[Robyn6447]

Hi Bryanna, I have a question for you and I hope you can answer it. I am getting two teeth pulled the first of the year. They are badly abcessed and decayed. I have alot of pain. To compound the problem I have Trigeminal Neuralgia on that side so I am double whammied! My question is: When I them pulled which btw i have been told my teeth are very difficult to pull can it affect the Trigeminal Nerve? Can there be further damage done to the nerve when they pull the two molars? Also the oral surgeon usually numbs me up really good while I'm out so I won't have much post op pain. I'm nervous about him doing that to that side because the very very few times I have been awake and rec'd a local I went thru the roof!! The nerve is hypersensitive and I can't stand for it to be even touched. Sorry if I've rambled I do that! Anyways I hope you put my mind at ease because I'm so worried I've been having nightmares about the procedure.....
Robyn

[Robyn6447]

Sorry I have another question for you. As I stated above my teeth are very abcessed and decayed, My jaw is swollen and very tender to the touch. I'm on penicillin but it hasn't made a dent in the infection. The two teeth involved are also part of a bridge and you can see the black decay all around the bottom of the crowns. Is there another antibiotic that will work better or is there something I can do to help clear up the infection? I'm not sleeping eating or talking because the pain is soooo bad. My dentist isn't helping so I need some ideas to throw at him. Thanks again!
Robyn

[Bryanna]

Hi Robyn,

The first thing that comes to my mind is.... does your oral surgeon know about your trigeminal neuralgia? That may seem like a silly question but so many patients forget (or don't) disclose alot of information because they either think it's not relevant and/or they assume the dentist somehow already knows. So it is imperative for him to know that you have TN and the history behind it as well as your dental history with the hypersensitivity in that area to local anesthetic. Since you are being put to sleep for the extractions, he may be able to give you a local anesthetic injection in an area that could bypass certain nerves which will still leave the area numb post operatively. This injection can be quite uncomfortable if awake... but no pain when asleep

Abcessed teeth in the lower jawbone can actually cause or contribute to present TN problems due to the inflammation and infection irritating the nerves. So it is always wise to have abcessed teeth removed as soon as possible... the more chronic/long term the infection, the more irritated the nerves become. Yes, the surgical process to remove these infected molars can irritate some nerve bundles, but removing them is the only way to treat the infection. Will the removal of these teeth cure or lessen your TN pain? In some people it certainly does improve it, in others the pain changes to a numbness or tingling feeling. And sometimes it takes weeks to months to see any difference. Perhaps you will be very fortunate and your pain will be diminished greatly!!

I see you posted a second time.... let me go there and see what that says...
Bryanna

Originally Posted by Robyn6447

Hi Bryanna, I have a question for you and I hope you can answer it. I am getting two teeth pulled the first of the year. They are badly abcessed and decayed. I have alot of pain. To compound the problem I have Trigeminal Neuralgia on that side so I am double whammied! My question is: When I them pulled which btw i have been told my teeth are very difficult to pull can it affect the Trigeminal Nerve? Can there be further damage done to the nerve when they pull the two molars? Also the oral surgeon usually numbs me up really good while I'm out so I won't have much post op pain. I'm nervous about him doing that to that side because the very very few times I have been awake and rec'd a local I went thru the roof!! The nerve is hypersensitive and I can't stand for it to be even touched. Sorry if I've rambled I do that! Anyways I hope you put my mind at ease because I'm so worried I've been having nightmares about the procedure.....
Robyn

[Bryanna]

No need to be sorry ... I'm only too happy to help if I can!

One reason for being put on the antibiotic prior to the extractions is to reduce the level of inflammation. Even a slight reduction is helpful. Another reason is because the bacteria from an infection alters the pH in the jawbone creating a very acid environment.... local anesthetic is very pH sensitive so when it's injected into an acid environment, the nerve fibers are not receptive to it. Which means the anesthetic will be less effective. So the antibiotic works to reduce the acidity so the anesthetic is more effective. Those are the two main reasons for prescribing a pre op antibiotic for tooth extractions. The medication will not cure the infection alone.. the teeth have to be removed.

How many days have you been on the penicillin? It takes 48 hours for an oral antibiotic to penetrate the cell membrane that surrounds the infection. So you wouldn't see any improvement prior to 48 hours. However, if it has been longer than that and you see no change or the swelling is increasing, then you need to call your dentist for either a different antibiotic or he may need to see you sooner.

The antibiotic Clindamycin is frequently prescribed for mandibular (lower jaw) infections when penicillin is not effective. Sometimes it is the first choice of antibiotics depending on the type and severity of the infection.

Robyn, when is your oral surgery scheduled for?

Bryanna

Originally Posted by Robyn6447

Sorry I have another question for you. As I stated above my teeth are very abcessed and decayed, My jaw is swollen and very tender to the touch. I'm on penicillin but it hasn't made a dent in the infection. The two teeth involved are also part of a bridge and you can see the black decay all around the bottom of the crowns. Is there another antibiotic that will work better or is there something I can do to help clear up the infection? I'm not sleeping eating or talking because the pain is soooo bad. My dentist isn't helping so I need some ideas to throw at him. Thanks again!
Robyn

[Robyn6447]

Thanks for getting back with me Bryanna! The first oral surgeon I had scheduled with back in Nov. for Jan. is very aware of my TN and knows all about it. I have been to him in the past for tooth extractions and really felt comfortable to have him do this surgery, however my dental insurance changed for next year and they don't accept it so now I have to go to the oral surgeon I have a consult scheduled for Jan. 7th. I am very upset about going to him. I had to see him for extractions of molars on right upper and lower side. Well I woke up while he was trying to extract my lower molar. I was strapped down in a chair and all I could do was scream and sob! His assistants kept making up different excuses to me when I woke up and he kept telling me to keep still and keep my eyes closed. Believe me if I had a choice I wouldn't be going to him. There is him and one other practice in my town that accepts my insurance and they couldn't get me in until Feb. 11th for a consult and I can't wait that long. Oh don't worry I will tell him all about my TN when I see him for the consult and will remind him the day of my my surgery. Whenever I see any type of medical/dental person the first words out my mouth is my TN and the history with it. I am about 8 days into my penicillin and the swelling has went down some it's still tender. I am right now using one of my duragesic patches, I had to apply one New Year's eve because my pain on a scale of 1-10 was an 18! It's taken care of the pain so I don't know if the pain is still with the teeth or not. I have an appt. scheduled for cleaning and x-rays with my dentist on Jan. 5th. As I stated above my consult for surgery is the 7th and I figure I will be scheduled for extractions the following week. Personally I wonder if he's so bad that is why I can always get in to see him quickly. All the other oral surgeons are always scheduled out at least a month ahead. I have one more refill on the penicillin and I'm going to fill it so I am still on it till the surgery. I'm not going to lie, I am very very scared that I'm going to wake up again during this surgery and I know without a single doubt that if that happens I will probably go out of my mind with pain!! My dentist had to do a filling just on a tooth that was just at the tip of that nerve. When he gave me a local it just hit the tip and I was gripping the armrests and had tears running down my face when the needle touched it. Between waking up to soon and wondering if when he gives me locals while I'm asleep that once they wear off if I'll have residual pain at the injection sites, I'm beside myself. I need these out bad but he's just plain scary! When he pulled the ones back in June I was still sobbing and shuddering in the chair when my daughter and grandaughters came back to take me home. When I have seen the other surgeon he has extracted molars and wisdom teeth I had absolutely no pain other than the wisdom teeth site hurting normally as it does with most people. I just hate this I don't know if you remember but I asked you about my dry mouth problems back in Nov. I think. That is why my teeth are decaying the way they are. I am viliagent about oral hygeine but it is to no avail, they just keep decaying..Sigh.... To compound all this I also have a phopia about dentures! I have had it for as long as I can remember. If I see someones dentures out of their mouth I start heaving and gagging and if I don't remove myself or someone removes them I will vomit! My dentist talked about me getting a partial for my bottom so I can chew food but I don't know if I can use one without throwing up. Sorry I'm rambling again but as you can see this is on my mind constantly. It just goes round and round. Thank you Bryanna!

[Robyn6447]

Sorry I have another question LOL! Last night I finall had the nerve to poke around my mouth with my finger. As I said in the post above I have a walnut size hard knot on my cheek. Well I found where it actually is, it's in that "pocket" that lays between your cheek and the bottom of your gums. I assume that is the infection site. Will that be a problem during the extraction? Is that a sign the infection has spread to my jawbone? I'm sorry I keep bugging you but I am "OCDing" really bad about this upcoming surgery and the fact it is on my Trigeminal Neuralgia side. When I had the microvascular decompression surgery for my condition I din't fret at all but this is gnawing at me constantly! Thanks Bryanna

[Bryanna]

Hi Robyn,

I know it is difficult to see a dentist out of your insurance network but this guy sounds like a doosey!! If you have had one terrible experience with him already, it may not be wise to see him again. Especially with the problem you already have on that side of your head with your TN.

From your description of the swelling.... you would be considered an emergency patient. That means you should not have to wait at all to be seen by a dentist. Did you describe your swelling to that other dental office that told you February?

With regard to partial dentures.... they fit differently than full dentures and most people can wear them without gagging.

Bryanna

Originally Posted by Robyn6447

Thanks for getting back with me Bryanna! The first oral surgeon I had scheduled with back in Nov. for Jan. is very aware of my TN and knows all about it. I have been to him in the past for tooth extractions and really felt comfortable to have him do this surgery, however my dental insurance changed for next year and they don't accept it so now I have to go to the oral surgeon I have a consult scheduled for Jan. 7th. I am very upset about going to him. I had to see him for extractions of molars on right upper and lower side. Well I woke up while he was trying to extract my lower molar. I was strapped down in a chair and all I could do was scream and sob! His assistants kept making up different excuses to me when I woke up and he kept telling me to keep still and keep my eyes closed. Believe me if I had a choice I wouldn't be going to him. There is him and one other practice in my town that accepts my insurance and they couldn't get me in until Feb. 11th for a consult and I can't wait that long. Oh don't worry I will tell him all about my TN when I see him for the consult and will remind him the day of my my surgery. Whenever I see any type of medical/dental person the first words out my mouth is my TN and the history with it. I am about 8 days into my penicillin and the swelling has went down some it's still tender. I am right now using one of my duragesic patches, I had to apply one New Year's eve because my pain on a scale of 1-10 was an 18! It's taken care of the pain so I don't know if the pain is still with the teeth or not. I have an appt. scheduled for cleaning and x-rays with my dentist on Jan. 5th. As I stated above my consult for surgery is the 7th and I figure I will be scheduled for extractions the following week. Personally I wonder if he's so bad that is why I can always get in to see him quickly. All the other oral surgeons are always scheduled out at least a month ahead. I have one more refill on the penicillin and I'm going to fill it so I am still on it till the surgery. I'm not going to lie, I am very very scared that I'm going to wake up again during this surgery and I know without a single doubt that if that happens I will probably go out of my mind with pain!! My dentist had to do a filling just on a tooth that was just at the tip of that nerve. When he gave me a local it just hit the tip and I was gripping the armrests and had tears running down my face when the needle touched it. Between waking up to soon and wondering if when he gives me locals while I'm asleep that once they wear off if I'll have residual pain at the injection sites, I'm beside myself. I need these out bad but he's just plain scary! When he pulled the ones back in June I was still sobbing and shuddering in the chair when my daughter and grandaughters came back to take me home. When I have seen the other surgeon he has extracted molars and wisdom teeth I had absolutely no pain other than the wisdom teeth site hurting normally as it does with most people. I just hate this I don't know if you remember but I asked you about my dry mouth problems back in Nov. I think. That is why my teeth are decaying the way they are. I am viliagent about oral hygeine but it is to no avail, they just keep decaying..Sigh.... To compound all this I also have a phopia about dentures! I have had it for as long as I can remember. If I see someones dentures out of their mouth I start heaving and gagging and if I don't remove myself or someone removes them I will vomit! My dentist talked about me getting a partial for my bottom so I can chew food but I don't know if I can use one without throwing up. Sorry I'm rambling again but as you can see this is on my mind constantly. It just goes round and round. Thank you Bryanna!

[Bryanna]

Robyn,

A walnut sized swelling is very large for an infection in the mouth. I urge you to call the other oral surgeon and tell him that is what you have. You really should be seen as soon as possible.

The infection is in the tooth and the bone surrounding the tooth. That swelling is inflammation caused by pressure from the infection. If the swelling is also filled with pus, then it could complicate the surgery to some degree or it might have to be drained prior to the extractions. So this is not something that should wait. Yes, the infection is in the jawbone as well as in the tooth.

Robyn, I know you are very scared about this surgery...... but the sooner you get this taken care of, the better. Your TN problem is there no matter what and there is no way to know if or how the surgery will affect it. With that said, the infection is definitely irritating the nerve and the surgery has to be done, those teeth have to be removed soon.

I am not trying to scare you... I am trying to inform you that you have a situation that needs attention sooner than later.

In the meantime.... rinse with warm salt water 3 times a day to help reduce some of the bacteria in your mouth. This is only a bandade until you can get the teeth out.

Bryanna

Originally Posted by Robyn6447

Sorry I have another question LOL! Last night I finall had the nerve to poke around my mouth with my finger. As I said in the post above I have a walnut size hard knot on my cheek. Well I found where it actually is, it's in that "pocket" that lays between your cheek and the bottom of your gums. I assume that is the infection site. Will that be a problem during the extraction? Is that a sign the infection has spread to my jawbone? I'm sorry I keep bugging you but I am "OCDing" really bad about this upcoming surgery and the fact it is on my Trigeminal Neuralgia side. When I had the microvascular decompression surgery for my condition I din't fret at all but this is gnawing at me constantly! Thanks Bryanna

[Robyn6447]

Thanks Bryanna, I'm going to call the other oral surgeon tomorrow and see if they can get me in sooner. Hopefully they will look at this as an emergency. I was afraid it had spread to the bone with it being so low in the gums/cheek I had a sneaky feeling. I will let you know what they say to me when I call.

[Robyn6447]

Well I seen my regular dentist today for a cleaning and xray then the oral surgeon came in and did a consult instead of waiting til Friday. It was an eventful appointment and I'm wore out so I will have to wait and post tomorrow and tell you what all they said. I need some input. I'll post as soon as I get up in the morning. Night.