Originally Posted by Bryanna

Hi friendlyd52,

Oh my goodness.... you have been on a horrible journey but I am so glad to hear that you are health conscious and under the care of an ND. Biological dentists have a broader knowledge of the oral and systemic connection but as with most dentists, they often back each other up like a pack of rats. Especially when the dental issue is complicated.

A few things instantly come to my mind....

1- Do you have a clenching and/or grinding habit? In someone who has a healthy dental history but has cracked or fractured teeth it tends to indicate a bruxism habit. This can cause minor or major cracking of the teeth, inflamed periodontal ligaments, abscesses, tooth mobility, unnatural wear patterns on the teeth, misalignment of the bite and even TMJ issues. So if you do have a bruxism habit, then it needs to be evaluated and addressed.

I have a history of PTSD, and this teeth issue started last year, when I was working/living in a very high-stress environment and doing a cross-country commute. (I do think I've had a grinding clenching issue in the past, but not chronically.) I also had a lot of back/hip pain last year, and it was contributing to grinding/clenching for sure.

I've slowed my life down considerably (I have a very accomodating employer) and it's helped a lot. My ND also has me on magnesium and calcium at night, as it works like a muscle relaxant. I did get a mouthguard a while back--a potential clenching/grinding problem was brought up last summer by my biological dentist--but it seemed to make my teeth hurt more, so I don't wear it very often (it's supposed to force my teeth closed in the front so the back ones are kept open). I have noticed that some people use some sort of taste-based method for dealing with bruxism--but it looks like that requires sautering or fabrication experience to set up the right kind of mouth guard. Do you know of any resources in that regard?



2- Tooth #3 (and most likely #2) was evidently cracked long before it was diagnosed. Initially the crack is a crazing line and does not pose any problems. But if and when that crazing line becomes deeper into the dentin of the tooth, bacteria is able to get into that opening and make its way to the pulp. This tooth would test vital until the pulp becomes infected. At which time an abscess is likely to develop.

This sounds consistent with what was happening. And of course, now I'm wondering if there are other teeth also waiting to do the same thing.

3- Root canal therapy simply adds insult to injury in a cracked tooth. The procedure itself is very traumatic and injurious to the tooth causing the crack portion to become more fragile. Add to that the toxicity of the disinfectants and the filling material..... you get the picture.

Yeah--that RC knocked me down for about 6 weeks--I had no energy to do anything other than the bare basics: work and sleep.

4- It sounds like the dentist who removed #3 debrided the site and bone thoroughly. Antibiotics are not always prescribed for extractions and he obviously didn't feel it was necessary at that time. I wonder what his findings were when he extracted that tooth... did he mention anything about the tooth being perforated through the apex during the root canal and that there was root canal filling material pushed beyond the apex? Did he mention anything about the sinus or a sinus communication? What were the surgical findings with tooth #2..... the black area on the xray was a cyst, was it removed? Any mention of a sinus communication with that tooth?

I have never heard any mention of a cyst, from anyone involved in my case. I will have to check on the surgical findings for both teeth to see if that was ever noted. If not, I will discuss it with the bio dentist who pointed out that black spot in the first place. Thank you for pointing this out. It seems very important.

5- Bone grafts are very beneficial when they are placed in healthy stable bone as they encourage the growth of new bone cells. However, they are not useful and can be detrimental when placed in unhealthy bone. So I wonder if the either or both sites, #2 and 3, were not stable enough to receive the graft and if this is contributing to the infection??

This is what I think the ENT is considering also--he mentioned that he thinks it likely he will need to debride the area, and I am assuming that means removing (?) the graft(s). Would that be an accurate assumption? I know that in terms of TX, the first dentist (in October--who did the RC) actually lanced the abscess (which was high up on my gumline) but when the teeth were extracted the gumline tenderness (which was recurring) was not addressed during either extraction. I have wondered infection elsewhere might have been missed and thus, is contributing to this--maybe this is the location of the cyst that you mentioned?

I do think it interesting the both times I had abscessing symptoms were in conjunction to flying, and I wonder what that might suggest, if anything. Is that consistent with cysts? As for the locale of the gumline pain, the ENT found the most painful point immediately, and was able to extrude material from that area for a culture--doing so brought tears to my eyes--but the OS and first dentist never did that sort of gum-level exam, even when I kept insisting there was a patch of pain and tenderness beyond the immediate extraction site. For some reason, they didn't seem to think that was important to pinpoint. For example, right before the second extraction, I had to insist that the dentist actually feel around on the gumline with his hand, and when he pushed on it and pus oozed out he said "Hey, there's pus in there!" (That's actually when he decided to take an X-ray--which is what revealed the black spot above #2.) At this point, the site of #3 (the first tooth extracted) appears largely healed. (#3 was done by the biological dentist, with the tooth cut out carefully--the procedure took about 40 minutes--including having the ligament removed, and the site was debrided and irrigated with ozone) The site of #2 is still very red, extremely tender (with pain in a large swath up the gumline and extending back into my mouth) with some oozing and granulation, which has become markedly worse in the last couple of weeks. (#2 was removed in about a minute by the OS with much more force and I have no idea if the ligament was removed, nor whether she used ozone or something more chemical/standard. )At this point, that extraction site feels quite hot. Before the OS removed #2, I did discuss in detail with the bio dentist the difference in approaches between him and the OS. I opted for the OS because she could do it the next day, whereas the bio dentist wasn't available for another week and I was not willing to wait after the ER and cellulitis issue came into play--I was really really sick at that point. I wonder if the difference in their approaches may have also contributed. Any thoughts on this?



6- Cellulitis is a serious condition and can spread to the lymph nodes and blood stream. Osteomyelitis is also a serious condition. So no wonder you feel so lousy!!!

Thank you for acknowledging this--I have never been this ill for such a long period of time, and it is very trying, especially when people in the dental/OS world seem to find my repeat visits tiresome (here she comes again!). Maybe this is where the "pack of rats" thing comes in...even the staff in the offices seem to be working hard to act like everything is just fine...when from my POV it is anything but.

The ENT has been very compassionate, as has been the bio dentist who took over my case, but for the most part the whole thing is just surreal, every time I have to go in and follow up again. This past week I saw both the dentist and the OS to follow up on the ENT findings--the bio dentist appears to be taking them seriously and is at least trying to collaborate. The OS's response was more confusing: initially, she seemed set to give me the same shpiel as the last time I saw her, without looking in my mouth or reviewing the CT scan ordered by the ENT (her office staff said they couldn't open it)--normal healing blah blah don't call us anymore there is nothing wrong with our work, your former dentist is a good dentist--but when I mentioned shoulder and neck pain she said "let me see" and when she looked in my mouth she exclaimed "it didn't look like this a few weeks ago!" and said she wanted to debride the area the next day--which I refused to discuss unless the scan was somehow opened. Then, her staff did manage to get the CT opened, and she backed off and said things looked normal to her, and to continue with the AB TX prescribed by the ENT.

Any thoughts on why she had such a strong reaction to the visual appearance of the tooth area, and why, after seeing the scan she backed off so quickly? At times I think I am just dealing with people who see so much of this sort of thing that they really do believe that things are OK in spite of hearing clearly what I am conveying; at other times it seems to me that they are not paying any attention AT ALL to what I am communicating, and thus, are totally missing the main point...which is that things are not getting better. And, I wonder to what extent fear about whether i might be litigious is affecting how they interact with me.


7- What is the outcome of the nodules that were found on your lung and thyroid? Do you have any auto immune disorders?

So far, tests are non-conclusive. One of the things I am learning now (having been blessed with a very strong body and good physical health until this crisis) is just how fragmented our medical system is and how easy it is to fall through the cracks. I self-referred to a pulmonary doc about the lung nodule--my PCP never even mentioned doing so. The pulmonary doc said that since it was only one, he doesn't want to perform a repeat CT, but is doing other tests to rule out serious lung/pulmonary illness. He is also evaluating me for sarcoidosis and repeating some tests for other autoimmune issues such as lupus and schleroderma (two things the OS recommended I be evaluated for at one point during the shortness of breath/high BP crisis, during which I also had a noticeable rash on my face/over my nose. I have always had broken veins/ruddy skin but it was very pronounced during the weeks right after the extractions.) I am seeing the pulmonary doc again in about a week. My PCP did do some very basic rheum tests that all came back negative--I am still trying to figure out if I should follow up with a specialist to have those repeated--I know that labs can use different ways to work up tests and this can affect the test findings. Let me know if you have any thoughts on this.

The thyroid issue has yet to be followed up on--my PCP also did a basic Thyroid test and tried to dissuade me from further workup but I am going to pursue it. Any suggestions regarding who to see in terms of specialties would be appreciated Following up on the thyroid nodule was on my list about two weeks ago, but when the extraction site started to increase in pain, and my face and neck started to swell again (this was the end of May, about 4 weeks after the AB TX from the extractions had ended) I found myself in a quandry trying to figure out "who do I see now?" I had this horrible moment where I realized that if I didn't take action to get a new perspective I might end up in really horrible straits--which is when I self referred to the ENT. It seems like the system is just set up for slow moving disasters in situations like this--people see you, don't know what to do/look for, or they've decided you're wasting their time, so they send you away. My chiropractor was very blunt--he said "You need to be rattling people's cages...you are not on anyone's list." And that's how I ended referring myself to the ENT--if I'd gone back to the OS she probably would have just put me off again.

8- Regarding the dentist comment about the ENT mistaking bone healing with infection... if the culture came back osteomyelitis, then there is no mistake, it is infected.

Thank you for this clarification. I will be checking on this on Monday--especially since the OS now is saying she thinks the CT looks normal (and seems to be implying she doesn't need to do anything else.) If I understand what you are saying, it is possible that a CT might look normal post extraction, but that doesn't mean there isn't an active infection. Is this correct? This seems important since the bio dentist also made the point that the "moth eaten" areas on the CT (as the ENT called them) were actually consistent for someone with recent tooth extractions and that the images were not conclusive by themselves. That may be true, but I think they are both being a little disingenuous by not adding that additional tests should be done to rule out/diagnose definite infection. This is the sort of run around that is really getting me down.

When I saw the ENT last week, he said the lab didn't want to do the culture initially, because they thought the sample was contaminated with some material that the bacteria had colonized. The ENT told me that this was very frustrating for him--because that is exactly what he sent them--some graft material from my mouth that he suspects is colonized with bacteria. So, at the moment I am not sure what the status is on that--or whether that meant that the culture wasn't done, or what. But I will check.

9- There are some considerations about re surgerizing the areas of which are too complicated to get into here. However, your systemic symptoms indicate a serious infection. Oral antibiotics may or may not be sufficient. They also will lower the effectiveness of your immune system so you can feel worse before you feel better.

I will be seeing the ENT next Friday. The bio dentist mentioned some concerns about another procedure as well--mostly along the lines of additional trauma to the area, possibility of more infection, and so on. And I am utterly exhausted, physically. the bio dentist recommended that I have an ozone TX of my sinuses at some point before another procedure, should the ENT recommend debridement or something else.

Are there specific things I should be watching for in terms of my symptoms that might indicate a need for more than oral ABs? At this point, I don't have the sense that Ceftin is doing much other than holding things at bay--I'm certainly not feeling better--and my understanding from the ENT was he wanted me to take Ceftin for 14 days for two reasons; first, to buy time to figure out the extent of what is going on, and second, to give him a chance to consult with an infectious disease colleague


10- Perhaps your best option is to stick with the ENT and encourage a consult with an infectious disease specialist. Also ask the ENT and ID Dr for a referral to an oral surgeon that they are familiar and comfortable working with. Because you may need complemented care from all of them.

Thank you for this suggestion. I wouldn't have thought to ask the ENT doc about this, but it makes sense to have someone he is comfortable with, and who can view my situation without the defensive overlay that the OS I have been dealing with may have, since she is a friend of the dentist who pulled the first tooth (and who I am no longer seeing).

11- It would behoove you to request all pre and post op xrays from all dentists and the surgical notes of every dentist that performed surgery and root canal therapy on you. It would be helpful to see what the written findings were so that the ENT and ID Dr have some clarity on the history of that area of your mouth.

I will follow up on this again on Monday. Is there particular language that works well to get these records--especially the surgical notes? For both the bio dentist and the OS I have asked and have provided written releases and have been told "we'll get back to you on that." Or they say they will forward them directly and then they don't. I know that i have the right to get my records, but the office staff seems to be unusually unwilling to provide the notes.

Hopefully your ND has encouraged you to eat healthfully and organically, avoid sugar, sugar substitutes, processed foods, soft drinks, alcohol, etc. Your nutrition is imperative during this time and diligent supplementation of probiotics is essential for the health of your digestive and immune system.

Yes--I've been doing a full complement of TX with my ND. Am going to try acupuncture soon as well. Currently following a no sugar, no caffeine, no yeast diet, doing cleanses and colon hydrotherapy, etc. I agree, it's imperative to keep this going. I would be a lot sicker if I didn't have such a great ND.

Check back when you can..... not sure how much I can help but I want you to know that you are not dealing with this alone.