[Vowel Lady]

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.

[Bryanna]

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

Originally Posted by Vowel Lady

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 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?

I am very concerned.

Thank you.

[Vowel Lady]

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.

[Bryanna]

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

[Vowel Lady]

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.

[Bryanna]

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.

[Vowel Lady]

Hi Bryanna

HELP! Here is where I am at the moment and need to make a decision very soon re: removing the graft. I have had the low grade fever for approximately three weeks after an extraction/dental graft. Also have had ear pain on the same side. I'm very concerned about my health.

Just a background reminder...I had a graft put in immediately (same day) after an extraction, which was relatively soon after a root canal. This is the same tooth that has been bothering me for 5 to 6 months.

To see what might be going on, I have had a lot of blood work...16 vials of blood altogether. I took a blood culture x3 at the hospital. This was taken approximately 6 days after being completely off of antibiotics. The preliminary report came back fine (no infection). The final report should be back any day now (they culture it for five days).

My blood work indicated that I have Sjorgens Syndrome (sp?). I've had dry eyes for some time now and dry mouth, actually for a very short amount of time.

The dentist office called regarding removing the stiches...which I did the other day and spoke w/ the doctor at length about my options. He also gave me a shot of Ozone in the area, saying that this might help with inflammation.

He said after 10 days it is hard to take out the graft and he said that the graft should NOT be causing any problems ... it looks perfect. I asked him to take an xray of the graft and he changed the subject and basically refused stating that it looked "textbook perfect," one of the best ones he has done.
However, he stated that he would be willing to remove the graft if I wanted him to.

I am very concerned about MY HEALTH.

I went to an Oral Surgeon for a second opinion and he stated that I justed needed more rest time...give it two more weeks...rinsing with salt water and the fever should abate. That was about a week ago. The fever is the same...perhaps a tiny bit worse.

Questions:
1. Is it possible to have an infection in the gums, tooth or w/i a dental cavity w/o it showing up in the blood work?
2. Have you ever heard of anyone having crazy fevers after a dental procedure and does it usually mean infection?
3. Is the removal of the graft after 10 days likely to be difficult and/or traumatic? Would it be better to go to an Oral Surgeon for this removal? (I'm kinda thinking I might have trouble convincing one to do it under these circumstances).
4. Is my ear pain likely nerve pain or muscle pain? (As a side note: I've been to an ENT twice and he says my ear pain is related to dental issues).

Thank you!!!

[Bryanna]

Vowel Lady,

I answered this post this morning... have no idea where it went to!

Oh Well, let's try again.

Questions:
1. Is it possible to have an infection in the gums, tooth or w/i a dental cavity w/o it showing up in the blood work?

YES, IT IS POSSIBLE BECAUSE THE IMMUNE SYSTEM HAS AN AWESOME ABILITY TO FIGHT INFECTION AND IT MAY BE MINUTE AT THIS POINT. IT COULD ALSO BE INFLAMMATION AND NOT AN INFECTION. THERE ARE MANY BLOOD TESTS THAT CAN BE DONE TO DETECT INFLAMMATION AND INFECTION. SOME TESTS ARE WBC, ESR, SERUM C-REACTIVE PROTEIN, HOMO CYSTEINE AND SERUM INTERLEUKIN-6 LEVELS.

2. Have you ever heard of anyone having crazy fevers after a dental procedure and does it usually mean infection?

FEVERS CAN OCCUR FROM ANY SURGICAL TRAUMA. SOMETIMES IT TAKES SEVERAL WEEKS FOR THE BODY TEMPERATURE TO BE NORMAL AGAIN.

3. Is the removal of the graft after 10 days likely to be difficult and/or traumatic? Would it be better to go to an Oral Surgeon for this removal? (I'm kinda thinking I might have trouble convincing one to do it under these circumstances).

ANY SURGICAL PROCEDURE IS GOING TO CAUSE TRAUMA TO THE SITE AND THE IMMUNE SYSTEM. DEPENDING ON HOW THE GRAFT WAS DONE AND WHAT MATERIAL WAS USED... IT MAY NOT MAY NOT BE DIFFICULT TO REMOVE IT. AN ORAL SURGEON DEFINITELY... NOT A GENERAL DENTIST.

4. Is my ear pain likely nerve pain or muscle pain? (As a side note: I've been to an ENT twice and he says my ear pain is related to dental issues).

YOUR ENT DR THINKS IT'S DENTAL RELATED. I TEND TO AGREE. HOWEVER, I THINK THE CULPRIT MAY BE THE ROOT CANALED TOOTH NEXT TO THE SURGICAL SITE MORE SO THAN THE GRAFT. THAT TOOTH HAS BEEN CHRONICALLY INFECTED SINCE IT WAS ROOT CANALED. THE BACTERIA FROM THAT TOOTH COULD BE SPREADING TO THE NEWLY SURGERIZED AREA. tHAT TOOTH NEEDS TO BE DIAGNOSED PROPERLY BECAUSE A SECOND SURGERY MAY NOT BE THE ANSWER IF THAT TOOTH IS THE CULPRIT OF YOUR CURRENT SITUATION.

I have had patients who had an elevated C-Reactive Protein for years. Their physicians associating it with cardiac .... never dental. After their root canaled teeth were removed, there CRP came down to normal. The same goes for patients with periodontal disease. This exact serum marker does not elevate with everyone.... it could be a different marker that is abnormal rather than the CRP.

My suggestion is to have the root canaled tooth evaluated properly and consider removing that source of infection. Also, you need to keep in mind that I have not seen you clinically or have I seen any xrays. So the information that I am giving you is the basic facts of what can occur in cases such as yours.

I know this is very scary to you.... what to do, what to do!! I've said it many times... root canaled teeth are a necrotic mess inside the dentin tubules. Any surgery that is done next to a root canaled tooth can be jeopardized due to the chronic state of infection that is living in that area of bone as it continuously shares the same blood supply. It is common sense and unfortunately commonly over looked.

Your dentist may not want to acknowledge the issues with this root canaled tooth. But if it were me, that is what I would be looking at.

Bryanna

Originally Posted by Vowel Lady

Hi Bryanna

HELP! Here is where I am at the moment and need to make a decision very soon re: removing the graft. I have had the low grade fever for approximately three weeks after an extraction/dental graft. Also have had ear pain on the same side. I'm very concerned about my health.

Just a background reminder...I had a graft put in immediately (same day) after an extraction, which was relatively soon after a root canal. This is the same tooth that has been bothering me for 5 to 6 months.

To see what might be going on, I have had a lot of blood work...16 vials of blood altogether. I took a blood culture x3 at the hospital. This was taken approximately 6 days after being completely off of antibiotics. The preliminary report came back fine (no infection). The final report should be back any day now (they culture it for five days).

My blood work indicated that I have Sjorgens Syndrome (sp?). I've had dry eyes for some time now and dry mouth, actually for a very short amount of time.

The dentist office called regarding removing the stiches...which I did the other day and spoke w/ the doctor at length about my options. He also gave me a shot of Ozone in the area, saying that this might help with inflammation.

He said after 10 days it is hard to take out the graft and he said that the graft should NOT be causing any problems ... it looks perfect. I asked him to take an xray of the graft and he changed the subject and basically refused stating that it looked "textbook perfect," one of the best ones he has done.
However, he stated that he would be willing to remove the graft if I wanted him to.

I am very concerned about MY HEALTH.

I went to an Oral Surgeon for a second opinion and he stated that I justed needed more rest time...give it two more weeks...rinsing with salt water and the fever should abate. That was about a week ago. The fever is the same...perhaps a tiny bit worse.

Questions:
1. Is it possible to have an infection in the gums, tooth or w/i a dental cavity w/o it showing up in the blood work?
2. Have you ever heard of anyone having crazy fevers after a dental procedure and does it usually mean infection?
3. Is the removal of the graft after 10 days likely to be difficult and/or traumatic? Would it be better to go to an Oral Surgeon for this removal? (I'm kinda thinking I might have trouble convincing one to do it under these circumstances).
4. Is my ear pain likely nerve pain or muscle pain? (As a side note: I've been to an ENT twice and he says my ear pain is related to dental issues).

Thank you!!!

[Vowel Lady]

November Update
Two neuros, a gp and another doc all strongly suspect nerve damage.
I'm on Lyrica three times a day, which is helpful. I have many days of tremendous pain.
The multiple dental surgeries somehow seem to have exacerbated my Sojourns (sp?) Syndrome, which originally was so mild, I wasn't aware I had it. I did have a hx of Lupus though and prior to all of this, was doing very well with that.
This started In April...I had no pain, no fever, no discomfort of any kind at all, but simply asked a dentist to replace an onlay which fell off and the problems associated with that request were outrageous and led to great pain.
Since then, I've had three surgeries, daily pain, thousands of dollars in dental work, have no dental insurance at the moment (it was all used up for the year) , am on daily medication with nasty side effects, my blood pressure has gone through the roof and my blood pressure meds have been quadrupled and I often have to take Percocet and stay home with a heating pad on my face. Oh, and the other day, a cold chill hit that side of my face, and I was in severe pain for approximately ten + hours.

People: Take any dental surgery, large or small, very seriously and the sad truth is your dental professional may not be best qualified or have your best interest in mind. Check, check, re check and check some more.

[zachameen]

Three weeks ago I went to see a dentist for minor filling job; during the procedure my tooth was really sensitive so she was keep poking needle in different places on the inner side of tooth #31. Two days after coming home I started to have many episodes of numbing jaw. I was hospitalized to rule out any possible heart Issues (nuclear test). Results were normal and negative toward any blockage. since then I have developed a low grade fever which stays in 100- 100.5 range and some times goes up to 101. I was on antibio-tics (amoxicillin) for a week and in a third week I have developed hyper sensitive skin ( every hair on my body hurts badly). my Glends on an inner side of my tooth (below tooth) is tasting like salt and other bitter chemicles.

I am having very smelly mouth and very smelly stool. CBC and other blood results came out negative toward any abnormal counts. My second dentist didn't find any infection; my Dr asked me to drop my antibiotic which I did two days ago but my fever is persistent. My ear and the jaw starts hurting badly some times, some times my my tooth start hurting without any reason but when I massage the glends with my tongue, it relieves me. I am exhausted please help me. no one knows whats wrong with me.