When to use the CBCT?

2TheApex:  When a conventional periapical radiograph is inadequate. (the uber simplified answer)

The AAE has published a revised position paper on the use of CBCT.  You can find it HERE(click).  This is the complete answer of when CBCT is indicated.  It’s a quick and easy 7 pages.

Example Case

CBCT Vs. Conventional Periapical radiograph. (recent case from Dr. Nordeen)

Pre-op periapical Image of Maxillary right

#4 PA

Obvious Findings: Radiolucent lesion tooth #4. Possible lesion tooth #2???

CBCT (mid-retreatment of tooth #4) of the same area using a custom curve. Note apex of tooth #7 caught in the field.

CBCT 2,4,7

Video while scrolling through CBCT. (from cervical to apices and back) Video is slightly zoomed in, so the detail we view images is better than this normally.

Obvious findings with Cone Beam: Radiolucent lesions on teeth #2, #4 and #7.  Almost complete furcal bone loss on tooth #2.

In our practice we use it routinely for surgery, retreatment, resorptive defects, inconclusive diagnosis and trauma. This technology has become as important in our practice as the microscope in providing the best care possible for our patients.  We have gone from using it only several times a month to almost daily.  This has been the next “game changer” in endodontics.

How do I do an oral cancer screening?

2TheApex: Very Easily

Oral cancer still has a poor 5 year survival rate although it has improved in the last 10 years to 57 percent.  Early detection is key!  Taking the time to do a screening could save someone’s life.  Here is a video on how to perform a comprehensive screening.  It’s worth the 11 minutes for a refresher.

Early in my practice this patient was referred for treatment of tooth #15.  I found this tongue lesion upon exam.


The lesion was squamous cell carcinoma.  It was removed in total by an oral surgeon and the patient needed no further care.

April is Oral Cancer Awareness month.  Click here for info on how to promote it within your practice.

Is diagnosis more challenging with a patient taking Ibuprofen?

2TheApex: Yes!


If a patient has been taking Ibuprofen symptoms can be masked.  Read found palpation to be masked up to 40% of the time.  Cold response was masked 25% of the time.  Be sure and ask patients if they have been taking any NSAIDs and at what dosage prior to pulpal testing.  The bite stick test is one test that seems to be least affected by taking NSAIDs.  We encourage patients to cease taking any pain medication at least 6 hours prior to the appointment if it sounds like the diagnosis might be challenging.