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Is Deep Fillings Near The Nerves Of The Tooth A Sign Of Oral Cancer?

Posted on Thu, 23 Jan 2014

Question: I am looking for some dental advice please I saw my dentist a couple of weeks ago about a small sore area of my gum. Ot is at the very top of the gum, upper right side above back wisdom tooth but at very very top of gum. When i put tongue to touch it, it felt like an open sore. I have been doing salty mouth rinses and the skin has knitted together. But when i feel the area there is still a tiny little raise bump, which is tender to touch. My dentist originally sainhe thought i had a chronic abscess and i han OPG xray yesterday which showed no abscess just very deep fillings near the nerves of the tooth. The dentist said he thought it was an aputhus ulcer healing, as did another dentist i saw on saturday. I just really do not think it is an ulcer. I am concerned about oral cancer. I am 33, never smoked and do mot drink alcohol. The three dentist have assured me it is not sinister but i am worried as the little bump doesnt seem to be going away, even though the open sore has healed.

Answered by Dr. Anshumala Singh (4 hours later)

Brief Answer: could be Periodontal pocket Detailed Answer: Hello and welcome. Thanks for sharing your concern. As you have mentioned in your history that your dentist had examined and confirmed that the lesion is not apthous ulcer or a chronic ulcer. I would order for a small incisional biopsy test too to rule out any tumour too. Though the chances for tumour is rare as per the given history but it is better to get it examined. Also I would like to know few more details from your side to answer better in this regard. 1.when did you last noticed this lesion? 2.what medication are you taking for that or are you taking any medication for any other problem than dental ? 3.Please give your medical history too,if any history of diabetes or hypertension. Awaiting your response. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Anshumala Singh (1 hour later)

No sorry two dentists have diagnosed it as a healing apathus ulcer. It is ME who is not convinced. I woke up a few months ago in excruciating mouth pain and got an emergency appointmet at the dentist for what i then believed to be toothache. The dentist told me i had cut my gum and prescribed antibiotics. The pain went away and i forgot about it. Then about 5 weeks ago i had sedation for 3 deep fillings in the area i have the little bump. After the procedure this area of my gum was very sore and i assumed it was from anesthetic injection. The pain settled down. Then last week i happened to run my tongue over the area and it felt like scar tissue or something and when i touched it with my finger it felt like a cut. This then appeared to become infected and i eent to the dentist and he gave me antibiotics. This has since closed over but the little bump remains. He said he thought i had a chronic abscess and believed bite wing xrays showed this. However when i had the opg xray they couldnt see and abscess and this dentist told me the bit on my gum is just a healing apthus ulcer. When i first noticed this i was pregnant and very badly anemic although i am not now. i have been tested for underlying illnesses as i suffer from anxiety and i have seen a haematologist for an array of blood tests, all normal. I have also recently seen and ENT as i was worried about my throat he examined my neck and scoped my nose and throat and again all was said to be normal.

Answered by Dr. Anshumala Singh (3 hours later)

Brief Answer: Apthous ulcer Detailed Answer: Hello and thank you for the complete details. After going through the complete history even, I would like to say that please do not be worried,it appears to be Apthous ulcers only.It is recurrent in nature and takes around two weeks to heal completely. Major Apthous ulcers heals after scaring the tissue but slowly it recovers. Now I would like to suggest you two things, please understand it very carefully. 1.The cause for Apthous ulcers is anxiety and stress,it also occurs due to vitamin B deficiency.Therefore please start with vitamin B complex and vitamin C supplements for a month and see the results. Simultaneously enrich your diet with lots of green leafy vegetables and fruits which are good sources of vitamins and nutrients.your diet should also include dietary fibers,eggs and meat. Once you are done with this,and minimize your stress, then please look for the results,it should recover soon. But in case if the problem still persists, that means your gums requires a clinical examination by the periodontist (dentist who deals exclusively with gum tissues) for thorough examination and if required gum surgery. One more thing I have noticed that you have mentioned there is chronic abscess seen in the bite wing x ray,then it is best to go for root canal treatment,after taking a short course of antibiotics. My advice would be that ,please go step by step in the process of treatment as you will be able to appreciate the results better. Hope I have given you detail answer. For any further doubts please let me know. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anshumala Singh (4 hours later)

Thank you I dont understand though why when it heals over when i press into the gum it feels like a tiny bump? A bit bigger than a grain of rice. Also why that bit never fully goes away smd comes back in same bit?

Answered by Dr. Anshumala Singh (1 hour later)

Brief Answer: Could be an abscess. Detailed Answer: Hello and thanks for reply. As I had mentioned in my reply that it could be an abscess which requires root canal treatment. For this please ask your dentist to confirm it radio graphically first by taking few more x rays (IOPA or intra oral periapical x rays) shooted at different angles. Once the diagnosis is confirmed you can go for root canal treatment as a priority treatment. Let me know for further doubts. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshumala Singh (13 minutes later)

Ok thanks If i keep proking a it and picking at it will it take longer to heal? The dentist did say that the filings are very deep and that i may need to consider root canal. The detist who did the bite wing xrays felt i had an abscess but the dentist who did the opg said he could not see an abscess?? Could this be cancer?

Answered by Dr. Anshumala Singh (14 minutes later)

Brief Answer: Avoid pricking Detailed Answer: Hello and thanks for reply. Please be sure that it is not cancer, I can suggest this based upon the history posted here, so only I said please go step by step. Regarding your doubt about OPG X-ray, I can say that it is not meant to see small Periapical lesions, as it gives overall view of the jaw. Therefore a bite wing or IOPA is generally recommended to see such minute lesions, for it is specific in nature. Therefore there is nothing to worry about the diagnosis made based upon the two x-rays. Also remember sometimes x-rays cannot detect the exact cause, because it cannot give 3-D view. This is the only reason because of which x-ray alone cannot be relied upon. It requires clinical proofs and examination as well. Hope I have explained you about your doubts. Also note that by pricking the lesion on and off, you are spreading the infection to surrounding tissues too. Therefore please avoid it. Let me know for further doubts. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshumala Singh (38 minutes later)

Are you saying you do not think it is cancer?

Answered by Dr. Anshumala Singh (32 minutes later)

Brief Answer: Does not appear to be cancer Detailed Answer: Hello and thanks for reply. yes,I donot think it is any kind of cancer.Please go ahead with your x rays and get the teeth treated by root canal treatment upon confirmation. Remember abscess and cancer are entirely different entity.The symptoms for any cancerous lesion is very different from what you have mentioned in your history. Let me know further doubts. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshumala Singh (8 hours later)

I have now caused a sore canker sore on the area from constant poking with my finger nail. Is this possible?

Answered by Dr. Anshumala Singh (9 hours later)

Brief Answer: vitamin b 12 deficiency Detailed Answer: Hello and thanks for reply. Yes this is possible to have canker sore upon continuous irritation.The cause for developing canker sore is again stress anxiety and vitamin B12 deficiency along with zinc and vitamin c deficiency. Therefore I had advised in my answer to start with vitamin B and vitamin C supplements. Hope it helps.Let me know for further query. Thanks. Take care.

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Above answer was peer-reviewed by : Dr. Prasad