I am writing for my wife who has been experiencing pain on the left side of her face (cheek, jaw, ear, & face) ever since a wisdom tooth extraction in April 2009. To this date no doctor has been able to specify what exactly is wrong with her, nor can they offer relief. There are many details so I apologize in advance for my randomness:

Her initial complaint was tenderness in and around her upper left molars. Her dentist decided to extract the wisdom tooth himself rather than refer her to an oral surgeon. The procedure turned out to be more difficult than he anticipated and took nearly 30 minutes of pulling and prying to remove the tooth. The dentist told us weeks later that he also removed pieces of bone along with the tooth.

My wife was in a lot of a pain following the procedure, more so than was normally expected. We noticed the next day that her left jaw protruded right at the joint whenever she opened her mouth, but not on the right side. It wasn't like that before the procedure and it's never gone away. She has had an MRI, two CT scans, and numerous X-rays but so far no doctor has found anything they felt was out of the ordinary.

Over the last 18 months she has been to numerous doctors and specialists which include: General Practitioner, 2 ENTs, Chiropractor, Oral Surgeon, Physical Therapist, TMJ Specialist, and Allergist.

The TMJ doctor told my wife that she did have TMJ and treated her for a period of time. This treatment included medication and a bite guard that she wears at night. During his exams he stated more that once that something was odd about her left jaw area but couldn't pinpoint it. On her last visit he told her the TMJ was gone, but that she should continue the medications he prescribed (Flexeril and Arthrotec 50) and continue wearing the nighttime mouth guard.

In February of 2010 we adopted a cat. A few months later my wife began having a lot of nasal congestion and drainage. Our GP suspected allergies and it was confirmed with a blood test that she was indeed allergic to our new cat. We promptly gave the cat up, and cleaned our home top to bottom, steam-cleaned everything in sight, and purchased HEPA filters. Her allergy symptoms have improved, but have not completely gone away.

Here's a point that I find interesting. Whenever my wife has a lot of sinus drainage, her pain subsides somewhat. And when the drainage stops the pain increases. This cycle has happened many times over the past months, so we don't believe it's a coincidence. It's as if the sinus and jaw issues are inversely related somehow.

Also, since day one, my wife has noticed what she calls "swelling" inside the left side of her palette. None of the doctors can see what she's referring to, but she insists it's always there. And the area she's referring to is in the same place she had complaints about when first visiting the dentist.

There are so many more bits of information but I don't want to inundate anyone with them. My wife has been suffering for so long with this ailment and to this date she's no closer to relief than she was back in April of 2009.

She's had good days and bad days throughout all of this. She's a wonderful woman and deserves a break from the bad ones, once and for all.

Thanks for reading.

-Craig V.

Hi craig,

As I read your thread, a few things come to mind....

Sometimes during the extraction of a tooth, too much force is used and the "buccal plate" portion of the jawbone is removed with the tooth. This is not an ideal situation of course, but it does not always cause chronic pain once the surgical site has healed. Sometimes, this portion of the bone or elsewhere is fractured during the extraction which again is not ideal but it may or may not cause chronic pain.

The protrusion of the jaw in the TMJ area upon opening is only normal if that is something that was always present. If it starts to do that after an injury and/or dental work, then it is not normal. That protrusion indicates the joint is being pulled out of alignment upon opening. This can be caused by a musculature and/or ligament issue which could have occured from an injury and/or straining to open the mouth too wide for too long a period of time.

TMJ treatment varies according to the individual problem and it tends to recur. However, in acute cases immediate treatment can usually provide long term relief. Once the problem has become chronic, it is more difficult to treat because the muscles and ligaments become very tight and rigid and inflammation sets in.

You said...<<<Here's a point that I find interesting. Whenever my wife has a lot of sinus drainage, her pain subsides somewhat. And when the drainage stops the pain increases. This cycle has happened many times over the past months, so we don't believe it's a coincidence. It's as if the sinus and jaw issues are inversely related somehow.>>> It most likely is not a coincidence. The sinus cavity is slightly different in everyone but the basic anatomy of it is actually very large and broad across the frontal area of the face. It goes up behind and above the eyes. So any pressure, congestion, inflammation associated with the sinuses can have an affect on the TMJ area .... and vice versa. The movements of the mandible (lower jaw) are connected to the musculature in the face, head, and neck. So any chronic condition of these areas or even one of these areas can have a profound affect on any of the other areas. When her sinuses drain, some of the pressure is relieved which reduces the inflammation and pressure in areas such as the TMJ.

The area that she feels the swelling inside of her mouth... is it always there or does it come and go? Is it tender to press on? Are any of the teeth near that area root canaled and/or had apicoectomies? Does she have periodontal disease?

Look forward to your reply....... =)
Bryanna





QUOTE=clvaughnsr;703501]I am writing for my wife who has been experiencing pain on the left side of her face (cheek, jaw, ear, & face) ever since a wisdom tooth extraction in April 2009. To this date no doctor has been able to specify what exactly is wrong with her, nor can they offer relief. There are many details so I apologize in advance for my randomness:

Her initial complaint was tenderness in and around her upper left molars. Her dentist decided to extract the wisdom tooth himself rather than refer her to an oral surgeon. The procedure turned out to be more difficult than he anticipated and took nearly 30 minutes of pulling and prying to remove the tooth. The dentist told us weeks later that he also removed pieces of bone along with the tooth.

My wife was in a lot of a pain following the procedure, more so than was normally expected. We noticed the next day that her left jaw protruded right at the joint whenever she opened her mouth, but not on the right side. It wasn't like that before the procedure and it's never gone away. She has had an MRI, two CT scans, and numerous X-rays but so far no doctor has found anything they felt was out of the ordinary.

Over the last 18 months she has been to numerous doctors and specialists which include: General Practitioner, 2 ENTs, Chiropractor, Oral Surgeon, Physical Therapist, TMJ Specialist, and Allergist.

The TMJ doctor told my wife that she did have TMJ and treated her for a period of time. This treatment included medication and a bite guard that she wears at night. During his exams he stated more that once that something was odd about her left jaw area but couldn't pinpoint it. On her last visit he told her the TMJ was gone, but that she should continue the medications he prescribed (Flexeril and Arthrotec 50) and continue wearing the nighttime mouth guard.

In February of 2010 we adopted a cat. A few months later my wife began having a lot of nasal congestion and drainage. Our GP suspected allergies and it was confirmed with a blood test that she was indeed allergic to our new cat. We promptly gave the cat up, and cleaned our home top to bottom, steam-cleaned everything in sight, and purchased HEPA filters. Her allergy symptoms have improved, but have not completely gone away.

Here's a point that I find interesting. Whenever my wife has a lot of sinus drainage, her pain subsides somewhat. And when the drainage stops the pain increases. This cycle has happened many times over the past months, so we don't believe it's a coincidence. It's as if the sinus and jaw issues are inversely related somehow.

Also, since day one, my wife has noticed what she calls "swelling" inside the left side of her palette. None of the doctors can see what she's referring to, but she insists it's always there. And the area she's referring to is in the same place she had complaints about when first visiting the dentist.

There are so many more bits of information but I don't want to inundate anyone with them. My wife has been suffering for so long with this ailment and to this date she's no closer to relief than she was back in April of 2009.

She's had good days and bad days throughout all of this. She's a wonderful woman and deserves a break from the bad ones, once and for all.

Thanks for reading.

-Craig V.[/QUOTE]

Hi Bryanna,

Thank you for your response.

The protrusion of her jaw definitely was not present before her dental work. She did indeed have her jaw open for a very long time while the dentist struggled with the extraction, and keeping it open like that was painful for her.

My wife, Annette, was seen by a TMJ specialist for nearly a year. The last visit was a number of months ago at which time he told Annette the TMJ was gone. The was confusing for her because she still had all of the same symptoms as before, so nothing seemed different from the time she began treatment.The specialist was at the point where he couldn't offer anything else to help her except that he suggested she begin seeing a psychiatrist to address any stress issues that may be causing her to grind or clench her teeth at night. Annette refuses to see a psychiatrist. After 24 years of marriage I have never heard her grind her teeth but it's possible she clenches them, I'm just not sure. At any rate, she has stopped going to the TMJ specialist since it appeared we were getting nowhere with him, and also because our health insurance covers nothing related to TMJ and we had already spent thousands of dollars to see him.

It seems that Annette gets some mild relief with the anti-inflammatory meds, but she hates taking them long term because of the pain-killing ingredient which makes her sleepy and foggy-headed. She had decent results taking ibuprofen but that began to trouble her stomach so they switched her over to Arthrotec 50. She hates taking any medication at all because she feels this is only masking the real cause of all this, which has yet to be discovered. Before this all began back in April 2009 she took ZERO medication and now she's on the following: Cyclobenzaprine, Arthrotec 50, Elavil, Prilosec, Asterpro, Advair HFA, and Ventolin HFA. And with all of this she honestly has very little relief.

What you said about the relationship between the sinuses and the TMJ area seems spot on. For some reason her sinuses drain very heavily now. In her words it's, "pouring down the back of my throat." This seems to be the first part of an endless cycle where she struggles to stop the drainage, then the pressure builds which causes even more pain in her jaw and face, which causes her to work on clearing her sinuses, and it all starts over. This struggle with sinus drainage really only started this spring which is a full year after the initial jaw pain began. We don't know what caused the drainage to begin. We assumed it was a reaction to the cat we adopted this spring, but now we don't know for sure. We gave the cat up a few months ago, but the sinus issues still continue. The drainage is so bad that it gets into her chest and gives her a very bad, wet cough.

About the swelling in her mouth... It is absolutely always there. In fact it was there even just before Annette visited the dentist for the first time. It is a little tender to press on, but she says it more so causes pain up into her face when she presses on the area, either with her finger or her tongue. This area is indeed right next to a tooth that had a root canal many years ago. She has never had an apicoectomy that we know of. She is an avid flosser and has no periodontal disease. The trouble is that Annette experiences and describes this "swelling" to every doctor and specialist that she's seen and not a one of them can detect it or address it. They all just say, "I don't see anything." I completely believe there's something going on in this area and wouldn't be surprised to find it's what began all these problems for her.

As a matter of fact, the initial dentist made an interesting remark a few weeks after the wisdom tooth extraction. He admitted that he wasn't 100% sure the wisdom tooth was really the problem, and he said that a root canal may be going bad. But with everything that Annette's been going through, which he has fully been aware of, he's never gone back to the issue of a possible bad root canal. Perhaps he's afraid of doing more damage so he doesn't want to do anything else? I don't know. Annette did go to a Root Canal Specialist early this year. They said they couldn't detect any problems, but if there was something wrong, it would present itself eventually.

Well "eventually" can't come soon enough for Annette!

Thanks for reading.
Craig

Hi Craig,

If you are familiar with my bio here... I've been in dentistry for over 30 yrs. With that said, I asked you about the health of the teeth near that palatal swelling because consistent swelling and tenderness in that are can be indicative of an infected and/or fractured root canal tooth. Chronic sinus drainage, facial pain, TMJ pain.... again indicative of an infected and/or fractured root canal tooth in the upper jaw. Sometimes, the dentist will put a post inside a root canaled tooth "for retention" before the crown is put on. Honestly, posts only serve one purpose, to cause inflammation and irritation to the dentin tubules (microscopic nerve canals) of the tooth. I'm telling you this because many times when the post is put in, it perforates the side of the tooth and ends up protruding outside of the tooth into the jawbone. This in of itself creates infection with or without definitive symptoms. Other times, the tooth is perforated during the root canal procedure with a file instrument and this also creates infection with or without definitive symptoms. These are typical conditions that occur and unfortunately they are not usually treated until severe symptoms occur.

Her wisdom tooth may or may not have been the problem after all. However, conventional dentistry often fails to recognize an infected root canaled tooth unless there is significant swelling and severe radiographic change in the area of that tooth.

My guess is that the root canaled tooth has had problems from the get go and the bacteria from the tooth has entered her sinus cavity. The inflammation/infection from this tooth is causing her to have facial pain and palatal swelling. I have seen this exact condition countless times go undiagnosed until a large swelling of the face occurs. IF this is her problem, then the only "cure" option would be to remove that root canaled tooth.

With regard to her medications.......... she is right, they are all masking her true problem and at this point, they are not even serving as a bandade.

If your wife is not getting satisfactory treatment from her dentist, I would suggest that she seek a consult with dentist who belongs to the IAOMT organization. Generally, these professionals have continued education that delves into chronic issues such as hers and will look at this from a different perspective.

Please keep us posted on how things are going!

Bryanna



QUOTE=clvaughnsr;705683]Hi Bryanna,

Thank you for your response.

The protrusion of her jaw definitely was not present before her dental work. She did indeed have her jaw open for a very long time while the dentist struggled with the extraction, and keeping it open like that was painful for her.

My wife, Annette, was seen by a TMJ specialist for nearly a year. The last visit was a number of months ago at which time he told Annette the TMJ was gone. The was confusing for her because she still had all of the same symptoms as before, so nothing seemed different from the time she began treatment.The specialist was at the point where he couldn't offer anything else to help her except that he suggested she begin seeing a psychiatrist to address any stress issues that may be causing her to grind or clench her teeth at night. Annette refuses to see a psychiatrist. After 24 years of marriage I have never heard her grind her teeth but it's possible she clenches them, I'm just not sure. At any rate, she has stopped going to the TMJ specialist since it appeared we were getting nowhere with him, and also because our health insurance covers nothing related to TMJ and we had already spent thousands of dollars to see him.

It seems that Annette gets some mild relief with the anti-inflammatory meds, but she hates taking them long term because of the pain-killing ingredient which makes her sleepy and foggy-headed. She had decent results taking ibuprofen but that began to trouble her stomach so they switched her over to Arthrotec 50. She hates taking any medication at all because she feels this is only masking the real cause of all this, which has yet to be discovered. Before this all began back in April 2009 she took ZERO medication and now she's on the following: Cyclobenzaprine, Arthrotec 50, Elavil, Prilosec, Asterpro, Advair HFA, and Ventolin HFA. And with all of this she honestly has very little relief.

What you said about the relationship between the sinuses and the TMJ area seems spot on. For some reason her sinuses drain very heavily now. In her words it's, "pouring down the back of my throat." This seems to be the first part of an endless cycle where she struggles to stop the drainage, then the pressure builds which causes even more pain in her jaw and face, which causes her to work on clearing her sinuses, and it all starts over. This struggle with sinus drainage really only started this spring which is a full year after the initial jaw pain began. We don't know what caused the drainage to begin. We assumed it was a reaction to the cat we adopted this spring, but now we don't know for sure. We gave the cat up a few months ago, but the sinus issues still continue. The drainage is so bad that it gets into her chest and gives her a very bad, wet cough.

About the swelling in her mouth... It is absolutely always there. In fact it was there even just before Annette visited the dentist for the first time. It is a little tender to press on, but she says it more so causes pain up into her face when she presses on the area, either with her finger or her tongue. This area is indeed right next to a tooth that had a root canal many years ago. She has never had an apicoectomy that we know of. She is an avid flosser and has no periodontal disease. The trouble is that Annette experiences and describes this "swelling" to every doctor and specialist that she's seen and not a one of them can detect it or address it. They all just say, "I don't see anything." I completely believe there's something going on in this area and wouldn't be surprised to find it's what began all these problems for her.

As a matter of fact, the initial dentist made an interesting remark a few weeks after the wisdom tooth extraction. He admitted that he wasn't 100% sure the wisdom tooth was really the problem, and he said that a root canal may be going bad. But with everything that Annette's been going through, which he has fully been aware of, he's never gone back to the issue of a possible bad root canal. Perhaps he's afraid of doing more damage so he doesn't want to do anything else? I don't know. Annette did go to a Root Canal Specialist early this year. They said they couldn't detect any problems, but if there was something wrong, it would present itself eventually.

Well "eventually" can't come soon enough for Annette!

Thanks for reading.
Craig[/QUOTE]

Hi Bryanna,

We took your advice and looked up a dentist who belongs to IAOMT. We found one nearby and my wife went to see him just two days ago. He listened to everything we had to tell him about the history of my wife's condition (I was along for moral support of course.) We brought along a panoramic x-ray from the TMJ's office that was taken back in March. The dentist said the quality of the scan was poor, but from what he could make out, it seems that all of my wife's upper left molars have roots that extend into her sinus cavity. They took two more x-rays and said the molar with the root canal most likely needs a new crown at the very least, and the tooth in front of it has decay underneath the filling. The dentist and his assistant also mentioned the same thing as you did, which is the possibility of something going on between the teeth and the sinuses.

In regards to her jaw being out of alignment, I think he suspects there was some trauma caused during the wisdom tooth extraction back in March 2009 that caused this. Before he does any sort of dental work he wants her to see an oral surgeon to have her jaw checked out. We have an appointment to see the surgeon in Mid-November and then we'll go back to see the dentist a week after that.

Our new dentist has assured us that he plans to see the issue through to the end, so we're quite excited that we may finally be on the right track. I'll be sure to post updates as we get them.

Craig

Hi Craig,

Firstly, I'm very glad that you sought the advice of another dentist. One thing that I want to tell you is that anytime the diagnostic quality of a radiograph is poor, it is in the patients best interest to take a new radiograph. It is never wise to guess what's on a radiograph because it's too easy to either misdiagnose or miss something altogether. What commonly happens when someone goes to a new dentist with a crappy radiograph from their previous dentist..... the new dentist is hesitant to suggest taking a new one because it makes the previous dentist look incompetent and/or can make the patient wonder why does this new guy want to do this again. I think it's wise to take a new panorex.

With regard to the root canaled tooth.... what did the dentist mean by "this tooth needs a new crown at the very least"? Did he mention anything about the possibility of that tooth being infected and/or fractured? Sometimes, the new dentist is careful about being too forward with information at the initial consultation unless there is an imminent problem. Once they get to know the patient a little better, then they divulge a bit more because they feel the patient has become more comfortable with them. It is best to question the health of that tooth because it shows him that you guys are truly concern about being informed about all of your options.

I am glad that he wants your wife to have further evaluation with regard to her TMJ.

Thanks so much for getting back to us. Please do keep us posted!

Bryanna

Hello all,

I'm sorry it's been so long since my last post. I've been hoping that something encouraging would happen in the last 6 months but sadly my wife's condition remains exactly the same as it has since April 2009. She still suffers from chronic pain and swelling in her left jaw area around the joint and into the front of her cheek.

She did indeed see a new dentist who gave her a very thorough exam and took high quality scans of her teeth. He found nothing out of the ordinary to explain her condition. His best guess was that an upper molar MAY be causing a problem and could need to be extracted but he had absolutely no data to prove his theory. It was just his best guess. My wife refused to have a tooth extracted based on a guess, especially since that's what the first dentist did to her. He extracted a tooth that he thought was the problem which didn't fix the problem at all, but instead gave her the severe pain she now has in her jaw and face.

He referred my wife to an oral surgeon who also took scans and found nothing out of the ordinary that would require surgery to correct. We specifically asked him if the problem was TMJ disorder and he flatly said no, it was not TMJ. My wife then went BACK to the dentist to have fillings replaced in two lower teeth. This of course did nothing to help her jaw and face pain. He then sent her on her way saying he'd see her again at her regular cleaning appointment in the fall.

So here we are, right where we started two years ago. We've seen a dozen specialists and nobody has a clue what to do about this. Many signs seem to point to TMJ disorder but two or more doctors say that it's not TMJ. Throughout the process the doctors have prescribed my wife to take a number of meds hoping they can at least relieve some of her symptoms, but they're mostly useless. And to top it all off my wife has now been told she has high thyroid levels. This happened once or twice in the last year or two but after retesting her levels were back to normal. She's about to start taking a new med to help bring her thyroid levels down.

Now we're wondering if any of this is connected and if some of the medications are actually to blame for the high thyroid results. As a result of all this she's currently taking: Flexeril, Arthrotec 50, Asterpro, Advair, and Ventolin.

It's an awful mess and we have no idea how to proceed. I'm not sure how much more suffering my wife can take at this point. And to add insult to injury, our medical insurance carrier still refuses to pay for anything they suspect is TMJ related. They even denied coverage for the oral surgeon evaluation even though he specifically stated on the report that there was no TMJ. The insurance company stated that because there was a history of TMJ in the past then this was related and therefore not covered. I swear that if I were a lawyer I'd be suing somebody by now.

Hi Craig,

If the symptoms have not improved at all with all the medication that your wife has been taking, would it not be better to stop taking the medication? Many medication have side effects and interactions that are impossible for doctors or pharmacies to know all about. In addition, some medicine, especially combinations of medicines, may put stress on the liver, which cannot be good in the future. Especially since no noticeable benefit or change has occurred with the medicine, it might be worth it to stop taking them ... after you have discussed this with a doctor or GP, of course.

Has there been a blood test recently that indicates white blood cell count? Has a doctor looked at your wife for swollen lymph nodes? If the regular swelling is indeed due to infection, that may lead to higher white blood cell counts. Has your wife ever taken antibiotics, and has she gotten even a little relief from the swelling while on the antibiotics? That may or may not indicate the swelling as due to infection.

These are just ideas, and should be discussed with a doctor, of course.

It seems like you guys have tried everything related to do with her jaw, teeth, etc. Have you had a doctor check out her heart? Heart disease or other heart related problems could cause the jaw pain. Heart problems develop and show symptoms differently in women, and could be the source of her pain. If you haven't already ruled it out I would definitely consider seeing a doctor about it. Hope to the best to both of you.

Craig,

Any chance you could post the xrays of that upper area of her mouth? I still say it's a good chance it's an infected tooth problem.

Bryanna