[Euclid]

Hi, okay here's my situation.

I went to my dentist approximately one month ago with aching and sometimes sharp pain in the lower left area of my mouth. Dentist found cavities, 8 to be exact, and told me to come back for fillings on four. When I came back I told him I was still experiencing pain and the way I was describing it had him thinking there was no way on earth this was just cavity pain. He went ahead with the fillings but as he was doing so, he figured out why I was in such pain... tooth #18 was cracked severely, it was down to the root and dying, it was hopeless in his opinion.

So on June 10th I had the tooth extracted at a dental school (University of Minnesota) with the oral surgeon popping in every so often as the two residents took care of it. Extraction went fine, they termed it "simple" and I received all the post op instructions. I am a non-smoker to be clear which is why getting a dry socket two days later was odd since I followed the directions! So I got the dry socket diagnosis and my local dentist ended up putting in the clove oil dressing. By the time I returned less than a week later, she said the socket looked really good, there was a clot and it was healing, she could tell. She took an x-ray of the area which showed nothing else going on. She basically told me she didn't even need to see me unless I had more issues, she was confident everything would continue to heal nicely. She took out the dressing too so I only had one dressing. Also, I read about the horrendous pain people can get from dry sockets and in all true honesty never had crippling pain where I was on the floor crying. I had annoying pain but advil and tylenol (yes, around the clock) did the trick. I almost felt lucky that I probably had a case of a "mild dry socket" if there is such a thing.

Anyway, as the days moved along, I was also noticing around 2 1/2 weeks that I was needing advil and tylenol less and less. It was great. I figured by this time, I would need nothing. Well that was before Friday happened... out of the blue on Friday as I was eating dinner, I started getting horrific pain in my lower left chin, jaw, cheek, socket area, upper and lower teeth on that side, you name it, it hurt! I suffered all this past weekend with this pain and advil and tylenol would not totally relieve it.. it would certainly take the edge off but not totally remove the pain the entire time in between doses which I couldn't believe because at the beginning of the dry socket diagnosis those over the counter drugs would zap the pain overall and hardly any overlap in between doses of pain existed.

So I marched back down to the University this morning for evaluation... the oral surgeon and resident both took a look and said the dry socket and socket area in general is healing beautifully. It is about 50% healed and filled up, no bone is exposed. He took a regular x-ray of the area to make sure and it was fine. He said everything looks great. I explained to him that this weekend I had some sort of setback because Friday night I was in an incredible amount of pain in the chin, left jaw, cheek, upper and lower teeth on that side and around the extraction area and it completely left me confused (and in pain) because things were going beautifully in my mind... then the advil and tylenol are not even helping the pain much. His diagnosis is severe jaw spasms that are flared up and angry over everything that has been done to me on that side. He thinks that's what it is... severe jaw/muscle spasms that are really angry pressing on nerves and causing this pain. He has referred me to a specialist in neuromuscular dentistry to help out with this.

So the good news is the socket is outstanding, doing just fine and healing nicely. Bad news is the jaw spasms that are causing horrible pain and now I have to see a different specialist for this. He said there's an outside chance this is a neuralgia of some kind but he believes it's jaw spasms that are angry over the surgery and they need to settle down.

Here's my questions:

1. Do you know why the pain would all of a sudden become horrific this past weekend and today when everything was going well before this time?

2. Do you believe jaw spasms could cause all of this? I will say that I was diagnosed with TMD years ago. I have had issues with my jaw muscles and neck (no curvature) due to sports injuries. Is this the most likely diagnosis? Can the jaw spasm that much and cause all of this pain, including pain in the extraction area?

3. My fear is jawbone infection... I have had my local dentist and a couple oral surgeons look at the site the past three weeks and not even a superficial infection was found. There was not even a debate over whether or not I had an infection in the least. But is it possible a jawbone infection is being missed right now? The regular x-ray he took today of the area, he said it was crystal clear and picture perfect, no root tips left or fragments, I thought he said the jawbone look good, but am not sure. Can a basic x-ray (I had to bite down on that thing) of the area show signs of a jawbone infection?

4. How does trig neuralgia differ from plain old jaw spasms?

Thanks. I have had appendix, gallbladder and traditional hysterectomy for surgeries and got through all three fairly easily. I get one little tooth pulled and this is by far the most severe out of all of those surgeries! LOL

[Euclid]

Bryanna, wow, what wonderful, expert advice and knowledge you have and give out. If you could take a look at my situation and respond whenever you can, I would ever so appreciate it. Thanks!

[Bryanna]

Hi Euclid,
I will re post your questions and answer in bold type.

<<Here's my questions:>>

1. Do you know why the pain would all of a sudden become horrific this past weekend and today when everything was going well before this time?

YOU STATED THAT THE PAIN OCCURRED WHILE YOU WERE EATING DINNER. THIS PRETTY MUCH INDICATES THAT YOU EITHER GOT SOMETHING CAUGHT IN THE EXTRACTION SITE AND/OR YOU MOVED YOUR JAW IN A WAY TO CAUSE IT TO SPASM WHILE TRYING TO AVOID EATING IN THAT AREA.

2. Do you believe jaw spasms could cause all of this? I will say that I was diagnosed with TMD years ago. I have had issues with my jaw muscles and neck (no curvature) due to sports injuries. Is this the most likely diagnosis? Can the jaw spasm that much and cause all of this pain, including pain in the extraction area?

YES, MUSCLE SPASMS IN THE FACE AND HEAD WILL CAUSE THIS TYPE OF PAIN. ONCE YOU ARE DIAGNOSED WITH TMD OR TMJ YOU ARE ALWAYS GOING TO BE PRONE TO RECURRENT PROBLEMS. ANY TRAUMA TO THE JAW, FACE, HEAD..... INCLUDING DENTAL WORK... CAN TRIGGER THE PROBLEM TO RECUR.

3. My fear is jawbone infection... I have had my local dentist and a couple oral surgeons look at the site the past three weeks and not even a superficial infection was found. There was not even a debate over whether or not I had an infection in the least. But is it possible a jawbone infection is being missed right now? The regular x-ray he took today of the area, he said it was crystal clear and picture perfect, no root tips left or fragments, I thought he said the jawbone look good, but am not sure. Can a basic x-ray (I had to bite down on that thing) of the area show signs of a jawbone infection?

SOME JAW BONE INFECTIONS ARE MICROSCOPIC AT THE ONSET AND ARE NOT PICKED UP ON THE X-RAYS. SO IF THE X-RAYS ARE NOT SHOWING ANY PATHOLOGY, THEN YOU WOULD HAVE TO WAIT IT OUT FOR A BIT TO SEE IF THINGS IMPROVE. A DENTAL CT SCAN CAN SOMETIMES PICK UP THESE INFECTIONS BUT NOT ALWAYS AND YOU HAVE TO WEIGHT THE PROS AND CONS OF THAT RADIATION EXPOSURE AT THIS TIME.

4. How does trig neuralgia differ from plain old jaw spasms?

IT DIFFERS A LOT. ONE IS MUSCULAR AND THE OTHER IS NERVE PAIN. MUSCULAR SPASMS TEND TO BE SHARP OR ACHEY, TIGHT AND HEAVY FEELING. NERVE PAIN TENDS TO RADIATE ALMOST STINGING, PIERCING, BURNING.....

Hopefully things will start to calm down. Avoid eating anything that requires a lot of chewing and try not to open your mouth too wide.... just in case it is spasms. Giving the jaw a rest may improve it significantly. Do you wear a night guard? You can also apply moist heat to that side of your face especially before bedtime and see if that helps bring some relief.