legends · 5 min read ·
Panoramic Radiograph, Patient 0731
A dentist's panoramic X-ray shows a second jaw closing slowly on the first.
**Harbourside Dental Practice · Patient Record · Patient: Irene Vosk, 52**
**Clinician:** Dr. P. Mensing · **Procedure:** Panoramic radiograph (OPG), 12 Sept
*Findings: all teeth present. Wisdom teeth 18, 28, 38, 48 impacted, mesial angulation. Bone levels within normal range. Mandible symmetrical.*
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**Clinician's note (Dr. Mensing, 12 Sept)**
Patient reports a dull ache in the left lower jaw, worse at night. No swelling. No history of trauma. Radiograph requested to rule out abscess.
Image shows the expected dentition. There is a shadow in the mandibular canal on the left side, which appears to be an impacted tooth. It is not in the expected position. The root tips are pointing up, towards the sinus, not down.
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**Radiograph report (Dr. Mensing, 13 Sept, addendum)**
On reviewing the image at full resolution, the shadow in the left mandible is not a tooth. It is an outline of a second mandible, smaller, sitting within the first, and in the position a younger jaw would occupy if the patient had been twenty when the image was taken.
The outline has the same wisdom teeth as the patient, but they are unerupted, and they show no roots. The bone around them is thin, and has been remodelled, the way bone changes when the same pressure is applied again and again over many years.
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**Patient's call to the surgery (Irene Vosk, 14 Sept)**
I've been to see my own dentist for as long as I can remember. I've never had anything in my jaw I didn't put there. But the ache has moved to the right side tonight, and when I put my tongue against the back teeth I can feel something pressing back, very gently, like someone trying to be polite about wanting to get out.
I asked the nurse what I should do. She said to bite down on a cotton roll. I did. Whatever it was bit back.
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**Clinician's referral letter (Dr. Mensing to Oral Surgery, Ashfield General, 15 Sept)**
Dear Mr. Thorne,
I'm referring Irene Vosk, 52, with an unusual radiographic finding. The panoramic image shows an extra mandibular outline in the left side, with unerupted molars, lying in a canal that does not exist in the patient's anatomy.
I have checked the image against her previous films from 2004, 2011 and 2019. The earlier films show no shadow at all. The bone has thickened gradually over time, as if the second jaw has been growing inside the first, very slowly, for the last twenty years.
Please see her urgently. The patient is distressed and asks that the image be given to someone who will not say it's a tooth.
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**Oral surgery note (Mr. Thorne, 18 Sept)**
Patient attended. Examined intra-orally. Lower left quadrant: no abnormality visible. Patient asked me to press on the gum above the third molar. I did. A small, hard object moved under my thumb, from inside, and pushed back against the pressure.
Patient said, "That's the one that's been wanting you to come and take a look."
Mr. Thorne has asked for a second opinion from the regional maxillofacial team.
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**Regional maxillofacial review (Dr. A. Pryor, 24 Sept)**
Second CBCT scan performed. Scan shows a complete second mandibular arch, fully formed, in a separate bone bed directly beneath the first. The second arch has 16 teeth, including the wisdom teeth, unerupted. The teeth are not human. Their crowns are smooth and white, with no enamel pattern.
Reviewing the scan, I noticed the second arch is angled toward the patient's own, as if the two jaws are closing together, very slowly, over time. The gap is now 2 mm. Last year it was 4 mm.
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**Complaint letter (Irene Vosk to Harbourside Dental Practice, 3 Oct)**
*Dear Dr. Mensing,*
*I am writing to complain about the radiograph you took of my jaw. I was told the image was clear and the findings were normal. They were not normal. I have been told by a surgeon that there is a second set of teeth inside me, and that they are getting closer every month.*
*I have stopped eating solid food. I can't chew on the left side. When I try, something on the other side of the bone clicks against my own teeth, very precisely, in time with my heartbeat, like someone counting out loud from the far end of a corridor.*
*Please tell me how to get it out.*
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**Practice reply (Dr. Mensing, 5 Oct)**
Dear Ms Vosk,
I'm sorry you have been distressed. I have reviewed your radiographs and I cannot find any abnormality beyond the impacted wisdom teeth, which are common. The images you have been shown appear to be a processing artefact.
I do not think there is a second jaw. But I have a request. Please don't bite down on anything for the next week. If the clicking continues, please come in and I will take another film. I'd like to see if the outline has moved any further toward the surface.
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**Final radiograph note (Harbourside, 28 Oct)**
Patient Irene Vosk did not attend her follow-up. Radiograph taken on 27 Oct by the practice nurse, at the patient's home, using the mobile unit.
The image shows the expected dentition. Wisdom teeth 18, 28, 38, 48 impacted, mesial angulation. Mandible symmetrical. There is no second arch.
*Radiographer's note: the patient's jaw has closed. Her teeth are all present, and perfectly aligned, and show a faint pale outline along the lower edge, as if they had been set into the bone with care. She was smiling when the film was taken. She asked us to write down that she has never felt so well fitted.*