Hi Bryanna,

My biggest concern is that if I wait before getting it seen to is that it is going to spread to more of my jaw or even other teeth? Is this a possibility?

Two weeks after I get back from holiday I am off on a two week work related trip, so there isn't really an open time for appointments for a while and in my head I am imagining this thing in my jaw getting bigger and bigger all that time. Plus the pain of course, which while it might be improving slightly is annoying.

However if there is nothing a dentist could do here (would different anti-biotics or something not help?) then I suppose there isn't really much point in going to one when on holiday.




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Hi Red,

If it is osteomyelitis, it can linger in that area, spread to other areas of your mouth or become systemic even after it is treated. This condition is the result of <<LINGERING>> infections from root canaled teeth, dry sockets, failing implants, periodontal disease..... etc. From my extensive experience in oral and perio surgery, I believe more people have this condition than are diagnosed because lingering infections are often undiagnosed/misdiagnosed, watched instead of treated, patched up with retreatment as in root canal therapy or apicoectomy surgery..... and until it gets clinically severe where the patient is chronically ill or in pain, nothing is done about it. All of this means that the average dentist does not recognize or diagnose the early stages of this condition, therefore, they don't know to treat it.

There is no way for me to know if this is what you have so I would not suggest that you run to the dentist in a panic and insist on some intervention. I can tell you based on what you stated about the dental history of this area... you are a candidate for this condition. But that does not mean that you currently have it or that it will turn into this. There really is no other way to deal with this right now other than to be aware of your pain.... is it increasing, are you feeling ill, are you having to take constant pain meds... these are the questions that you will be asked by whomever you see and the treatment will be based on the answers. If an xray were to show a definitive pathological problem, then your symptoms, whatever they may be, would be taken into consideration but more than likely, the area would be surgically debrided and antibiotics would be given based on the findings on the xray.

However with regard to the findings on an xray....that area is still healing, so the bone is not going to look normal (filled in) to begin with. So you see, there is no definitive diagnosis at this time. This is why I cannot stress enough to everyone.... it is imperative not to prolong dental treatment when there is an infection and root canaled teeth are a major source of infection.

Antibiotics may or may not help at this point. If there is just some residual bacteria that is in the bone but has not deeply infiltrated it, then they may help. But overuse of antibiotics including taking them when not necessary can create resistance to any similar strain of that antibiotic for anything that arises in the future.

Red, monitor your symptoms....and rely on your instinct. Sometimes we become very anxious about the what ifs and those fears consume our actual physical sensations. Do you know what I mean? Be mindful of the pain... when, where, duration, intense, dull, lingering, less, more......... you will have soreness, sensitivity even in adjacent teeth, dull achiness, sharp intermittent nerve twinges...all of these are normal healing symptoms from the dental work that you have had done and they may continue for several weeks. But they should show signs of decreasing = healing.

I'm sorry if I've repeated myself.... I wish I could offer something more reassuring.

Bryanna



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Many thanks again for the detailed and helpful reply Bryanna, your help has been very useful and informative. I'll monitor it and see how it goes.

I know what you mean about fears of the what ifs overriding or being more dominant than the actual physical problem. I'll try not to get carried away with imagining the worst case scenario.



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Hi again,

The pain doesn't seem to be decreasing much. It's perhaps slightly better but still there and still centered on the implant site.

The gum itself looks fine, the pain is coming from 'within' that area. It it is a bone infection is surgery always required or could antibiotics still work alone?

Many thanks

Hi Red,

If there is "pain" or extreme achiness, and the gum has closed over, the dentist may decide to perform a surgical debridement of that area. If that is done, then it would be smart for him to take a specimen of some of the bone and have it biopsied and cultured. This way the strain of bacteria can be determined and the proper antibiotic can be prescribed. Sometimes there are several species of bacteria which would require more than one type of an antibiotic.

Have the dentist take an xray and describe your pain in detail.... when does it hurt, how long, what seems to trigger it, what seems to make it better... things like that.

It is usually better to see an oral surgeon for this, not a general dentist.

So sorry you are still uncomfortable :-( I hope this gets remedied soon!!

Keep us posted...
Bryanna

Yes, the gum has completely closed over and looks normal, but the pain and head pain still comes and goes often and can be very distracting.

I go back to the UK next week and will try and see an oral surgeon then. My concern is that if I see an NHS (government health service) one I can only do so by getting a referral from my normal dentist and the whole process can take a while.

The alternative is to see a private one which would be a lot quicker, but if it needs surgery and biopsy and things I really don't think I will be able to afford that.

I want to do something soon, I'll look up a good private one and book an appointment for when I am back.

Having to conform to the "system" can be very difficult especially when you are in pain! I cannot imagine having to wait to see an oral surgeon because of paperwork or whatever ...I just think that's awful.

Do the best that you can.....I have no idea how expensive the surgery would be, but it makes alot of sense to also have the bone biopsied and cultured because the <<proper>> antibiotic prescription will be imperative if the bone is infected.

Let us know how things are going...
Bryanna

Well I'm back home and I saw a private oral surgeon today.

He told me nothing. He took a panoramic x ray and said the area looks fine, no sign of infection and said it is probably just healing pains and maybe I clench my teeth which makes it worse.

The whole consultation, including x ray, took 10 mins, seemed quicker than I was expecting.

Can he really tell from a panoramic x ray what is happening in there?

Hi Red,

Well......... I agree that 10 minutes may not have been enough time to properly evaluate your situation, especially since he had never personally seen you before... therefore he had no clinical history to compare to. Taking the panoramic xray was a good idea but I cannot tell you if that xray was enough to properly diagnose you or not. It was imperative that he take your entire dental history about that area of your mouth into consideration. Do you feel that he did that?

Any chance you would or could post that xray here or IM it to me? Depending on the clarity of it, I may have some insight.

Anytime you have oral surgery, there could be some temporary nerve involvement that could cause any degree of achiness, soreness, shooting pain....all of which could be considered normal for a short period of time providing there was no pathology present either clinically or radiographically. Cases such as yours have a complicated dental history meaning that you could have residual (nerve) problems.... infections.... etc from any of the procedures that were done to that tooth and/or that portion of your jawbone.

The only other thing I can think of to help determine if you are dealing with an infection is to have some blood work done that would include tests that indicate inflammatory cells. A CBC w/ differential and C-Reactive protein are a good start.... your physician may want to test others as well.

What do you think about that idea? Hopefully everything is ok and your pain is residual healing issues and nothing more.

Bryanna

I would gladly send the x ray, but I don't have it. I realised after I left the surgery that I didn't have a copy so I emailed them asking for a one and they never replied. I will ask again if I don't hear soon.

I don't completely feel that he considered the full history. For example he seemed to pick up things and focus on that, so when I said the pain had decreased since the worst point he immediately said something like "well there you go, sounds like it is getting better", which may be true but I don't feel he fully considered the amount of time it has been like this. Perhaps I am being harsh and he really did know his stuff, but my impression is that from the first moment he head my description of the problem he decided it was getting better slowly and fitted everything into that diagnosis rather than diagnosing that from hearing what had happened.

The idea of blood tests is a good one, except, I am waiting for a referral to see an endodontist about another root canal which might need retreated as it is probably infected, would this affect the results? This must make it sound like I am a dental nightmare. I only have 2 (well lost one of them) teeth which have had root canal treatments, honestly I am not much of a nightmare... ;-)