Hi all,
Grateful to have found this forum.
A little back-story, which could serve as a cautionary tale.
Please feel free to skip ahead.
About 15 years ago I had only 1 small cavity on #19 molar
I managed to scrape the money to do the proper thing and go to the dentist.
I was shocked told that I had 14 cavities. Being more naive and timid then I did not ask to see the x-ray or anything but I knew enough to know this did not seem right.
So I paid for the x-rays but did not get the cavity fixed.
This incidence kept me from taking care of the cavity when it was small.
Finally about 5 years ago it had grown so large that I had to over come my issues and find a honest reputable dentist. Upon carefully examine my teeth it was confirmed I had only 1 cavity which was now quite large and he put a composite filling on it . My suspicions were confirmed, my previous dentist had lied when he told me I had 14 cavities.

Which bring us up to date.

Tooth #19 with the large filling gave some slight discomfort recently with mild soreness on my jaw line. The panoramic x-rayed reveled a large abscess under the filling the oral surgeon commented that the abscess had started eating away at the jaw. X-ray attached below.
The soreness on jaw line went away after I was given some amoxcillian and the tooth was pulled a few days later. I’m supposed to go in for a post op Monday and start taking Keflex (Cephalexin).
I have read quite a bit online about Osteomyelitis along with the info Bryanna has shared here. Some places say it’s very rare other sources say it is quite common. If this is in fact Osteomyelitis then is it “usually” successfully treated by oral antibiotics alone? I voiced my concern to my oral surgeon and he said there shouldn’t be any complications as long as I have a healthy immune system, which I think I do (barring the resent stressful events). I wonder if he’s not taking a aggressive enough approach in the treatment.
I’m not against the idea of IV antibiotics or even surgery as long as it will rid me off the infection. I have read that infections in the jaw are difficult to treat cause it hard for the antibiotics to reach that area but he seemed fairly confident the oral antibiotics would take care of it.
Only good thing to come out of this so far is I stopped my 2 cigarettes a day habit for good.

Any thoughts input would be greatly appreciated.


Jay

Attached Thumbnails

 

Hi Jay,

Thank you for posting the xray. It is a bit skewed but the area of #19 is very evident. I am going to assume that you interjected the comments on their describing the situation? If so, very clever

Okay so yes #19 whoa infection! If this is osteomyelitis then you may require long term oral or IV antibiotics. Whether it is or not OR whether you do the long term meds or not.... this area should be monitored periodically with a periapical radiograph ad jaw bone infection can be difficult to eradicate even with additional surgery.

Yes, your immune system plays a part in this but your immune system is also busy dealing with whatever else comes along. So it is not reasonable to think a bone infection is going to clear up because the patient has a healthy immune system. Also, antibiotics (and other meds) compromise the immune system because in order for those meds to take effect, they have to reduce and destroy the healing cells that our immune system naturally produces to kill the bad bacteria.

On that note... if you are not already taking one ... you would benefit from supplementing with a probiotic. Do you know what that is? Do you want information on it?

Bryanna

hi Bryanna,

Thank you for your comments greatly appreciated.
Glad the comments I interjected helped clarify.
Yes, thanks I read a previous post in which you mention antibiotics. In your experience is the success rate pretty high with just oral antibiotics? I'll update on Monday after the oral surgeon.

Kind regards

Jay

Typo meant * probiotic

Hi Jay,

I have seen many patients with varying degrees of Osteomyelitis of their jaw bone. Some had oral medication, some had IV.... some had the combination of both at different times. I also have had patients who were diagnosed with Osteomyelitis by their orthopedic surgeon after having surgery on their spine, their knee, etc. I've had patients who had artificial joints fail due to Osteomyelitis. The commonality of "these" people were root canaled teeth, or long standing infected teeth and/or uncontrolled periodontal disease. So the theory was that the infection originated from their jaw bone and spread through the blood stream to a weak or compromised area. Some had compromised health prior to the orthopedic diagnosis ..... others did not.

There is no way to gauge if oral antibiotics will cure Osteomyelitis. I have known patients to become well after being treated. However, I also know patients who have had long term health problems associated with the infection. Lingering sinus problems are the most commonly seen with the upper teeth. Of course, if we lost touch with the patient or if they died, we never knew if their infection had been eradicated or if their infection was a contributing factor to their demise.

Osteomyelitis is a serious infection and needs to be taken seriously. Hopefully you don't have it!

The probiotic..... this is a nutritional supplement that helps to replace the healthy bacteria that are destroyed by the antibiotic. Once the intestinal flora becomes abundant with bad bacteria, physical illness will occur. Common ailments that are often the result of this are .... all chronic digestive disorders any place in the intestinal tract from the mouth to the ****, skin disorders, inflammation, fatigue, etc.

Bryanna

Thank you for such a through response Bryanna.
Hopefully since the tooth was removed it will make healing less complicated.

Many thanks

Jay

Jay,

You are welcome

Removing the tooth is always imperative and the first step in dealing with this type of infection. So glad no one tried to talk you into keeping that tooth!!

Wish you a perfect healing.... please keep us posted!

Bryanna

Thank you kindly for the well wishes Bryanna,

Actually the endodontist thought he might be able to save the tooth, that's what there trained to do I suppose.
Well I'm back from seeing my oral surgeon for a quick visit, nice guy. The site of the extraction is healing well.
Again I addressed my concern whether or not the extraction and the course of amoxcillian (which I just finished) would be enough to
wipe the infection that had made its way into my jaw. He said 99% of the time the extraction is enough to cause total healing. He compared it to
removing a splinter in a finger.
I asked if I could have another x-ray to help reassure myself, but he said a xray would not show enough changes so soon, and that a xray might be a good idea 3 months down the road.

Now I will start taking the Keflex as prescribed. I'm wondering if I should ask my regular Dr if he can write me a percription for Clindamycin or perhaps Penicillin
to take along side with the Keflex as a added precaution. I've read that Clindamycin is good with bone penetration.
Keflex seems kinda light weight considering the size of the abscess and its spreading to the jawline.

Is there anyway to confirm the infection is truly gone rather then waiting 3 months to have a xray?
Thanks for all your help. Hope to start a thread about emerging technologies on the fight against dental caries.

Best wishes

Jay

Hi Jay,

Yes, endodontists earn a magnificent living doing root canals and rarely explain anything about the risks associated with this procedure. I really hope that someday dentists will exchange their marketing statement from "save the tooth" to "retain the tooth". Big difference between the two!

Regarding the 99% comment by the OS about extractions being the cure all for bone infection....... he was being optimistic with you which is not a bad thing. But the percentage was a bit over zealous! The healing from removing a tooth that recently became infected or a tooth that had no infection but had broken down beyond repair is probably 99%. The healing from the removal of an infected tooth, one in which has infected the jaw bone is not in the 90 percentile. There are many issues that affect the healing and the patients overall health is a huge factor. His comparison between the tooth and the splinter makes me laugh out loud because I use that here and at work all the time when I explain the comparison between a root canaled tooth and a splinter in the finger. Both can be festering infections if the culprit is not removed!

He is right in that removing the tooth is imperative as this gives the immune system the opportunity to deal with the residual infection.

Regarding the antibiotic Keflex.... I don't know if it would be okay to take this with clindamycin or penicillin. You would need to discuss that with your OS and physician.

There is no real way to know if the site is healing in the bone or not at this point. It is wise to be aware of any unusual symptoms that suddenly occur that indicate a bacterial infection. Definitely get an xray at the 3 month mark even if all remains quiet. I would get another xray every 3 months for the first year to monitor the healing because it is always best to intervene early if necessary.

And yea.... by all means start a thread on the battle of tooth decay!!!

Take care,
Bryanna

hi Bryanna,

I really appreciate your advise. If there was a donate button I'd hit it now. I look forward to reading more threads here and your input.

Kind regards

Jay