Monday, May 24, 2010

Odontogenic Tumor

I am usually very diligent about going to the dentist--every 6 months.  I brush my teeth at least twice a day.  I use mouthwash with each brushing.  I am not the best flosser, but I do floss at least once a week.  I replace the toothbrushes every 3-4 months and after infections.  I take care of my teeth.  I never had a cavity until I became pregnant with Ellie.  Twenty-eight years with no cavities!  Last year I missed my dental x-rays because I was pregnant with Ellie.  Then I missed my 6 month appointment at the end of December due to a change in insurance.  So in April, I finally got around to it.  Yes, I was 4 months late on the exam and cleaning.

Everyone, please please please see your dentist for the regular cleanings and X-rays.  I know the dentist is scary for many people, but please read on. . .

On April 23rd I saw my brand new dentist under my new dental plan, Cigna DHMO.  He is fabulous, kind, and thorough.  I knew going into this I would need at least one filling.  The filling that I did not get because I was pregnant.  As it turns out, I also bought myself a root canal on my very front upper tooth.  I had some trauma to the tooth back when I was 15 or 16 and the tooth finally died.  Okay so that was not happy news.   I then learned that there was a suspicious spot on the left lower area of my xray near tooth #22 aka the canine/cuspid.  This area looked like a textbook abscess of radiolucency.  The kicker: I never injured the tooth, I never had treatment to the tooth, and I had absolutely no symptoms.  That bought me a referral to an oral surgeon.  Great prefect teeth to: 1. filling; 2. endodontist for root canal to dead tooth; 3. oral surgeon for possible abscess.  Fabulous.

After two visits to the endodontist, my front upper tooth experienced a root canal.  It is slightly darker than the neighboring teeth, but it is not overly obvious.   I requested that she look at #22 and she too thought abscess.  She ran some basic tests and ruled it out.  It was not an abscess to her surprise so she advised me to keep my oral surgeon appointment.  Another visit to the dentist last week and I have a beautiful filling in my back molar.  Hurray.

Moving on to the oral surgeon. . .there is only one (1) oral surgeon in my Cigna DHMO plan.  A very nice Dr. K.  He looks at my X-ray and thinks abscess.  (Are you guys noticing a theme?)  No symptoms, trauma, or previous dental work so he thinks cyst.  He is not worried and advises a "watch-&-wait approach".  As he prepares to walk out the door, he decides to order a CT scan of the maxillary-facial bones with a focus on the mandible (jaw).

I get the CT Scan and follow-up with Dr. K last Thursday.

To his surprise, it is a solid mass affecting tooth # 22 (left lower canine) and it has scalloped the mandible.  Apparently, that means I have a tumor in my jaw that is disrupting the structure of my mandible and is quite possibly adhered to my tooth.  If left alone it will continue to growth and affect the other teeth and the mandible.  Dr K is shocked. My dentist is shocked.  I am not happy.  Apparently, this is not very common, especially among people who have their permanent tooth.

Dr. K's plan is to perform surgery under general anesthesia at the hospital.  He would remove the odontogenic tumor and some of the surrounding bone, send it to pathology, and then use bone grafting in my jaw.  I would most likely lose the tooth so I would need a temporary prosthesis and eventually an implant.  At this point, my mass is now bone-related rather than tooth-related so my visit went from dental insurance to medical insurance.  Dr. K does not accept my medical insurance and I had to pay for  this visit out-of-pocket.  That is another story all together and I shall spare you the details.

Most of the literature that I was able to find was not for non-medical people.  It was all medical jargon from case studies and fancy surgical journals and I only understood part of it.  It seems that  "odontogenic tumor" is a loose term for many different masses that are associated with the teeth, but are actually in either the mandible or maxillary bones.  Complete excision of the growth is necessary as they tend to grow--some more aggressively than others.  Some also have high occurrence rates and some in rare cases can become malignant.  So it seemed that Dr. K's plan was on par with what most of the literature stated.

That brings me to today.  I found Dr. N who is only one of 2 oralmaxillaryfacial surgeons in my medical plan.  He has a brusque, no nonsense type of manner that reminds me of one of my old ENT colleagues.  Believe it or not, this is a good things.  Those with the poor bedside manner make the best surgeons.  Dr. N looks at my mouth, asks some questions, briefly reviews the CT scan and report, and studies the Xray.  He too thinks cyst (again, notice a theme?) but he says "odontogenic tumors and cysts are very broad terms for something that is in the jaw".  He said that he would prefer to biopsy the mass first and then after getting the pathology report go from there.  It is more of a conservative approach.  He also noticed on my X-ray in addition to the tumor, two other suspicious areas along my lower very front teeth. Goody, more masses.

So today my poor mouth got sliced & diced.  I was not prepared for this.  I ate breakfast.  I arrived to the office by myself.  I had plans for the rest of the day. . . so  I call my beloved husband to come and be my ride home for I needed to undergo IV sedation.  Andrew, with Ellie in tow, comes to my rescue.  IV sedation is rather interesting.  I am wide awake one minute talking to the assistant about versed and propofol and the next I am awake with blurred vision and slurred speech.  I am almost certain that I tried to grab my specimen off of the table.  In fact, it wouldn't surprise me if I tried multiple times to get a glimpse of what came out of my jaw.  How embarrassing.  I do remember asking about Ellie multiple times and asking the assistant if my husband still "looked hot".  Yep, that is me alright and yes, my husband is still smokin' hot.

Dr. N cut along my lower gum line from the right cuspid to my left molar.  The lower lip was pulled way down the gums were slid up to reveal the bone.  Ouch!  I have many stitches and a big swollen lower lip.  I am thinking that the Angelina Jolie look is really not for me.  I have a huge pressure bandage on my chin and extending upwards to the corners of my mouth.  That will come off in 2- 3 days.  The pain--it is worse than childbirth.  The pain meds and ice packs help somewhat.  Actually, I think the pain meds are keeping me awake.  I feel loopy as I type this, but I am wired.  Ellie Bear will wake up nice and early in the morning and here I am typing a late night blog post.  The worst thing is that I have trouble talking!  Okay just kidding!  I imagine that my honey-bear is enjoying the silence in the house.

Dr. N talked to Andrew and me after the surgery but I was pretty out of it. Fortunately Andrew was there and the Dr. N called this evening to check in.  Here is what I know:

1. There were two small, fluid-filled cysts in the mandible on the very front (think your 4 front lower teeth).  The fluid drained easily and has been sent to pathology)
2. Bone-like material was removed from larger lesion on the left lower jaw (canine/cuspid) and sent to pathology.
3. The "tumor" was actually a hollowed out cavity in the mandible.  Dr. N is hopeful that the cavity will close itself back up.  My fear is that I will have an avulsed tooth instead and need bone grafting.

It is a relief that Dr. N took a more conservative approach.  If I went with jovial Dr. K, I would have been under general anesthesia and loosing a chunk of my jaw along with my tooth.  I would also be out a lot of money since he does not take my insurance.  Of course I require close of monitoring.  I might still lose the tooth or require a root canal.  Dr. N might need to perform more surgery in which I lose more bone and need grafting.  At this point, I am leaving it all up to God. It isn't over yet!

Thank you everyone for your prayers and support.  This has all been really stressful and scary.

Thank you Andrew for being my rock.  For carrying for both me and Ellie when you have so much work right now.  Thank you for the jello and the fabulous iced mocha.  I love you very much and I am so grateful to have you as my husband.

BTW: I would love to give you guys some fun photos but that will need to wait until I know what type of tumor I had and once I have had more sleep.

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