for me? I thought I could go in and edit the post, but doesn't seem like I can anymore. I know this will probably sound really silly / trivial to anyone but me, but because of my personal issues, I'm extremely self conscious, so would really rather my ugly x-ray wasn't online forevermore now that my questions about it have been answered.
Thanks so much in advance.

 

[Gordon]

Done.