Hi Bryanna, thank you so much for your indepth consideration, insights and advice


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.

I am 55, so the wisdom teeth extractions were 30 year+ ago - I have seen it on the x- ray (it was me who actually first questioned it) and I have been told it is as it is not in the same area and not right near the sinus area.

<<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 am not sure about the tissue graft....the gum surgery was around both of those teeth and I have never had a root canal.

<<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.

My night guard is checked and adjusted at every 6 month dental appointment -I have been advised it is still in good shape

<<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?

No, no root exposure

<<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.

Yes, it is always at it's worst when I am upright

<<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?

She was my second dentist - I had been seeing her for the past 20 years, with the symptoms only appearing in the last 4 years

<<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?

Left side and many years (30) inbetween


<< 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?

Periodontist did a dental CT scan 2 years ago - the oral surgeon will probably be the next...and last..specialist I consult over this




<< 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?

brush my teeth twice a day, rarely use mouthwash as it stings and burns like the wine does, floss or use interdental brushes every night


<<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.>>
WHY THE ORTHO SPLINT? IS THE TOOTH MOBILE?


My new dentist put the splint on in case there was a crack - some of the in surgery crack tests led her to feel there may be a crack (the ice pen test, the pressure test etc) I had it on for 2 weeks, then went back to see her and advise if there was any difference in the symptoms- there wasn't but she left it on until after I had seen the endodontist. He has advised me to keep it on until I decide what I want to do next.



<<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?


No, they were not able to do that - I am seeing my dentist again on 8 May for a followup discussion of the endodontist's findings - I may be able to get a copy then.



<<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?


No, they all have assumed that was part of the issue (based on my description of the pain) and also with the diagnosis of trigeminal neuropathic pain , The RH side of my face has always been a tiny bit lopsided I suppose - but, yes, that is normal for one side to be different any way

<<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?

Purely based on description of the pain and the triggers.



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?

Yes, I am leaning towards the extraction and that would be done by an orial surgeon, so no doubt there would be consultation prior to this - I know no one will extract teeth on demand! I will not be having a root cancl or a crown - I strongly believe that these would not resolve my isues and be a waste ot time and money.

again, thankyou so much for your time and advice