I need of MAJOR help re: persistent low grade fever after an extraction (actual question below).

Background:For six months, I have been having weird dental problems and now they are potentially serious.

It actually started with NO problems.....no pain, fever...NOTHING. This concerns tooth #31 (lower right)

I had an onlay fall off. I went to the dentist and she said a crown would be better. She had GREAT problems putting on a crown. It broke repeatedly. Then, she put on one with permanent cement and it cracked before I left the office! Perhaps there are lab problems...I just don't know. Eventually, that tooth became over the top painful, I believe from the trauma.

I ended up with a root canal. The next thing I know, I had ear pain and a weird bump next to that tooth. I was dx'd with two sinus infections, but later an ENT checked me out and told me he didn't think they were sinus infections, but dental concerns.

Flash forward:

I went to a new dentist and extracted the tooth. He also did a graft. That was 11+ days ago. The actual surgery went well. I was on antibiotics...ended up on two of them at the same time. The only thing is next to the tooth that was extracted, I had a root canaled tooth from many years ago. During the extraction, it was ripped apart and the filling is exposed. The dentist has said repeatedly it is not of a concern, but considering the fever...I'm concerned.

Since the day after the extraction, I have had a low grade fever. 99 to 100 degrees. This is high for me. My blood pressure has gone up and my B Pressure medication had to be doubled. Also, my ear pain continues. Also had malaise.

I went to my internist and he is running many blood tests. So far, no sign of infection, so I got off the antibiotics. I did two CBCs before making this decision. AFter getting off the antibiotics, I feel generally a little better, but the low grade fever persists. And the ear pain persists.

I went back to the ENT and he said my sinuses look great. I went back to the dentist and he said the surgery site looks great.

There are still many, many tests that have not come back yet. I have to go to the hospital for a few more tests next week...biologic testing. The actual site of the extraction/bone graft looks good...no redness, etc. I've had little pain at the actual site of the extraction/bone graft.

Has anyone had a low grade fever for a VERY LONG TIME after an extraction? What might this mean? Other than blood work, what else might I look for? One suggestion made is to remove the graft..thoughts on this???

I am very concerned.

Thank you.

Hi Vowel Lady,

First of all, if your blood work was done anytime during the course of the antibiotics or even within several days after you stopped taking the antibiotic, your test results may not be accurate. Which means they should be repeated to check for inflammation and infection.

You said you're having weird dental problems..... are you referring to just the right side of your mouth or elsewhere?

The problem with tooth #31 had several contributing factors....

...The tooth was obviously broken down/decayed underneath the onlay which then required a bit more drilling away of tooth structure to place a crown on it. This could have resulted in trauma to the nerve which would cause the pain that you described. The fact that the new crown would break repeatedly indicates a problem with the way the tooth was prepared by the dentist and/or the way the top teeth occluded into this tooth.. meaning the occlusion (bite) is too strong on this tooth. So adjustments needed to be made to the top teeth to allow for a better fit.

Root canal therapy only made matters worse because it just causes more inflammation to an already inflamed tooth and the bacteria left behind in the tooth after this procedure sets up for a nice infection. So if you think about it... Tooth #31 had decay in it, then it was repeatedly drilled on, then the root canal added more insult to injury... therefore it was festering from the onset of the decay until it was removed.

I'm thinking your ongoing fever and other physical symptoms are not just related to #31 but also to the root canaled tooth in front of it tooth #30. The fact that the root canal filling is now exposed is not the real problem... the fact is that #30 is also infected as all root canaled teeth are and the trauma to #31 and that surrounding area of bone has stirred up the bacteria that's been living in an around tooth #30.

In all fairness to you, when #31 was being evaluated for a new crown... for the root canal.... and for the extraction... each one of your treating dentists should have been diagnosing #30 as well. Root canals are not able to cure infected teeth they simply allow a person to "retain" an infected tooth for an undisclosed amount of time. The the older the root canal, the more the tooth is infected.

Placing bone graft material in an area of jawbone that is not healthy can cause systemic symptoms..... referred pain to areas unassociated with the original site, fever, malaise, elevation in BP, etc.

Have you had any dental scans other than regular xrays?

Bryanna

What you have said makes absolute perfect sense and you even mentioned things that I did not mention. I am almost in tears. I am so frightened. It is a relief to read/hear something that makes sense, because this has been a nightmare and has only worsened no matter what I do, how much money I spend, etc.

I agree, I have to get another CBC. Only the right side of my mouth hurts.

Tooth 31 actually had a crack in it. I did not know this. The endodontist continued with the RC even though that was the situation. Perhaps it was too late, I don't know.

The original dentist filed my top tooth above 31 like crazy and it is now a small, pathetic, odd shaped tooth that gets dirty very easily.
AND the tooth next to it (on top) is cracked. This seems to be a new situation.

The new dentist, did a panoramic xray of my mouth/sinuses before doing the extraction and the graft. I have not had this type of scan since the fevers.

During all of this, I had gotten some second opinions. ONe dentist, who I didn't stay with because she had old time equipment...no digital stuff...did mention problems with my bite. I also think there are problems with the original dentist's lab...so it is likely a double whammy.

After the fevers, I insisted that the new dentist check my top tooth and tooth 30 for any problems. He used a hand held device to get a picture. He said they were fine. No one else checked #30, and he only did after I insisted. I'm not sure if taking a picture w/ the hand held device was sufficient. ????

I believe now, I likely have to remove the graft and possibly #30. BTW, #30 has four canals in it and the prodecure was done years ago. It is my only rc tooth right now.

However, here are some questions:
1. If I am putting a lot of pressure on the area, what will happen to this part of my mouth/face if I remove #30????
2. I do NOT think I want implants. Can I get some sort of partial immediately?
3. Should my next move be to see an Oral Surgeon? Another type of professional like a periodontist????
4. I live in *. I will see anyone in the South part of the country if you think there is a highly trained, expert/professional with an excellent reputation who might be able to help me.
5. Is removing the graft dangerous? Is it likely to be of some help at this point?
Please advise as soon as you can. I am deeply concerned.
Thank you.

Hi Vowel Lady.

I will follow your questions with my answer in caps...

1. If I am putting a lot of pressure on the area, what will happen to this part of my mouth/face if I remove #30????
GENERALLY THE BITE NEEDS TO BE ADJUSTED IN GENERAL, NOT JUST THE ONE SIDE. ANYTIME YOU REMOVE TEETH, THE OPPOSING TEETH DIRECTLY ABOVE OR BELOW THOSE REMOVED WILL TEND TO DRIFT UP OR DOWN INTO THE EMPTY SPACE. TEETH ARE MEANT TO BITE AGAINST OTHER TEETH. SO DEPENDING ON WHAT TEETH YOU HAVE IN YOUR UPPER RIGHT SIDE WILL DETERMINE IF YOU SHOULD REPLACE #30 OR 31.

2. I do NOT think I want implants. Can I get some sort of partial immediately?
IMPLANTS ARE A RISKY OPTION WHEN THEY ARE REPLACING A ROOT CANALED TOOTH OR ANY TOOTH THAT HAS HAD A LONG STANDING INFECTION. SIMPLY BECAUSE THE JAWBONE BECOMES INFECTED WITH THE BACTERIA FROM THE TOOTH AND THERE IS NO GUARANTEED THAT ALL OF THE INFECTION IS OR CAN BE REMOVED DURING THE EXTRACTION. BACTERIA CAN LAY DORMANT IN THE BONE FOR MONTHS, YEARS, WITHOUT OBVIOUS SYMPTOMS. THEREFORE, PLACING AN IMPLANT IN BONE THAT IS QUESTIONABLE, IS RISKY.

3. Should my next move be to see an Oral Surgeon? Another type of professional like a periodontist????
AN ORAL SURGEON OR A DENTIST WHO HAS EXTENSIVE EXPERIENCE IN ORAL SURGERY FOR A COMPLETE EVALUATION OF THE SURGICAL SITE #31 AND THE REMOVAL OF #30. A PERIODONTIST TREATS GUM DISEASE WHICH HAS NO BEARING ON YOUR SITUATION.

4. I live in *. I will see anyone in the South part of the country if you think there is a highly trained, expert/professional with an excellent reputation who might be able to help me.
I DO NOT KNOW OF ANYONE IN * TO REFER YOU TO. YOU COULD CHECK OUT THE IAOMT ORGANIZATION TO SEE WHO IS LISTED WITH THEM.

5. Is removing the graft dangerous? Is it likely to be of some help at this point?
REMOVING THE GRAFT IS NOT DANGEROUS. IT WILL REQUIRE A QUALIFIED SURGEON OR QUALIFIED GENERAL DENTIST WITH EXTENSIVE ORAL SURGERY EXPERIENCE TO REMOVE IT. IF THE SITE IS INFECTED, THE GRAFT SHOULD BE REMOVED. SO THAT'S WHY THAT SITE AND #3O NEED TO BE EVALUATED FIRST.

Bryanna

Hi Bryanna...you are so very helpful. This has been harrowing.

What tests are used to evaluate for infection? I have no swelling or redness around my gums. Does this mean anything at all?

What is the best way to test tooth 30 for infection?

How might a dental professional determine if the graft is infected?

Tooth #31 has been extracted. Perhaps 30 will be at some time. Can I get a partial bridge without some kind of anchoring tooth?

Thank you.

Vowel Lady,

What tests are used to evaluate for infection? I have no swelling or redness around my gums. Does this mean anything at all?
A DENTAL CT SCAN WOULD SHOW ABNORMALITIES IN THE BONE INDICATIVE OF INFECTION. INFECTION RESIDING IN THE BONE DOES NOT ALWAYS SHOW AS SWELLING OR REDNESS AT THE GUM LEVEL UNTIL IT IS ADVANCED.

What is the best way to test tooth 30 for infection?
IF TOOTH #3O HAS BEEN ROOT CANALED, IT IS INFECTED. THERE IS NO CURE FOR AN INFECTED TOOTH.

How might a dental professional determine if the graft is infected?
DIAGNOSIS VIA DENTAL CT SCAN... SOMETIMES A PANORAMIC RADIOGRAPH.... SOMETIMES THEY HAVE TO SURGICAL GO IN AND LOOK AT IT.

Tooth #31 has been extracted. Perhaps 30 will be at some time. Can I get a partial bridge without some kind of anchoring tooth?
YES, YOU HAVE SAID THAT #31 IS ALREADY EXTRACTED. A UNILATERAL PARTIAL DENTURE REPLACES TEETH THAT ARE MISSING ON ONE SIDE OF AN ARCH. THIS TYPE OF APPLIANCE USUALLY HAS A METAL BAR THAT COMES ACROSS THE BACK OF THE LOWER FRONT TEETH. YOU WOULD HAVE TO DISCUSS YOUR REPLACEMENT OPTIONS WITH YOUR DENTIST.