Are "Radio-opacities" concerning?

[troubledsoul]

I received this note along with the provided xray: "eval and tx #17, 32 area radio-opacities noted on the angle of mandible in both areas". My general dentist referred me elsewhere and it's taking forever to hear back from them. He also mentioned they would possibly take a biopsy to check if cancerous. Based on what's circled, are those area lymph nodes? That's what I am really worried about because as you may know that's not a good thing. Please provide any assistance /knowledge you have.

51 yr female old with just partial denture in lower teeth

 

[honestdoc]

The image is very difficult to evaluate. All dental x-rays should be available in digital format. You are free to request them. That being said, the radiopacities are fairly symmetric and borders appear distinct (well defined) indicating slow growth. Usually radiopacities are not as sinister in the jaw bone. Since the x-ray is only 2 and not 3 dimensional, there is a remote possibility that the submandibular lymph node may be calcified. That is usually from Tuberculosis and or other infectious scar forming diseases. In my opinion, it is not sinister but a 3D CT scan may be helpful before getting a biopsy.

 

[troubledsoul]

The image is very difficult to evaluate. All dental x-rays should be available in digital format. You are free to request them. That being said, the radiopacities are fairly symmetric and borders appear distinct (well defined) indicating slow growth. Usually radiopacities are not as sinister in the jaw bone. Since the x-ray is only 2 and not 3 dimensional, there is a remote possibility that the submandibular lymph node may be calcified. That is usually from Tuberculosis and or other infectious scar forming diseases. In my opinion, it is not sinister but a 3D CT scan may be helpful before getting a biopsy.

ty for your reply
I've been on google for hours trying to figure out if there are lymph nodes in the jaw, so you're saying there are ? What out of the circled items do you suspect being a node (if any)? and if the image was 3d how would its appearance change?

Last year I underwent surgery for stage 1b1 cervical cancer, luckily there was no micrometastasis which was good news and I didn't need additional chemo/radiation. After this xray, having gone through traumatic times and knowing about the whole lymph node scenario when it comes to the c word I couldn't help but worry about what was circed being node(s) and even worse cancerous. The place I was referred to is covered by my insurance aka no charge to me so they are taking forever and my anxiety is soaring.

 

[honestdoc]

I don't think it's the lymph nodes. Try to obtain a digital copy of your x-rays. You can request them from your provider. I can't accurately assess with your image provided.

 

[Dr M]

Good day,

I agree with honestdoc. More advanced imagery is needed to accurately diagnose the lesions. Another possibility might be submandibular sialoliths or " salivary stones ". If small, these are harmless, but if they are larger, they can block salivary flow and drainage and then additional treatments might be required.
BUT first step would be to get a better image to make an accurate diagnoses.

 

[honestdoc]

Good day,

I agree with honestdoc. More advanced imagery is needed to accurately diagnose the lesions. Another possibility might be submandibular sialoliths or " salivary stones ". If small, these are harmless, but if they are larger, they can block salivary flow and drainage and then additional treatments might be required.
BUT first step would be to get a better image to make an accurate diagnoses.

Good point on sialoliths. I thought of them but the symmetry of the radiopacities threw me off. What are the chances right?

 

[troubledsoul]

ty for your replies. dentist that i was referred to is asking for another xray and won't take that one, the xray they want is the one where your whole jaw is examined by the machine going around you while you bite on something.. how much radiation does that emit?

 

[Dr M]

It sounds like you are referring to another Panoramic x-ray. It might be that he doesn't agree with the quality of the one you supplied and just wants a new one. The radiation emitted is the same you previously experienced. Modern digital radio-graphs emit low dosages of harmful radiation. A lot less than a few decades ago.

 

[honestdoc]

Dr. M is correct. Dental companies stopped supporting film based x-rays years ago. Film x-rays need more radiation to expose the silver particles to reveal the image. Digital require very minimal radiation to produce better quality images. As in everything in health care, the doctor and patient must weigh the risk of radiation exposure to the benefits of accurate diagnosis.