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Old 01-20-2015, 12:48 PM #1
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Default root canal and eventual extraction of tooth number 3... Lingering pain

Bryanna,
I thank you in advance for your insight into my issue. Please forgive the rather long post but wanted to ensure you had all the proper information. At the end of 2012 beginning of 2013 I went to the dentist for tooth that was giving me pain and sensitivity issues after biting down on a nut. Dentist referred me to endodontist who took an xray and determine pulp was still viable. I began using Sensodyne and allowing time for tooth to heal. In 2013 when I returned and dentist took x-ray notice a black spot at the base of the route and was informed I would need a root canal. I decided to try oil pulling as I have read that some has heal their teeth using oil pulling. when I returned in 2014 I was told that I needed to get the tooth taken care of because it was not healing. At this point the tooth was not sensitive to hot or cold and it was just sore. On September 30th 19, 2014 I had root canal performed. The endodontists said he did not see a lot of puss in that the nerve was dead. He cleaned it out and packed it and schedule an appointment for me to come back in two weeks to finish. The day after the anaesthetic wore off I began to get headaches. I called the endodontist and he put me on a round of amoxicillin. I did take probiotics and prevented myself from getting diarrhea but I did have a lot of GI discomfort. The headaches never really subsided and the tooth became extremely sore. When I went back to finish the root canal it was extremely difficult to get me numb. The dentist finished the root canal and did not give me any additional antibiotics. He did note that it was likely that the periodontal ligament was inflamed. As time went on the two struggled to heal and I begin to have systemic issues, heart rate increase and continued headaches. I went to an oral pain specialist who told me I was having ghost pain. After a few weeks I asked to be seen by an oral surgeon who discovered I had a crack in the tooth. I had a tooth extracted on December 9th 2014. The oral surgeon noted the crack also noted he found three granulomas and that the sealer used in the root canal went past the tip of the root and was likely irritating my gum. in about 2weeks heart rate was back to normal and headaches had subsided about 85%. The oral surgeon said the site was healing good. However I continue to tell him that I still have slight headaches and he said to give it a while. When I went in for my second visit I told him that I had some discomfort around the gum tissue and he continued to tell me that it would take about 8 weeks before I would probably notice lessening of all the symptoms. Well it has been about 6 weeks and the gum tissue continues to show signs of irritation to me and I do have slight headaches. I am NOT a dental professional but have attempted to research as much as I could and I am concerned about the following: potential jaw muscular tissue, inflamed gum tissue, slight infection in jaw, or shifting teeth. I have not had any fever, swelling or gum discoloration. I do not know where to go next to try to get at what remains as the oral surgeon has told me to allow for 28 weeks for pain symptoms to subside. In your experience is that a reasonable amount of time? I continue to feel that the sensitivity in the area it's worse then when I first had the tooth extracted although the headaches bone to ensure he gets all the infection and he said that that was not necessary based on his years of scraping the jaw bone to ensure he gets all the infection and he said that that was not necessary based on his years of experience he did say he went in and cleaned it out and he showed me the periodontal ligament which came out he showed me where they were three granulomas and he showed me a speck of material which she said was the sealer from the root canal which was likely irritating my gum tissue. I have a follow up coming with him soon and I'm not sure what to ask because I don't feel he believes there is a lingering issue but I know that there is something be at the gum tissue or the jaw or the muscles. Any help you can provide would be appreciated.
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Old 01-20-2015, 04:05 PM #2
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Hi muffie,

Welcome to neruotalk!
I am happy to try and help you. I am going to re-post some of your thread and comment in bold type. It just makes it easier to follow.

<< I went to the dentist for tooth that was giving me pain and sensitivity issues after biting down on a nut. Dentist referred me to endodontist who took an xray and determine pulp was still viable. I began using Sensodyne and allowing time for tooth to heal.>>

IT IS POSSIBLE THAT THE TOOTH FRACTURED WHEN YOU BIT DOWN ON THE NUT. THE DENTIST AND ENDODONTIST SHOULD HAVE DONE SOME FURTHER TESTING TO TRY AND DETERMINE WHERE THE TOOTH WAS FRACTURED. SOMETIMES THIS CAN BE DIFFICULT TO DIAGNOSE SO A WAIT AND SEE APPROACH IS TAKEN.

<<In 2013 when I returned and dentist took x-ray notice a black spot at the base of the route and was informed I would need a root canal.>>

THE BLACK AREA IS A DEFINITE SIGN THAT THE TOOTH IS INFECTED AND THE BACTERIA HAS SPREAD INTO THE BONE THROUGH THE ROOT OF THE TOOTH. IF THE BLACK AREA WAS NOT VISIBLE ON THE X-RAY AT THE FIRST DENTAL APPOINTMENT, THEN THIS PRETTY MUCH CLINCHES THE NOTION THAT THE TOOTH DID FRACTURE WHEN YOU BIT DOWN ON THE NUT.

<< I decided to try oil pulling as I have read that some has heal their teeth using oil pulling.>>

OIL PULLING IS BENEFICIAL FOR THE AREAS OF A TOOTH THAT ARE VISIBLE AND ABOVE THE GUM LINE. YOU HAVE TO UNDERSTAND THAT THE INFECTION WAS INSIDE OF THE TOOTH AND OIL PULLING IS NOT GOING TO PENETRATE THE TOOTH AND CURE THE INFECTION.

<< when I returned in 2014 I was told that I needed to get the tooth taken care of because it was not healing. At this point the tooth was not sensitive to hot or cold and it was just sore.>>

THE TOOTH WAS NOT TEMPERATURE SENSITIVE BECAUSE THE NERVES WERE DYING AND BACTERIA WAS TAKING OVER THE CANALS THAT CONTAIN THE NERVES. THE INFLAMMATION FROM THE BACTERIA WAS AFFECTING THE PERIODONTAL LIGAMENT WHICH WOULD CAUSE THE TOOTH TO BE SORE.

<< On September 30th 19, 2014 I had root canal performed. The endodontists said he did not see a lot of puss in that the nerve was dead. He cleaned it out and packed it and schedule an appointment for me to come back in two weeks to finish.>>

PUS IS ONLY ONE SIGN OF AN INFECTION AND THE AMOUNT IS NOT ALWAYS A CLEAR INDICATOR OF HOW SEVERE THE INFECTION IS. IN YOUR CASE, THE BACTERIA WAS DRAINING THROUGH THE TIP OF THE ROOT AND THE MAJORITY OF THE PUS COULD HAVE BEEN IN THAT DRAINAGE.

<< The day after the anaesthetic wore off I began to get headaches. I called the endodontist and he put me on a round of amoxicillin.>>

HEADACHES AFTER ROOT CANAL THERAPY OR OTHER DENTAL PROCEDURES ARE A COMMON THING. PUTTING YOU ON AN ANTIBIOTIC INDICATES THAT THE ENDODONTIST FELT THAT THE INFECTION WAS MORE SEVERE THAN HE THOUGHT WHEN HE DID THE PROCEDURE.

<< I did take probiotics and prevented myself from getting diarrhea but I did have a lot of GI discomfort.>>

IT IS BEST TO TAKE PROBIOTICS EVERY DAY, WHETHER YOU ARE SICK OR NOT. THE IDEA IS TO PREVENTATIVELY BUILD UP A HEALTHY SUPPLY OF BENEFICIAL BACTERIA SO THAT WHEN YOU ARE SICK OR HAVE TO TAKE MEDS YOU WILL BE LESS LIKELY TO GET ANY GI UPSET. UNLESS YOUR DIET CONSISTS OF A LARGE QUANTITY OF FERMENTED OR PROBIOTIC FOODS ON A DAILY BASIS, IT IS WISE TO STAY ON THE PRIOBIOTICS INDEFINITELY.

<<The headaches never really subsided and the tooth became extremely sore. When I went back to finish the root canal it was extremely difficult to get me numb. The dentist finished the root canal and did not give me any additional antibiotics. He did note that it was likely that the periodontal ligament was inflamed.>>

THE LINGERING HEADACHES COULD BE DUE TO THE INFLAMMATION FROM THE INFECTION AND FROM THE ROOT CANAL PROCEDURE. YES THE PERIODONTAL LIGAMENT WAS INFLAMED BECAUSE THE TOOTH WAS INFECTED AND THE INFECTION WAS SPREADING BEYOND THE INTERIOR OF THE TOOTH. ALSO A FRACTURED TOOTH, REALLY ANY INFECTED TOOTH, UNFORTUNATELY CANNOT BE REPAIRED OR MADE HEALTHY AGAIN BY A ROOT CANAL TREATMENT AS THERE IS NO WAY TO REMOVE ALL OF THE DISEASED TISSUE INSIDE OF THE TOOTH. SO YOU HAD LOTS OF INFLAMMATION GOING ON.

<< As time went on the two struggled to heal and I begin to have systemic issues, heart rate increase and continued headaches.>>

THIS LEADS ME TO THINK THAT THE ENDODONTIST MAY HAVE PERFORATED THE TOOTH WHILE DOING THE ROOT CANAL PROCEDURE AND/OR HE INSTRUMENTED THROUGH THE FRACTURE AND THE DISINFECTANT AND/OR THE FILLING MATERIAL WENT PAST THE TOOTH AND INTO THE TISSUE AND/OR BONE.

<< I went to an oral pain specialist who told me I was having ghost pain.>>

I BET YOU WANTED TO KICK HIM!! PAIN SPECIALISTS ARE NOT WELL VERSED ON TOOTH RELATED PROBLEMS.... HE SHOULD HAVE INFORMED YOU OF THAT.

<< After a few weeks I asked to be seen by an oral surgeon who discovered I had a crack in the tooth.>>

OKAY... SO THERE YOU HAVE IT! FINALLY A PROPER DIAGNOSIS!

<< I had a tooth extracted on December 9th 2014. The oral surgeon noted the crack also noted he found three granulomas and that the sealer used in the root canal went past the tip of the root and was likely irritating my gum.>>

OKAY... I AM GLAD THAT THIS ORAL SURGEON GAVE YOU THIS INFORMATION AS HE COULD HAVE JUST NOT INFORMED OF IT. THE GRANULOMA TISSUE FORMS WHEN BACTERIA BECOMES ABUNDANT AND ALSO FROM THE IRRITATION FROM THE ROOT CANAL SEALER THAT IS NOT MEANT TO BE PUSHED BEYOND THE TOOTH. THAT OVERGROWTH OF TISSUE NEEDED TO BE REMOVED AT THE TIME OF THE EXTRACTION.

<< in about 2weeks heart rate was back to normal and headaches had subsided about 85%. The oral surgeon said the site was healing good.>>

GOOD SIGNS THAT YOUR BODY WAS TRYING TO HEAL FROM THE INFECTION AND INFLAMMATION.

<< However I continue to tell him that I still have slight headaches and he said to give it a while. When I went in for my second visit I told him that I had some discomfort around the gum tissue and he continued to tell me that it would take about 8 weeks before I would probably notice lessening of all the symptoms. Well it has been about 6 weeks and the gum tissue continues to show signs of irritation to me and I do have slight headaches.>>

YOU HAD A VERY BAD INFECTION IN THAT TOOTH, THE SURROUNDING TISSUE AND THE BONE. IT IS A GOOD THING THAT YOU HAD THAT TOOTH REMOVED. IT CAN TAKE SEVERAL WEEKS FOR THE AREA TO CALM DOWN. THE BONE WILL NOT FILL IN COMPLETELY FOR ABOUT A YEAR. SO A LOT HAS TO HAPPEN FOR THE SITE TO HEAL COMPLETELY.

<< I am NOT a dental professional but have attempted to research as much as I could and I am concerned about the following: potential jaw muscular tissue, inflamed gum tissue, slight infection in jaw, or shifting teeth. I have not had any fever, swelling or gum discoloration.>>

OTHER THAN THE DISCOMFORT AROUND THE GUM TISSUE, YOU ARE NOT HAVING ANY TELL TALE SIGNS OF AN INFECTION. THE GUM CAN BE IRRITATED FROM EATING OR FROM HITTING IT WITH YOUR TOOTH BRUSH. WHAT ARE YOU USING TO RINSE YOUR MOUTH OUT WITH?

<< I do not know where to go next to try to get at what remains as the oral surgeon has told me to allow for 28 weeks for pain symptoms to subside. In your experience is that a reasonable amount of time?>>

YES, IT CAN TAKE THAT LONG OR LONGER. HAS THE ORAL SURGEON TAKEN A POST OP XRAY OF THAT AREA? IT IS TOO SOON TO SEE ANY BONE FORMATION BUT IF THERE IS A LINGERING INFECTION OR A RETAINED PIECE OF TOOTH OR ROOT CANAL FILLING THOSE THINGS ARE LIKELY TO SHOW UP ON AN XRAY.

<< I continue to feel that the sensitivity in the area it's worse then when I first had the tooth extracted although the headaches bone to ensure he gets all the infection and he said that that was not necessary based on his years of scraping the jaw bone to ensure he gets all the infection and he said that that was not necessary based on his years of experience he did say he went in and cleaned it out and he showed me the periodontal ligament which came out he showed me where they were three granulomas and he showed me a speck of material which she said was the sealer from the root canal which was likely irritating my gum tissue.>>

THIS PARAGRAPH IS CONFUSING TO ME. HOWEVER, IF HE SCRAPED OUT THE GRANULOMA TISSUE, THE PERIODONTAL LIGAMENT AND THE ROOT CANAL FILLING MATERIAL THEN IT DID WHAT HE WAS SUPPOSE TO DO. IT IS ALWAYS POSSIBLE THAT SOMETHING WAS LEFT BEHIND OR WAS MICROSCOPIC AT THAT TIME AND MAY BE MORE VISIBLE ON A NEW XRAY.

<< I have a follow up coming with him soon and I'm not sure what to ask because I don't feel he believes there is a lingering issue but I know that there is something be at the gum tissue or the jaw or the muscles. Any help you can provide would be appreciated.>>

WHAT ARE USING TO RINSE YOUR MOUTH? DO YOU EAT ON THAT SIDE OF YOUR MOUTH? DO YOU EAT SPICY OR SHARP FOODS, LIKE HOT PEPPERS OR CRUSTY BREAD?

AT YOUR FOLLOW UP APPOINTMENT, ASK HIM TO TAKE A PERIAPICAL XRAY OF THAT AREA TO BE SURE THERE IS NOTHING LEFT IN THAT SITE.

I HOPE THIS INFORMATION IS HELPFUL TO YOU. PLEASE CHECK BACK WITH US.

Bryanna
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 01-21-2015, 12:15 PM #3
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Bryanna,

Thank you for your timely response. My appointment with the oral surgeon is set for this Monday and this information is most useful. I am so appreciative of this site and your willingness to help. I will use your format for response since it seems to work for you and I like it as well. Your response comments are in CAPS.

<<THE BLACK AREA IS A DEFINITE SIGN THAT THE TOOTH IS INFECTED AND THE BACTERIA HAS SPREAD INTO THE BONE THROUGH THE ROOT OF THE TOOTH. >>

Now that the tooth is extracted, will the body heal the infection in the bone?

<< OIL PULLING IS BENEFICIAL FOR THE AREAS OF A TOOTH THAT ARE VISIBLE AND ABOVE THE GUM LINE.>>

So is it safe to assume people who oil pull and say their avoided root canal either did not have infection or they are temporarily masking the issue?

<< THE INFLAMMATION FROM THE BACTERIA WAS AFFECTING THE PERIODONTAL LIGAMENT WHICH WOULD CAUSE THE TOOTH TO BE SORE.

Can an inflamed ligament repair and heal on its own? Mine did not appear to be happy.

<< IN YOUR CASE, THE BACTERIA WAS DRAINING THROUGH THE TIP OF THE ROOT AND THE MAJORITY OF THE PUS COULD HAVE BEEN IN THAT DRAINAGE.>>

What I don't understand is why was my body seemed to be handling the drainage and showing no signs of illness prior to root canal and then post root canal, headaches and systemic changes started?

<< IT IS BEST TO TAKE PROBIOTICS EVERY DAY, WHETHER YOU ARE SICK OR NOT.>>

Thanks for the education on probiotics.

<<THE LINGERING HEADACHES COULD BE DUE TO THE INFLAMMATION FROM THE INFECTION AND FROM THE ROOT CANAL PROCEDURE...SO YOU HAD LOTS OF INFLAMMATION GOING ON.

Yes. Saw cardiologist and he pretty much said what you noted above and that inflammation and the body fighting infection can present with elevated heart rate and possibly increased blood pressure. Funny, none of the dentists believed this. I am hoping headaches fully resolve soon.

<< THIS LEADS ME TO THINK THAT THE ENDODONTIST MAY HAVE PERFORATED THE TOOTH WHILE DOING THE ROOT CANAL PROCEDURE AND/OR HE INSTRUMENTED THROUGH THE FRACTURE AND THE DISINFECTANT AND/OR THE FILLING MATERIAL WENT PAST THE TOOTH AND INTO THE TISSUE AND/OR BONE.

He did. In fact when I spoke with him he said he goes past the tip of the root to stimulate tissue, break up cyst if forming, and promote healing. First I had heard of that. Could this have contributed to systemic responses I experienced?

<< PAIN SPECIALISTS ARE NOT WELL VERSED ON TOOTH RELATED PROBLEMS.>>

This is a clinic that has orofacial pain specialist and oral surgeons working together. My endo gave me referral to oral surgeon, but the facility decided I should see oral pain doctor first. I spent a month with him not even looking at my x-ray and ignoring my inputs. I was really disturbed by that level of service. I want to followup with but don't want to be labelled and run risk of oral surgeon not wanting to help me through the healing phase.

<< THE GRANULOMA TISSUE FORMS WHEN BACTERIA BECOMES ABUNDANT AND ALSO FROM THE IRRITATION FROM THE ROOT CANAL SEALER THAT IS NOT MEANT TO BE PUSHED BEYOND THE TOOTH. THAT OVERGROWTH OF TISSUE NEEDED TO BE REMOVED AT THE TIME OF THE EXTRACTION. YOU HAD A VERY BAD INFECTION IN THAT TOOTH, THE SURROUNDING TISSUE AND THE BONE. IT IS A GOOD THING THAT YOU HAD THAT TOOTH REMOVED. IT CAN TAKE SEVERAL WEEKS FOR THE AREA TO CALM DOWN. THE BONE WILL NOT FILL IN COMPLETELY FOR ABOUT A YEAR. SO A LOT HAS TO HAPPEN FOR THE SITE TO HEAL COMPLETELY.>>

He showed it to me when he finished. What I don't understand is this debridement that I read about? (shaving down the bone - my dentist did not do that) He got ligament, granulomas, and sealer material. He took an x-ray post extraction to insure no pieces of bone, sealer material was left. Now that tooth is gone will the bone heal? What if there is some residual infection/inflammation? Will it cause me issues? I assume if there was a periapical cyst that would have been removed upon extraction as well?

<<OTHER THAN THE DISCOMFORT AROUND THE GUM TISSUE, YOU ARE NOT HAVING ANY TELL TALE SIGNS OF AN INFECTION. THE GUM CAN BE IRRITATED FROM EATING OR FROM HITTING IT WITH YOUR TOOTH BRUSH. WHAT ARE YOU USING TO RINSE YOUR MOUTH OUT WITH? DO YOU EAT ON THAT SIDE OF YOUR MOUTH? DO YOU EAT SPICY OR SHARP FOODS, LIKE HOT PEPPERS OR CRUSTY BREAD?

I am rinsing with salt water. I do not chew on that side. The soreness is right at the top of the gumline connecting to jaw tissue. I have tried massaging the area with the belief if it is a tight muscle, I will get relief. It helps a little but it must be irritating a nerve because the right side of my tongue will burn or tingle after massaging the sore spot. The soreness actually is a little worse than it was a couple of weeks ago. I want to rule out signs of tissue infection, blister (doesn't appear obvious), or bone issue (since extraction there has been a raised lump over extraction site - dentist says that is bone and normal.

<<AT YOUR FOLLOW UP APPOINTMENT, ASK HIM TO TAKE A PERIAPICAL XRAY OF THAT AREA TO BE SURE THERE IS NOTHING LEFT IN THAT SITE.>>

I will. It doesn't seem from your initial response you sense a high level of concern and that helps me. Based on your response to this note I will be ready for followup visit and will ask the questions you suggest. I just didn't know what could be remaining that would make my mouth so sore in that one spot and would irritate nerves when I massage it? (possible nerve sensitivity??

Bryanna, I look forward to your response. You are awesome. You don't know how lonely and frustrating it can be when no one seems to listen to you and try to help. Bless you for taking time to make a difference.
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Old 01-21-2015, 03:09 PM #4
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Hi Muffie,

Glad you found the information helpful!
I will re post your questions and answer you in bold type.

<<Now that the tooth is extracted, will the body heal the infection in the bone?

THE TOOTH WAS THE ORIGINAL SOURCE OF THE PROBLEM. SO EXTRACTING THE TOOTH TOOK CARE OF THE SOURCE. IDEALLY, THE SURGICAL SOCKET SHOULD BE SCRAPED CLEAN OF ANY DISEASED TISSUE AND BONE AS SOON AS THE TOOTH IS REMOVED. THIS STEP IS IMPORTANT BECAUSE ANY WOUND OR SURGICAL WOUND ANY PLACE IN OR ON THE BODY THAT IS LEFT "UNCLEAN" IS GOING TO STRUGGLE TO HEAL PROPERLY. SO THERE IS NO AUTOMATIC HEALING THAT OCCURS AFTER A TOOTH IS REMOVED... THE SITE NEEDS TO BE CLEAN OF DISEASED TISSUE FOR COMPLETE HEALING TO OCCUR.


<<So is it safe to assume people who oil pull and say their avoided root canal either did not have infection or they are temporarily masking the issue?>>

OIL PULLING IS VERY THERAPEUTIC FOR ORAL HEALTH, ESPECIALLY THE GUM TISSUE. COCONUT OIL HAS SOME THERAPEUTIC VALUE ON REMINERALIZING THE ENAMEL IF TOOTH DECAY IS IN VERY, SHALLOW AND IN THE EARLY STAGE.

BUT THERE ARE SEVERAL REASONS WHY OIL PULLING WILL HAVE NO AFFECT ON AN INFECTED TOOTH.

ONE) THERE IS NO ACCESS TO THE INFECTED NERVE TISSUE INSIDE OF THE TOOTH VIA MOUTH RINSING.

TWO) THERE IS NO ACCESS TO THE BONE SURROUNDING THE CIRCUMFERENCE OF THE ROOT OF THE TOOTH VIA MOUTH RINSING.

THREE) EVERY TOOTH HAS MANY HUNDREDS OF CURVY MICROSCOPIC CANALS THAT LINE THE INTERIOR OF THE TOOTH. THESE CANALS CONTAIN NERVE TISSUE WHICH BECOMES DISEASED WHEN THE TOOTH BECOMES INFECTED. EVEN DURING A ROOT CANAL PROCEDURE THESE CANALS ARE NOT ACCESSIBLE. SO MOUTH RINSING OR OIL PULLING IS NOT GOING TO BE ABLE TO ACCESS THEM EITHER.

FOUR) IT IS NOT UNCOMMON FOR A TOOTH INFECTION TO CAUSE SORENESS, SWELLING OR PAIN IN THE GUM TISSUE. SOMEONE CAN MISTAKE THE TEMPORARY DECREASE IN SWELLING, SORENESS OR PAIN OF THE GUM TISSUE WHILE DOING THE OIL PULLING AS A CURE OF THE INFECTION.

***AN INFORMATIONAL SIDE NOTE PERTAINING TO A TOOTH INFECTION..... THE PATHOLOGICAL PROGRESSION OF A TOOTH INFECTION CONSISTS OF SEVERAL DIFFERENT TYPES AND STRAINS OF BACTERIA. THE LONGER THE BACTERIA IS ALLOWED TO MULTIPLY, THE STRONGER OR MORE PROLIFIC THE INFECTION BECOMES.

<<Can an inflamed ligament repair and heal on its own? Mine did not appear to be happy.>>

AN INFLAMED PERIODONTAL LIGAMENT THAT HAS BECOME DISEASED FROM AN INFECTED TOOTH AND/OR UNRESOLVED PERIODONTAL DISEASE CANNOT REPAIR OR HEAL ON IT'S OWN.

AN INFLAMED PERIODONTAL LIGAMENT CAUSED BY THE MOVEMENT OF TEETH DURING ORTHODONTIA CAN REPAIR AND HEAL ITSELF AS LONG AS THE TRAUMA TO THE LIGAMENT IS SHORT LIVED, NON BACTERIAL AND NOT SEVERE.

<<What I don't understand is why was my body seemed to be handling the drainage and showing no signs of illness prior to root canal and then post root canal, headaches and systemic changes started?>>

PRIOR TO THE ROOT CANAL PROCEDURE, THE BACTERIA INSIDE THE TOOTH ATE THROUGH THE TIP OF THE ROOT AND PRODUCED A SWELLING, A CYST OF INFECTION, (THAT BLACK AREA ABOVE ROOT). BACTERIA WAS ABLE TO DRAIN FROM THE TOOTH THROUGH THAT CYST PREVENTING THE ACCUMULATION OF BACTERIA IN JUST ONE AREA. SOMETIMES THE CYST OR THE OPENING WILL CLOSE OFF AND THE AREA WILL SWELL UP OR A FISTULA WILL FORM.

IN MOST PEOPLE, THE IMMUNE SYSTEM BECOMES ALERTED TO AREAS OF INFLAMMATION AND INFECTION AND IT SENDS REPAIR CELLS TO THAT AREA. THESE CELLS TRY TO RUN INTERFERENCE BY ALLOWING DRAINAGE TO OCCUR WHICH CAN TEMPORARILY PREVENT OR MINIMIZE PHYSICAL SYMPTOMS. ONCE THE DRAINAGE OPENING CLOSES OFF, OR THE IMMUNE SYSTEM IS NO LONGER WILLING OR ABLE TO DEAL WITH THE PROBLEM, THE SYMPTOMS OF THE INFECTION BECOME APPARENT.

THE TRAUMA AND INFLAMMATION CAUSED BY THE ROOT CANAL PROCEDURE, THE ACCIDENTAL PERFORATION OF THE TOOTH DURING THE RC PROCEDURE ALLOWING BACTERIA AND TOXINS TO ENTER A DIFFERENT AREA OF THE TISSUE/ BONE, ALONG WITH THE ORIGINAL TRAUMA FRACTURING THE TOOTH THE TOOTH WERE ALL TOO MUCH FOR YOUR IMMUNE SYSTEM TO HANDLE. THUS THE ONSET OF THE PHYSICAL SYMPTOMS.

<<Thanks for the education on probiotics.>>

YOU ARE WELCOME. PROBIOTICS MAKE THE WORLD OF DIFFERENCE IN THE HEALTH OF OUR IMMUNE SYSTEM.

<<Yes. Saw cardiologist and he pretty much said what you noted above and that inflammation and the body fighting infection can present with elevated heart rate and possibly increased blood pressure. Funny, none of the dentists believed this. I am hoping headaches fully resolve soon.>>

IT'S IMPORTANT TO KNOW THAT DENTISTS ARE NOT PHYSICIANS. THEY ARE VARIOUS SKILLED TOOTH CARPENTERS WHOSE EDUCATION HAS FOCUSED ON THE CARPENTRY, NOT THE PATIENTS HEALTH. MAINSTREAM DENTISTRY FOR THE MOST PART DOES NOT CONNECT THE TEETH TO OUR OVERALL HEALTH. I KNOW THAT SOUNDS A BIT SILLY BUT IT'S THAT WAY IT IS. I AM GLAD THAT YOUR CARDIOLOGIST HAS BEEN UPFRONT WITH YOU WITH THE INFORMATION ABOUT THE CONNECTION.

<<He did. In fact when I spoke with him he said he goes past the tip of the root to stimulate tissue, break up cyst if forming, and promote healing. First I had heard of that. Could this have contributed to systemic responses I experienced?>>

IN MY 36 YEARS IN THE DENTAL PROFESSION, I HAVE ONLY KNOWN OR HEARD OF A HANDFUL OF DENTISTS WHO BELIEVE OR SAY THEY BELIEVE THAT PERFORATING THE APEX (ROOT TIP) OF THE TOOTH DURING THE RC PROCEDURE IS ADVANTAGEOUS. NEVER HAS THAT "BOO-BOO" BEEN PROVEN TO BE THERAPEUTIC. COMMON SENSE TRULY TELLS US THAT PUSHING A FOREIGN TOXIC MATERIAL INTO LIVE TISSUE AND BONE WHERE THERE IS INFECTION BREWING IS HIGHLY LIKELY TO CAUSE AN UNFAVORABLE SYSTEMIC REACTION. THUS YOUR HEADACHES, ETC.

<<This is a clinic that has orofacial pain specialist and oral surgeons working together. My endo gave me referral to oral surgeon, but the facility decided I should see oral pain doctor first. I spent a month with him not even looking at my x-ray and ignoring my inputs. I was really disturbed by that level of service. I want to followup with but don't want to be labelled and run risk of oral surgeon not wanting to help me through the healing phase.>>

THE CONCLUSION THAT I COME TO WITH THE DELIVERANCE OF POOR QUALITY CARE FROM THE ORAL PAIN DR IS THAT HE WAS MISTAKENLY UNDER THE IMPRESSION THAT SINCE THE TOOTH WAS ROOT CANALED, YOUR PAIN WAS NOT ASSOCIATED WITH THAT TOOTH. AS YOU HAVE LEARNED, THAT WAS NOT THE CASE AT ALL. IF HE HAD LOOKED AT THE XRAY AT THE ONSET HE WOULD HAVE SEEN THE PROBLEM.

FOLLOWUP WITH AN ORAL SURGEON, NOT THE ORAL PAIN SPECIALIST. THE SURGEON WHO EXTRACTED YOUR TOOTH, IS RESPONSIBLE FOR YOUR CONTINUED CARE.

<<He showed it to me when he finished. What I don't understand is this debridement that I read about? (shaving down the bone - my dentist did not do that) He got ligament, granulomas, and sealer material. He took an x-ray post extraction to insure no pieces of bone, sealer material was left. Now that tooth is gone will the bone heal? What if there is some residual infection/inflammation? Will it cause me issues? I assume if there was a periapical cyst that would have been removed upon extraction as well?>>

THE BLACK AREA WAS A CYST AS WELL AS GRANULOMA TISSUE. IT SOUNDS TO ME LIKE HE DEBRIDED THE SOCKET AND BONE PRETTY WELL. NOT EVERY CASE NEEDS TO HAVE THE BONE SHAVED DOWN... THAT OCCURS UNDER CERTAIN CIRCUMSTANCES. USUALLY IN CASES WHERE THE TOOTH HAD BEEN ROOT CANALED YEARS PRIOR AND/OR THERE WAS PERIODONTAL DISEASE PRESENT. WHEN THE SURGEON SCRAPES/DEBRIDES THE SURGICAL SOCKET HE CAN FEEL WITH THE INSTRUMENTS WHEN HE IS AGAINST SOLID BONE AND HE CAN TELL THE HEALTH OF THE CLEANED AREA BY THE COLOR, SMELL AND VOLUME OF THE BLOOD. IF THE AREA FEELS MUSHY OR SMELLS BAD, OR THE BLOOD IS DARK AND NOT VOLUMINOUS, THEN HE KNOWS HE HAS MORE WORK TO DO.

IT IS ALSO A GOOD SIGN THAT HE TOOK A POST OP XRAY AFTER HE REMOVED THE TOOTH AND DEBRIDED THE BONE. THIS TELLS ME THAT HE WAS THOROUGH IN HIS CARE AND KNEW THAT HE HAD TO GET EVERYTHING VISIBLE OUT. HE KNEW IT WOULD BE BETTER TO GO IN AND CLEAN IT AGAIN AT THAT TIME, RATHER THAN LATER, IF SOMETHING HAD APPEARED ON THE XRAY.

YOU CAN STILL END UP WITH SOME SMALL BONY FRAGMENTS THAT ARE NOT VISIBLE ON THAT XRAY THAT MAY WORK THEIR WAY TO THE GUM SURFACE. BUT YOU WILL KNOW IF THAT OCCURS AND THAT IS NOT UNUSUAL. MOST TIMES THESE TINY SPLINTERS COME OUT ON THEIR OWN, SOMETIMES THEY NEED A LITTLE HELP.

<<I am rinsing with salt water. I do not chew on that side. The soreness is right at the top of the gumline connecting to jaw tissue. I have tried massaging the area with the belief if it is a tight muscle, I will get relief. It helps a little but it must be irritating a nerve because the right side of my tongue will burn or tingle after massaging the sore spot. The soreness actually is a little worse than it was a couple of weeks ago. I want to rule out signs of tissue infection, blister (doesn't appear obvious), or bone issue (since extraction there has been a raised lump over extraction site - dentist says that is bone and normal.>>

I SUGGEST THAT YOU STOP MASSAGING THAT AREA. YOU COULD HAVE SOME IRRITATION TO A BUNDLE OF NERVES EITHER FROM THE INFECTION, THE INFLAMMATION OR THE ANESTHETIC INJECTION. JUST LET IT HEAL, DO NOT TRY TO HURRY UP THE HEALING PROCESS. MOST NERVE IRRITATIONS WILL SUBSIDE ON THEIR OWN IF THEY ARE NOT REPEATEDLY TRAUMATIZED.

<<I will. It doesn't seem from your initial response you sense a high level of concern and that helps me. Based on your response to this note I will be ready for followup visit and will ask the questions you suggest. I just didn't know what could be remaining that would make my mouth so sore in that one spot and would irritate nerves when I massage it? (possible nerve sensitivity??>>

I AM NOT OVERLY CONCERNED AT THIS POINT. BASED ON YOUR DESCRIPTIONS, IT SOUNDS LIKE THE ENDODONIST EXACERBATED THE ORIGINAL PROBLEM BUT THE ORAL SURGEON DID HIS JOB WELL. YES, COULD BE NERVE RELATED AND I THINK THE SYMPTOMS THAT YOU HAVE WHEN YOU MASSAGE THAT AREA INDICATE TO LEAVE IT ALONE AND LET IT HEAL.

<<Bryanna, I look forward to your response. You are awesome. You don't know how lonely and frustrating it can be when no one seems to listen to you and try to help. Bless you for taking time to make a difference.>>

THANK YOU FOR THE KIND WORDS
I DO UNDERSTAND HOW LONELY AND SCARY IT CAN BE WHEN YOU HAVE A LEGITIMATE PROBLEM AND THOSE YOU HAVE TO TRUST TO TAKE CARE OF YOU, ARE NOT LISTENING OR MANAGING YOUR PROBLEM PROPERLY. YOU HAVE DONE WELL IN PURSUING YOUR SITUATION TO THIS POINT AND ALL YOU CAN DO NOW IS TAKE GOOD CARE OF YOURSELF, INCLUDE TAKING THOSE PROBITICS ), AND FOLLOW UP WITH AN XRAY AT THE ORAL SURGEON.

KEEP US POSTED... I'M HERE IF YOU HAVE ANY FURTHER QUESTIONS OR CONCERNS.

Bryanna
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 01-23-2015, 08:49 AM #5
muffie7 muffie7 is offline
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Default TMD symptoms

Bryanna,

I had increased facial pain yesterday and noticed more clicking when I talk. The pain developed into a full headache.

I have had tooth 2 pulled a while ago and it appears wisdom tooth has shifted over diagonally (crooked). Now with tooth 3 being removed, could the wisdom tooth be irritated and pressing on a nerve which is causing me discomfort?

Could this be symptoms of TMD? If so, who is the best to treat this? The orofacial pain specialist I saw suggested TMD but all he did was send me to PT and they worked on my back and shoulder for neck pain but didn't address facial pain.

Lastly if I want to get a partial denture for tooth 3 replacement will the wisdom tooth need to be pulled, since it is crooked. and I get a partial denture. I have heard negative stories about wisdom teeth being pulled, particularly in the 40+ age group.

I will ask the oral surgeon about the x-ray you suggested. Would he also be able to evaluate the health of the wisdom tooth, not as it relates to decay but to position, and TMD?
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Old 01-23-2015, 05:20 PM #6
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Hi muffie,

<<I had increased facial pain yesterday and noticed more clicking when I talk. The pain developed into a full headache.>>

CLICKING? DO YOU MEAN IN THE JAW OR THE JAW JOINT?

<<I have had tooth 2 pulled a while ago and it appears wisdom tooth has shifted over diagonally (crooked). Now with tooth 3 being removed, could the wisdom tooth be irritated and pressing on a nerve which is causing me discomfort? >>

TEETH CAN SHIFT WHEN ADJACENT TEETH ARE EXTRACTED. THE SHIFTING OF A TOOTH OR TEETH CAN ALTER THE ALIGNMENT OF THE JAW JOINT AND THE BITE. YES, SHIFTING OF A WISDOM TOOTH, DEPENDING ON WHERE IT IS LOCATED IN PROXIMITY TO THE NERVE BUNDLES IN THE JAW BONE, CAN CAUSE IRRITATION TO CERTAIN NERVES. ESPECIALLY IF THAT WISDOM TOOTH IS GETTING USED TOO HARSHLY WHEN YOU CHEW AS IT COULD BE IF IT HAS SHIFTED OUT OF IT'S ORIGINAL PLACE.

<<Could this be symptoms of TMD? If so, who is the best to treat this? The orofacial pain specialist I saw suggested TMD but all he did was send me to PT and they worked on my back and shoulder for neck pain but didn't address facial pain.>>

IT COULD BE TMD OR TMJ, SAME THING. DID YOU HAVE TMD PROBLEMS BEFORE YOU HAD THE TEETH REMOVED? IF NOT, THEN THE SHIFTING OF YOUR BITE COULD BE CAUSING THE CURRENT JOINT PROBLEM. P/T WILL HELP ALIGN THE BACK AND SHOULDER IF IT IS BEING THROWN OFF BY THE JAW PROBLEM. WHICH BY THE WAY, IS PRETTY COMMON. HOWEVER, P/T WILL NOT BE A PERMANENT FIX UNLESS THE MISALIGNED BITE IS CORRECTED.

<<Lastly if I want to get a partial denture for tooth 3 replacement will the wisdom tooth need to be pulled, since it is crooked. and I get a partial denture. I have heard negative stories about wisdom teeth being pulled, particularly in the 40+ age group.>>

IT IS NOT IDEAL TO USE A CROOKED WISDOM TOOTH TO ANCHOR A PARTIAL DENTURE OF PERMANENT BRIDGE. HOWEVER, IN ORDER TO HAVE A PARTIAL DENTURE, IT IS BEST TO HAVE A BACK TOOTH TO ANCHOR THE PARTIAL ONTO SO IT IS STABLE WHEN YOU CHEW. YOUR DENTIST WILL HAVE TO EVALUATE YOUR BITE AND GIVE YOU OPTIONS OF WHAT IS BEST SUITED FOR YOUR PARTICULAR SITUATION.

<<I will ask the oral surgeon about the x-ray you suggested. Would he also be able to evaluate the health of the wisdom tooth, not as it relates to decay but to position, and TMD?>>

OKAY, GOOD IDEA. YES, HE CAN EVALUATE THE HEALTH OF THE WISDOM TOOTH AND ALSO THE JOINT PROBLEM.
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 02-09-2015, 01:00 PM #7
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Default Update from oral surgeon visit

Bryanna,

I went to see oral surgeon as we discussed. I told him of the pain on the right side of my face and that bite guard helps some but does not address soreness in mouth. He did not take x-ray of my teeth to evaluate condition of other teeth, said all looks good, and suggested I use a bite guard if it helps. He said "I believe you are in pain but there is nothing medically or scientifically I can address." So irritating when you don't know what to do and you don't get the help you should because someone has decided nothing is wrong.

It has been 2 months since tooth extraction and I have a bony lump on the gum on top of the extraction site. When I run my tongue over the spot, it is sore. I have read about bony fragments. I wonder if this is what I have.

1. Is it common to get bony fragment on gumline on top of the extraction site? The lump does feel smaller than it was a month ago but it is still sore and I am still having some neck discomfort. Can this irritation cause pain in face and jaw?
2. My chiro says neck discomfort could be from jaw/c1 vertebrae connection as the c1 atlas doesn't seem to want to stay in place. Could this be from inflammation? bloodwork doesn't show any inflammation markers so doctor thinks all is well, but I know I still have headaches and neck discomfort. I have no swelling, no fever.
3. Also could neck discomfort be from healing of bony fragment? How much time should I allow for this?
4. I do have stomach discomfort, not sure if it is from pain or from irritated stomach from antibiotic therapy. I have also read about tooth meridians and tooth 3 is connected to stomach so I wonder if there is some connection there as well?
5. Lastly I wonder if there is vagus nerve involvment as I have had the stomach and heart and neck connections which can all have vagus involvement. Heart rate is getting better when I treat stomach irritation (taking digestive enzymes). Any suggestions on how to get a proper diagnosis?

Thanks Bryanna.
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