Hi AnneB,

I am in the dental field and can offer you some information here. I am going to re post some of your inquiry and reply to you in bold type. Just makes it easier for you to follow.

<<in my early 20’s, I had my 4 wisdom teeth extracted – all extractions were done under local anesthetic - a hideous experience that still haunts me – the upper right tooth broke during the extraction and the dentist therefore had to ‘dig out’ the roots. I have been told (and seen on x –rays) since my current issue surfaced that a very small part was left behind, but advised this would not be the cause of my current problem.>>

YOU DID NOT GIVE YOUR AGE SO I DON'T KNOW HOW LONG AGO THESE TEETH WERE EXTRACTED. HOWEVER, WHEN A DENTIST "DIGS" AROUND FOR BROKEN PIECES OF A MAXILLARY MOLAR THERE IS A GOOD CHANCE THAT THERE WILL BE A SINUS PERFORATION AND/OR THAT SOME PIECES OF TOOTH AND/OR DEBRIS FROM THE SOCKET BEING SCRAPED WILL GET PUSHED UP TOWARDS OR INTO THE SINUS. SOMETIMES THEY ARE PUSHED UP INTO THE TISSUE OR FURTHER INTO SOFT BONE. DENTAL XRAYS OR A PANORAMIC RADIO GRAPH SHOULD BE ABLE TO DETERMINE WHERE THESE PIECES ARE. BUT IF NOT, THEN A DENTAL CT SCAN COULD LOCATE THEM.

ANYTIME FRAGMENTS OF A TOOTH ARE NOT REMOVED THEY ARE GOING TO IRRITATE THE LOCATION THEY ARE STUCK IN AND BACTERIA MOST OFTEN WILL FORM AROUND THE FRAGMENTS. DEPENDING ON WHERE THEY ARE LOCATED, SOMETIMES THEY WILL MOVE UP, DOWN , SIDEWAYS, ETC. SOMETIMES THEY WILL ACTUALLY WORK THEMSELVES OUT THROUGH THE GUM TISSUE... IT DEPENDS ON WHERE THEY ARE LOCATED AND HOW MUCH INFLAMMATION THEY HAVE CAUSED.

<<Approximately 7-8 years ago, I had gum surgery as I did have a receeding gum issue that was at it’s worst in that area. I see the periodontist every year for a checkup and he is always pleased with my ongoing care and the state of my gums.

WHERE WAS THE TISSUE GRAFT DONE? WAS IT THE UPPER RIGHT FIRST OR SECOND MOLAR? IS THE FIRST MOLAR ROOT CANALED?

<<I do grind my teeth at night and have worn a mouth guard at night for the past 5 years.>>

HAVE THE FIT OF THE NIGHT GUARD CHECKED AND IF IT VERY WORN, HAVE A NEW ONE MADE.

<< 4 years ago, I started to notice a ‘leaking’ feeling in the upper right part of my mouth – it seemed to be coming from the upper back molar on RH side (sorry, I am not sure on tooth numbering). I would then take a little bit of extra care in flossing and it would subside. Then, one day it simply did not go away and has remained ever since along with the other symptoms that emerged.>>

THIS LEAKING FEELING COULD BE A SLOW RELEASE FROM A DRAINING SINUS AND/OR A DRAINING INFECTION WHICH COULD MILD BUT PERSISTENT. THE FLOSSING WOULD SEEM TO MAKE IT SUBSIDE BECAUSE THERE IS CHANCE THAT THE FLOSSING MAY HAVE ACTUALLY INFLAMED THE GUM WHICH BLOCKED UP THE DRAINAGE. WHEN THE INFLAMMATION WENT DOWN, THE LEAKING RE OCCURRED. FLOSSING IS A GOOD THING IN MOST CASES. BUT SOMETIMES FLOSSING CAN EXACERBATE AN IRRITATION AND IN SOME CASES THAT IS A GOOD THING AND IN OTHERS NOT SO MUCH.

<<This is my ‘pain in the face’ that runs and ruins my life – it is a dull ache that never goes away. It varies in intensity, sometimes escalates to a full on throb – occasionally, I will get the sudden ‘electric shock’ type jolts . But, it is always there, pushing, aching in the background. My tooth aches intermittently but the leaking , drainage from the tooth area has never gone away. This is accompanied by the most horrible tastes in my mouth –some days it is sharp and bitter and burns my tongue and mouth, other days it is sweet and salty, other days it tastes ‘phlegmy’ – some days the drainage feels thick and lumpy like phlegm also.>>

THIS SOUNDS LIKE IT COULD BE A FRACTURED TOOTH IN COMBINATION WITH SOMETHING ELSE GOING ON. MEANING YOUR TOOTH COULD BE FRACTURED AND YOU COULD ALSO BE HAVING LATE STAGE COMPLICATIONS FROM THE REMOVAL OF YOUR WISDOM TEETH WITH THE LEFT BEHIND FRAGMENTS, ETC. IS THERE ANY PORTION OF THE ROOTS EXPOSED ON YOUR FIRST OR SECOND MOLAR?

<<If I suck in my mouth, I can feel the fluid drawing down from the tooth area. At night, if I lie on the left side of my face , I can feel it running down across my mouth – if I lie on my right side, the pressure builds up and wakes me up during the night with a numb face.>>

WELL THAT SURE SUMS IT UP AS FAR AS SOMETHING BEING WRONG. THOSE DEFINITIVE ONGOING SYMPTOMS INDICATE A CHRONIC BACTERIAL ISSUE THAT IS DRAINING. WHILE YOU ARE UPRIGHT, IT IS ABLE TO DRAIN THANKS TO GRAVITY. BUT WHEN LAYING DOWN IT IS UNABLE TO DO THAT.

<<And so began my expensive, exhausting 4 year journey for an answer. My long term dentist (who has just retired now unfortunately) had been very patient with me. I initially had the old original fillings removed and replaced. However, she told me that I was ‘imagining’ the drainage/taste in my mouth. When I broke down and cried and cried and cried, she could then see how much this was impacting me. She thought it was possible that there is a crack in the tooth or a root fracture, and advised me if that is the case, it can take years for this to become apparent, if at all.>>

I AM GLAD SHE RETIRED. GIVEN YOUR LONG TERM CHRONIC DEBILITATING SYMPTOMS YOU ARE CERTAINLY NOT IMAGINING ANYTHING. IT CAN BE DIFFICULT TO DIAGNOSE A FRACTURED TOOTH AND SOMETIMES IT IS NOT DIAGNOSED UNTIL THE TOOTH IS REMOVED AS THAT IS WHEN THE FRACTURE CAN BE SEEN. PLEASE CLARIFY FOR ME, DID THESE SYMPTOMS OCCUR AFTER SHE REMOVED THAT UR WISDOM TOOTH?

<<I have had my salivary glands checked, I have seen 2 ENTs – one diagnosed it as GERD and told me to not eat tomatoes and elevate my bed – I took GERD tablets that made me sick and did nothing else. I had sinus surgery as there was a polyp and I had a deviated septum – no change.>>

WHAT SIDE WAS THE NASAL POLYP REMOVED AND HOW LONG AFTER THE WISDOM TOOTH REMOVAL?

<< I have had MRIs , CT scans....umpteen X rays ....nothing..nothing. The periodontist did a one of those full circle scans....nothing.>>

DID YOU HAVE A DENTAL CT SCAN OR JUST A HEAD CT SCAN? DID YOU CONSULT WITH AN ORAL SURGEON ABOUT THIS?

<< I went to the TMJ specialist – he could find nothing wrong with my jaw other than it is a bit ‘clicky’ but could see that there is some nerve damage in my face as the right side of face has a bit of a ‘droop’. In between all these appointments, I give up and just live with it. >>

A LOT OF PEOPLE HAVE A CLICKY JAW ESPECIALLY THOSE WHO GRIND THEIR TEETH. I HAVE A HARD TIME BELIEVING THAT HE COULD DIAGNOSE NERVE DAMAGE BASED ON ONE SIDE OF YOUR FACE SEEMS TO DROOP COMPARED TO THE OTHER. UNLESS HE KNEW WHAT YOU LOOKED LIKE PRIOR TO THAT VISIT AND HE COULD DIAGNOSE SEEING A CHANGE IN THE SHAPE OF YOUR FACE... THAT DIAGNOSIS IS WACKY TO SAY THE LEAST. NO ONES FACE IS PERFECTLY SYMMETRICAL AND UNLESS IT WAS DROOPING LIKE IN BELL'S PALSY OR SIMILAR, HE CANNOT DIAGNOSE NERVE DAMAGE BY NOTICING A SLIGHT DROOP. UNLESS YOU HAD BELLS PALSY AT SOME POINT IN YOUR LIFE AND IT HAS BEEN REACTIVATED?

<<It hurts, day in, day out. It hurts when I smile, it hurts when I chew on something in just the wrong place ,>>

THE PAIN IS INFLAMMATION AND AS IT DRAINS THE INFLAMMATION GOES DOWN BUT THEN BUILD UP AGAIN... DRAINS... BUILDS UP AGAIN.

<< the drainage gets worse when I brush my teeth,>>

BECAUSE WHEN YOU BRUSH YOU OPEN UP THE TISSUE WHERE IT'S ABLE TO DRAIN FROM.

<< it gets worse with stress with my job (I probably grind more at night when I am stressed.>>

EXACTLY, GRINDING YOUR TEETH ALSO OPENS UP THAT AREA AS IT PUSHES THE TEETH ALLOWING SPACE TO OCCUR IN BETWEEN THE TEETH AND THE GUMS. IT CAN BE A MILLIMETER OF SPACE AND DRAIN.

<< I cannot drink wine anymore as it reacts with the fluid and burns. I shy away from close contact with other people because I am certain that my breath must be really bad with all this and there is nothing I can do to stop it. >>

WHAT ARE YOU USING TO RINSE WITH? MOUTHWASH? WHAT IS YOUR DAILY ORAL HYGIENE REGIMEN?

<<I am certain the drainage is coming from in between my back molar and the one next to it. The ONLY time it stopped for an extended period was when my dentist stuck some dental cement in between them when I explained that by wedging food in there or sticking chewing gum over there stopped it briefly.>>

WHICH TOOTH HAD THE GUM GRAFT DONE? PUTTING CEMENT OR GUM IN THAT AREA WILL PREVENT THE LEAKAGE BUT IT WILL THEN CAUSE THE LEAKAGE TO RE ROUTE AND FIND A NEW PLACE TO DRAIN OR THE AREA WILL SWELL UP. SO THAT IS NOT GOOD.

<<I was referred to a facial pain specialist who diagnosed me with trigeminal neuropathic pain and advised there is little that can be done for this condition at present>>

OF COURSE HE DID. HE HAS NO EDUCATION ON TEETH AND SEES YOUR PAIN AS FACE PAIN, NOT TOOTH RELATED.

<< I had some some success for the pain with capaiscin cream but the drainage continued of course. The specialist told me this was ‘adrenaline’ from the nerve, but I was not certain about that diagnosis.>>

CAPSAICIN IS ACTUALLY DERIVED FROM CHILLI PEPPERS AND IT ACTS AS AN IRRITANT WHICH STIMULATES BLOOD TO FLOW IN THE AREA WHERE THE CREAM IS APPLIED. iT IS NOT A CURE, JUST ANTIDOTE FOR INFLAMMATION.

<<the filling was removed again, a temporary put in and put an orthodontic brace on the tooth – this has had no impact on the symptoms.>>

IS THIS THE 2ND MOLAR? WHY THE ORTHO SPLINT? IS THE TOOTH MOBILE?

<<he listened carefully to my symptoms, did a few checks and an x ray. He informed me (and showed me) that the pulp in the tooth is very inflamed but there is no sign of infection.>>

OKAY SO AN INFLAMED PULP INDICATES A CHRONIC CONDITION IS OCCURRING, SO IT IS NOT YOUR IMAGINATION AS YOU HAD BEEN TOLD PREVIOUSLY. FRACTURE IS A GOOD POSSIBILITY.

<<He was very interested in the drainage as he said he has had patients with tooth cracks describe this and he explained how if a cracked tooth flexes, it can draw in mouth fluid, and then when it expands again, the fluid is expelled. However, he could not see a crack but feels it is possible one of the roots is fractured and the crack may start near the gumline....>>

OKAY THIS MAKES SENSE AND I AGREE WITH HIM. BY ANY CHANCE CAN HAVE THAT OFFICE EMAIL YOU THE XRAY AND POST IT HERE?

<<His recommendation is either one of 2 options – a root canal to remove the inflamed pulp – >>

A ROOT CANAL REMOVES MORE THAN THE PULP. IT INCLUDES SCRAPING ALL OF THE LARGE CANALS BUT LEAVES THE HUNDREDS OF TINY CANALS FULL OF DEAD NERVE TISSUE. DO THE ROOT CANAL IS JUST TRADING ONE PROBLEM OFF FOR ANOTHER ONE.

<<She feels that this is a trigger for the facial nerve pain and if it is removed, there is a ‘good chance’ the facial pain will subside (but as the facial nerve is obviously damaged, can’t guarantee it) but this would not solve the drainage/taste issue.>>

THE ACUTE PAIN COMING FROM THE INFLAMED PULP TISSUE MAY SUBSIDE BUT THE RC PROCEDURE DOES NOT IN ANY WAY MAKE THIS TOOTH HEALTHY AGAIN. IN FACT JUST THE OPPOSITE HAPPENS BECAUSE THE RC PROCEDURE LEAVES THE TOOTH NON VITAL WHICH CARRIES A SLEW OF BACTERIAL PROBLEMS. THERE IS NO EVIDENCE, NONE THAT YOU HAVE MENTIONED SO FAR HERE, THAT INDICATES YOU HAVE FACIAL NERVE DAMAGE. SHE IS RIGHT ABOUT THE DRAINAGE IN FACT THAT WOULD PROBABLY INCREASE AS ADDITIONAL BACTERIA SETS IN THE TOOTH AFTER THE RC PROCEDURE.

<< It would then be likely a crown would be needed.>>

THE CROWN WOULD BE A WASTE OF MONEY IF THE TOOTH IS FRACTURED.

<<The other option - the only likely way to stop the drainage issue would be extraction (but again, no guarantee of success)>>

IT IS FIRST IMPERATIVE THAT THE REAL PROBLEM BE DIAGNOSED AND BE DETERMINED WHICH TOOTH IT IS FOR CERTAIN. IF YOU ARE DEALING WITH A FRACTURED TOOTH AND IT IS REMOVED... IF THE FRAGMENTS OF THE WISDOM TOOTH ARE REMOVED AND ANY CHRONIC SINUSES ISSUES/PERFORATIONS THAT YOU MAY HAVE FROM YOUR DENTAL PROBLEMS ARE REMEDIED... YOU COULD END UP FINE.

<<When I told him I can live with the pain (I am used to it and can deal with it – heat packs, pain killers etc) and that the drainage/taste is what is my main concern , he said extraction is therefore a 'legitimate option'. I have asked over the past 4 years about the possibility of having my tooth extracted – everyone has advised against this and said there is no guarantee it will do anything and losing a tooth should only be a last resort. The endodontist also explained how extraction will then put more pressure on the next molar and similar issues may develop.>>

AGAIN THESE DENTISTS ARE ASSUMING YOU HAVE PERMANENT NERVE DAMAGE BUT WHAT GIVES THEM THAT IMPRESSION? IS IT STRICTLY BASED ON WHAT THE TMJ DR SAID? DID YOU YOU NOTICE A SIGNIFICANT DROOP IN YOUR FACE PRIOR TO HIM TELLING YOU THAT? DO YOU NOTICE THAT NOW?

<<So, here I am now, being finally offered the option to have the tooth extracted. I do not want a root canal - I had already decided that before I went to see him. I know that, based on much reading over the past few years, that this can exacerbate trigeminal neuropathic pain.>>

IT IS A KNOWN FACT THAT ANYTIME YOU HAVE A TOOTH EXTRACTED YOU RUN A RISK OF NERVE DAMAGE...... COULD BE TEMPORARY OR PERMANENT. HOWEVER, PERMANENT NERVE DAMAGE AFTER ORAL SURGERY IS RARE AND THE SLIGHT CHANCE OF THAT OCCURRING NEEDS TO BE WEIGHED AGAINST WHAT YOU ARE LIVING WITH NOW. AGAIN, WHAT HAS DETERMINED THAT YOU HAVE FACIAL NERVE DAMAGE NOW?

<<If the tooth is extracted and it does not change a thing, at least the lingering doubt that has always been in my mind that the tooth is the cause will be gone. Or, I can continue to do nothing and once and for all, give it all up as a lost cause and resign myself that this will never go away and it is indeed a life sentence.>>

DEPENDING ON WHERE AND HOW SEVERE YOUR TOOTH IS FRACTURED BACTERIA WILL CONTINUE TO GET INTO THE FRACTURE AND THAT WILL CONTRIBUTE TO OTHER PROBLEMS WITH THE TOOTH. ALSO THOSE BONY FRAGMENTS FROM THE WISDOM TOOTH EXTRACTION NEED TO BE EVALUATED BY AN ORAL SURGEON AS THEY MAY BE CONTRIBUTING TO YOUR FACIAL PAIN.

<<I am not asking for someone to tell me exactly what I should do – I would like to know if anyone has had anything similar to this or can give me any insight or an informed opnion.>>

ANNE, MANY PEOPLE PRESENT WITH FRACTURED TEETH ALL THE TIME. THEY ALSO PRESENT WITH FRAGMENTS OF TEETH NOT REMOVED BY THEIR PREVIOUS DENTIST. SO ALTHOUGH YOU FEEL LIKE YOU HAVE BEEN GIVEN A BIT OF A RUN AROUND... WHICH I THINK STEMMED FROM YOUR ORIGINAL DENTIST... YOUR CASE IS NOT UNUSUAL.

IF YOU HAVE NOT CONSULTED WITH AN ORAL SURGEON, THEN I WOULD SUGGEST THAT BE YOUR NEXT STEP. BUT PLEASE DO NOT GIVE UP AS THIS SHOULD NOT BE SOMETHING YOU JUST HAVE TO LIVE WITH. OKAY?

Bryanna