How can a tooth infection be identify in an X-ray?

  • If you notice the second tooth from the left, you can see a dark aura surrounding the tip of the root. That indicates bone loss since the less denser the material, the darker it gets on an X-ray. That is a typical sign of an infection originating from the tooth’s pulp. Our body, smart (or not) as it is, pulls the bone away from the infection to try to contain it and form an abcess.

    No. And yes.

    What it can show is the destruction of the alveolar bone that holds the teeth in. This is a sign of the breakdown of the gingival seal, which occurs when the gingiva (gums) are attacked by a chronic (long term) external infection.

    This bone loss infers a previous and ongoing gum infection. The gums cannot be seen on x-ray in any definitive way.

    Sometimes yes, but oftentimes no. X-rays are a pretty blunt diagnostic instrument; small changes in your mouth won’t show up on an X-ray; but as the infection increases, so does the likelihood of detecting the problem in an X-ray.

    Also, X-rays don’t show soft tissues, only hard tissues (tooth, bone); this is another reason why some things don’t show up while others do.

    For these and other reasons, we use multiple diagnostic tests (of which X-rays are one: Sensitivity to cold, hot, and pressure will also be tested.

    What we’re trying to avoid is doing a root canal when it’s not needed. Root canals are a proven remedy for prolonging your dental life span; but it’s also true that root canal-treated teeth have shorter lifespans than other teeth.

    Nothing I write is dental advice. The California Dental Practice Act prohibits hygienists from diagnosing disease and/or recommending definitive treatment.

    Cathye L. Smithwick, RDH, MA

    Silicon Valley Dental Hygienist

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    It is a good thing that you do not have decay because that is destructive to your teeth. The reason for your sensitivity is that some kind of germs has infected the tiny tubules (tubes) that make up the inside of your dentin. Dentin is the main substance of your teeth. It is alive, with the cell body living inside the pulp where the blood supply is. The dentin is a living part of the tooth, kept moist by the tiny bit of the cell body that is inside the tubules. It can feel, including hot and cold and pain. When certain bacteria infect these tubules, it sets up the pain that you are experiencing.

    It is a mystery to me why Dental schools do not teach young dentists about these technologies. The reason is that unlike Medicine, where they have their best doctors train the next generation, Dentistry does not have their best dentists train the next generation. The best dentists are busy running their practices. They are not going to work for the tiny bit of money that Dental Universities can afford to pay them. That is why the leading dentists are not training in dental schools. They train other dentists who fly in from all over the world to attend weekend training classes where dentists pay thousands of dollars to attend. They have the best trained staff, they have the latest technologies such as lasers, CAD/CAM computers, CAT scans, digital xrays, T-scans computerized bite pressure machines, TMJ biopaks, TMJ jaw trackers, etc. There is even more for advanced dentists because they team up with chiropractors to electronically measure walking and standing gait. Yes, even gait, where you can stand with balance or not tells us a lot about what is happening in your mouth. Besides that, there is a lot about breathing and sleep. Sleep Apnea is a huge part of modern dentistry. Sleep apnea will kill you and there is nothing Medical doctors can do to help you. Dentists can change your skull by opening up your palate and enlarging your airway. They can change your jaw position so that your posture is straight and maybe even eliminate your snoring.

    Dental schools have none of this equipment. Not only that but the dentists there know nothing of these technologies. Dentistry unlike medicine has developed these sciences totally outside of Universities. All this science has been developed by individual dentists and then shared with other dentists through seminars at various conferences. That is why the professors know nothing about them. This is totally different from Medicine.

    Now you understand why talking to dental schools is useless. Anyway, what you have to do is to find dentists in your area who have this knowledge and equipment.

    You need to treat your teeth with this ozone gas and kill the bacteria and oxidize the poisons that the germs create inside your dentinal tubules. This will eliminate the pain instantly. Ozone is toxic and will destroy the lining cells inside your lungs so by regulation it has to be handled by a dentist who has suction equipment. Usually, the dentist has a rubber cup-like tip to keep the gas over each tooth that he treats. The saliva ejector sucks the gas out continuously. Each dentist has his own favorite.

    Do a google search in your area for ozone therapy. Remember, dentists are not all alike. Some never study after graduating, others never stop learning and improving. If you care about yourself, find a dentist who never stops learning. The other kind of dentist is still putting mercury fillings in because that is all he ever learned at dental school. That is one way you can tell what kind of dentist he is. Just phone the receptionist and ask whether her dentist uses Amalgam(mercury filling) and does he/she wears magnifying loops with lights? I wouldn’t go to a dentist who is not advanced. Would you choose your medical doctor that way?

    Hope this helps you.

    Ionizing radiation (X-rays) is a well-known risk factor for cancers: if you have X-rays, your risk for cancer will be elevated. Pregnant women and young children are also at greater risk than is the general population. As dental professionals, we are required to cover all x-ray patients with a lead apron and thyroid collar (protects thyroid gland). The Collar can’t be used for all x-rays, however.

    Update 4/13/22 to add perspective, including a comparison chart.

    But let’s put things in perspective: radiation comes from many sources, some of them are natural. Dental X-rays are a tiny fraction of the exposure from other sources. See table below.

    Dental professionals are taught to practice the ALARA (“as low as reasonably achievable”) principle, per safety guidelines.

    Like other environmental hazards, we don’t know if or when this radiation damage will occur. What we DO KNOW is that X-rays are a valuable tool with potential side effects.

    The most important thing to remember about X-rays is this: radiation’s effects NEVER DISSIPATE—they accumulate in the body over time. Also, we are constantly exposed to background radiation. X-rays add to this accumulation.

    For these reasons, dental professionals work hard to “get it right the first time.” Unnecessary retakes are to be avoided. Also, in the US, the X-rays belong to you; should you ever change dentists, be sure to get copies of your X-rays.


    Dentists and their staff are required to avoid all unnecessary exposure to their patients. This translates to full-mouth or Panoramic X-rays for new patients, not to be updated any more than every 5–7+ years. Bite wings, which we use for decay detection between the teeth, should be done no more than once every 12–24 months. There’s no reason for dentists to x-ray you just because you walk in the door.

    NOTE: when getting a root canal, the dentist will need to take several X-rays of the same tooth. This is appropriate, given the situation.

    Silicon Valley dental hygienist


    This is just not how infections migrate in the body. Dental pain can be referred to the ear via nerve connections in the trigeminal ganglion half way between the teeth/ear and the brain.

    This pain can be referred the other way too, but usually from tooth to ear.

    Ear infections can enter the mastoid air sinus, and tooth infections can rarely erode into the maxillary sinus. It is more common (although rare) for an upper tooth infection to develop a fungal infection, mucor mycosis, that invades the maxillary artery and travels either to the eye or brain. The ear is not in the chain.

    The air sinuses and eustacian tubes do connect eventually, but infections don’t just slop around and infect things that are technically outside of the body.


    Let’s consider the current accepted diagnostic terminology from the American Association of Endodontists:

    Symptomatic and asymptomatic irreversible pulpitis will not show radiographic changes. Early stage pulpal necrosis will likely not show any radiographic signs. Symptomatic apical periodontitis may not show radiographic bone loss.

    How a diagnosis is determined is by a combination of clinical exam, endodontic testing and radiographic exam. The purpose of testing is to reproduce the patient’s symptoms. Understanding of the disease process with the information gathered from the examination is used to arrive at a diagnosis. Sometimes it is a working diagnosis and addition procedures may be required. Endodontic diagnosis can be quite complex and can’t merely be determined by an x-ray alone.

    Tooth infection, or gum infection is seen as black/gray. The infection is a pocket of pus which is less dense than healthy gums. Tooth densities show white except for cavities which are black.

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    No dentist in his or her right mind would extract a tooth without a thorough health history and an X-ray. I’m not sure I know what you mean by post procedure, but often after a difficult extraction the dentist will want to check you a few days later.

    First off an x-ray will not show a fractured tooth except in an unusual situation where the fracture aligns exactly with the x-ray beam. Hardly ever happens. I may have seen a scant few (3 or 4) in my 34 years of practice.

    A tooth fracture can be a difficult diagnosis. And can be easily missed at times. But diligent sleuthing will usually reveal the diagnosis.

    And to complicate things there are several “types” of tooth fractures. Many are treatable. But unfortunately some are not.

    I would suggest a “third” opinion here. But do not mention the previous diagnosis of cracked tooth. But rather tell about what you are experiencing. Pain, constant, on/off. sensitivity to hot, cold, biting, chewing food, any other symptoms. Ask pointed questions such as how did they arrive at their diagnosis, what treatment options are available.

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