The extent of bone loss around a tooth, though felt to indicate the severity of its infection, does not do so. Doctors Basker and Stern, in separate studies, reported that 85 to 100 percent of dental granulomas and redicular cysts do not contain bacteria. This does not mean the tooth itself is not infected.

When the dentist removes or treats a tooth but the patients continues to have a toothache, it may seem the wrong tooth was removed. The pictures in this chapter show how a second tooth is often involved.

Because lateral canals can contain infection, dentists have been taught to advise root filled teeth be x-rayed each year or two.

None of this implies the use of x-ray pictures is to no avail. Quite the contrary, good x-ray pictures often disclose disease conditions which should receive immediate attention if the patient's health is not to be jeopardized.

Both pointed out that the visual areas of abnormalities on x-ray pictures are not necessarily areas of infection harboring bacteria. Dr. Stern stated that, for the most part, such visible areas are lisions that have been identified as radicular cysts and granulomas.

The granulomas are reactive lesions caused by bacterial destruction originating from an infeced root canal that opens into that area. Experiments indicate the granuloma is a response of cells to the bacteria in the root canal, but, at the same time, bacteria cultures taken from the areas of lost bone at the root end of the tooth have proven negative 85 to 100 percent of the time.

These studies are yet another substantiation of discoveries made by Dr. Price in this regard some 45 years previous to the publication of the Baskar and Stern articles.

These are numerous other types of pathologic conditions which challenge the diagnostic ability of dentists. Some of these conditions are misinterpreted as tooth infections,but as descriptions of them would require complicated explanations that are not germane to the purposes of this book, I mention them only to further indicate the number of difficulties inherent in the use of dental x-ray pictures in the interpretation of dental pathology.