I'm 33 years old and started having a problem 1 year ago. It's pretty long and drawn out. However, 1 year and 2 months later. I have a stange taste in my teeth between #28-29 and I know something is still going on. I'm just not sure what or who to turn to since the Dentist says everything looks good.

November
•11-24 - Woke up with shooting pain into my right ear with pain along gum-line between teeth #29-#31.
•11-25 – Went to dentist and she referred me to an Endodontist for a possible root canal on tooth #30 or #31 (she said there was some decay under the filling of #30 and a large filling in #31 close to the nerve).

December
•12-1 – Went to the Endodontist for a consultation and she felt #31 needed the root canal because it had a large filling very close to the nerve and a small crack.
•12-3 - Root Canal procedure was done on #31.
•12-9 – Still had pain in the root canalled tooth, and pain along the gum-line between #29-#31 and when I pressed on tooth #29.
•12-28 – Went to Urgent Care because the pain was so bad. I was given a Z-pak and Ultram.
•12-29 – The pain went away in neck/ear but the pain persisted in tooth with a bad taste in my mouth.

January
•Still in pain in #31, ear, teeth and jaw area.
•Went to a Neurologist for an MRI of the brain to rule out nerve issue. MRI was normal.
•My childhood dentist sent for a third opinion and he said there was a vertical crack in tooth #31 and it needed to be extracted.

February
• 2-5 – I was referred for an extraction. The tooth was removed.
•The pain was resolved. Then a new pain started; I had a dry socket. Tooth was packed to help dry socket pain.
•The pain in #29 and #30 and jaw still remained and the gum felt sore when I pressed on the teeth I feel pain. Dr. prescribed another medrol pak.

March
•A new pain started after the dry socket, burning, and continued to have pain in the ear and jaw. The oral surgeon was baffled and told me to see another Neurologist. He didn’t see anything on the panoramic x-ray.
•There was a burning pain in and around the extraction site and still into the ear.

April
•I was referred to a Neuro Surgeon for a possible cervical spine issue. I had a MRI scan of my cervical spine and it was normal.
•He referred me to Neurologist who did a CT scan of my neck, head and said it was normal.
•This Dr. put me on 1800 mg. of Gabapentin, I’ve been taking this since April 9, 2009.
•Went back to childhood dentist and he referred me to a gum specialist. The gum specialist said the gums looked swollen but nothing too bad and put me on Clindamycin.

July
•Since I’ve been on the Gabapentin the excruciating pain has gone away. However, I have a salty taste in my mouth and I’m not sure if this is from another tooth (tooth #30 has a cavity under the filling) and an odd taste/feeling along the inside gum line of #28-30. Mainly between 28-29.

August
•Right jaw bone scan done and came back normal.
Off the Gabapentin now for 5 months.

November 09
•Teeth cleaning. All teeth look great according to my Dentist accept for small cavity in tooth #7.


Questions:
Is this a low grade infection somewhere? Even thought bloodwork all came back fine.
Does this sound Neuralgia related?
Are they missing something – The Dentist that is?
Who could I go to for help?
Does it sound like a cavitation?

I talked to my Neurologist and he said I have Atypical Trigeminal Nueralgia even though I don't have all the typical symptoms. I wonder if he is right or if the dentists are still missing something. Since I am no longer on Gabapentin he suggested using Ultram on an as need basis.

Hi admaria,

A few questions.....
What is the health of teeth #29, 30 and 32?
Is tooth #29 root canaled?
Did you have the cavity restored on tooth #30?
Do you still have your wisdom tooth #32?
If tooth #32 was extracted, was it a complicated extraction? Was that tooth partially or fully impacted in the bone? Did you have a dry socket after that extraction?

Anytime you have a dry socket from a tooth extraction, there is a chance of neuralgia to develop due to the infection and trauma to the bundle of nerves in the area of the extraction. Sometimes it is permanent and other times it's not.

The reason for the dry socket is due to a disruption in the formation of the blood clot in the tooth socket after the extraction. The blood clot keeps the jawbone from drying out and allows the healing process to begin as if the clot was a blanket protecting the bone from the outside world. The blood clot begins to form immediately after the tooth is out and the area is debrided.

Things that can disrupt the formation of the clot are.... overuse of a local anesthetic with epinephrine restricts the blood flow which disrupts the natural formation of the blood clot .... inadequate debridement of the socket meaning debris is left in there and this disrupts the clotting process ..... unsterile surgical practices similar to the response to inadequate debridement. Any or all of those things along with any or all of these things ....... patient smokes or takes certain medications or has medical conditions that prohibit blood clotting factors or limits their flow of saliva...... patient removes the gauze too many times or pulls the clot out with a piece of gauze. Patient gets debris it the socket and bacteria sets up house in there.

The medication placed in the dry socket is very helpful in healing the jawbone but only if the socket has been thoroughly debrided of all remmants of the tooth, the periodontal ligament, any infected tissue and bone as well as diseased bone. This should always be done at the time of the extraction without any question but if not, then it should be done before placing the medication.

The bad taste in your mouth can be indicative of many things. It could be digestive or medication related. It could be from breathing with your mouth open especially if you do that at night while sleeping. It could be sinus related. It could be from a build up of plaque or periodontal disease. Root canaled teeth in general will cause a bad taste or bad breath even if they are not symptomatic because there is bacteria harboring inside of all root canaled teeth from the original infection that was not able to be removed during the root canal procedure. It is very common to see a patient who complains of bad breath or taste and then sure enough...... radiographically an infection shows up in a previously root canaled tooth.

This issue is often hard to diagnose properly and the patient ends up going through a series of diagnostic tests and procedures. Yes, you could have a cavitation with osteonecrosis and/or osteomyelitis. Since tissue has not been biopsied from that site, it is hard to tell if you have any of those things. To have it biopsied, the exact location of the problem would have to be identified first. Sometimes the biopsies show few bacteria even when this condition is present. Sometimes a spiral CT scan which is taken from the middle of the sinus to the lower mandible can detect a cavitation. I'm not sure if the jaw scan that you had was specific enough.

A cavitation in the jawbone is fairly evident during exploratory surgery. The bone takes on a specific mushy consistency and visually it is diseased.

I know this is a difficult issue to deal with and getting help for it seems nearly impossible. Have you checked out the IAOMT site for a dentist in your area that is familiar with this condition?

Bryanna

Hi there,

Thank you for responding.

Here are some answers to your questions:

A few questions.....
What is the health of teeth #29, 30 and 32?
Is tooth #29 root canaled?
Did you have the cavity restored on tooth #30?
Do you still have your wisdom tooth #32?
If tooth #32 was extracted, was it a complicated extraction? Was that tooth partially or fully impacted in the bone? Did you have a dry socket after that extraction?


According to the dentists #29 and #30 look good. #30 was said to have slight decay under a current filling. This was detected from diagdent (SP?) testing, however my childhood dentist just uses the standard tool and didn't want to do anything because he said it was fine and did not want to refill the tooth until all the pain settled down.

29 is not root canaled.
30 has not been restored.
Wisdom #32 was removed when I was a teen and yes I got a dry socket after removal. I also got a dry socket after they removed tooth 31. I do not have any other root canaled teeth.

The dentist did not see peridontal disease. I was not on any medication my entire life except for the Gabapentin.

Do I need to see another ENT and ask for the spiral CT scan to see if they can see a cavitation?

Thank you again for responding. Any help in resolving this could help end this misery. My nuerologist has just called it ATN. However, I'm still searching to make sure it's not something else they have missed. I find it strange to have this terrible taste only between 28-29 even after they root cananled and finally extracted 31.