The importance of having conventional 2-dimensional radiographs reviewed by oral and maxillofacial radiologists

The following examples reflect the importance of periodic imaging, review of radiographs, and knowing when to refer to an oral and maxillofacial radiologist for further evaluation. In the first case, a 26-year-old male dental student obtained a panoramic radiograph in September 2019, stating “I would like to get a pano since I have never had one.” The radiographic findings were reported by a general dentist as “No pathology present. Patient has no missing teeth.” Two years later, the patient, now the proud owner of a cone beam computed tomography (CBCT) machine, noticed changes in the left posterior maxillary area and had a CBCT acquired and sent the volume for a report. The area ended up being a plum-sized OKC that required extensive surgical intervention and follow-up. In the second case, A 79-year-old female patient complained of pain on chewing from a crown that was seated in November 2021, but clinical pain originated from #31. The patient developed a large fluctuant swelling in late December 2021/early January 2022 that had cervical lymph node involvement. #31 displayed bone loss on the PA and had 10 mm + pocketing, class III mobility, and heavy occlusal contact with #2. #31 was extracted on January 16, 2022 and a bovine graft was placed. Her discomfort somewhat resolved, but chewing discomfort returned 1/30/22. A PA taken February 4, 2022, revealed that bone loss has extended to #30. These periapical radiographs were never sent for review until February 2022, when a CBCT volume was acquired and sent for review. The findings were highly suggestive of an aggressive process such as gingival carcinoma invading the bone. The patient was the referring doctor's mother, and no follow-up information was provided due to the sensitive nature of the case.