Hi again Bryanna,

I appreciate you & every bit of advice that you share!

A couple of things. One is that I made sure that the OS will do a culture along with the debridement & biopsy this Saturday. Yay! Thank you for reminding me, I would have easily forgotten to have that done.

Regarding the CT results and the osteomyelitis. Before the OS did the first debridement and biopsy, I was in nasty, unbearable pain due to swelling, etc….. Currently, I'm only having a subtle stinging sensation; the only real discomfort I've had was when the OS was examining the area the other day.

My layperson mind wants to ask---can osteomyelitis exist in the body without exhibiting many outward symptoms? I'll be the first to admit that I haven't felt very good lately, but I figured that I was due for an adjustment to my depression meds. lol

As always, thank you for listening. ~Laughter

P.S. I'm working on my soft food diet; thank goodness it's only temporary.

Hi Laughter,

... And I appreciate your appreciation.. .. ~'.'~

Osteomyelitis can be present with severe, subtle or on/off symptoms. It can become a chronic infection and can also spread from one area of the body to another. Given those issues it can be hard to diagnose definitively if there is no blatant pathology in the area that it is suspected to be in. I know that is not reassuring and I am sorry :/ So it is very wise to have the culture and biopsy done during your oral surgery on saturday to be certain of the bacteria and to be prescribed the proper medication to kill that bacteria. Unfortunately there is still no guarantee that the infection will be cured but it certainly gives you a better shot at it!

The risk of developing osteomyelitis is strongly associated with any severe or long standing tooth or bone infection. I personally feel that all people have the right to be informed of this risk prior to consenting to a root canal. I feel it is just one of the many risks that should be presented and not left unsaid.

Feeling physically lousy is a sign that your immune system is dealing with a lot. I know I sound like a broken record..... but I am a mother and have earned that right.... your diet has a huge impact on how your immune system handles infection and stress. Eating a variety of healthy fresh foods feed the body the nutrients it needs to cope with life. Processed and refined foods deplete the body of nutrients and just add insult to injury. So please go eat an apple and I promise you will feel better.... or maybe I'll just feel better

Do you own a blender or nutri-bullet? Drinking vegetable or fruit smoothies during the healing from oral surgery are excellent choices of nutrition. So are home made soups. Any of that sound appealing to you or do you already comsume those things?

Bryanna

Good morning Bryanna,

I hope that you had a Happy Mother's Day.

Thank you for your latest response; my intention was to reply before my surgery on Saturday, but I ran out of time!

Although I didn't eat an apple as you suggested, the neighbor brought over fresh pineapple, cantaloupe, grapes and watermelon that very same day--- how's that for timing? How's that for having great neighbors?

Saturday's surgery is finally over. Instead of sharing long, drawn out conversations with you (the kind that make your forehead hit your keyboard...lol), I want to give you the surgeon's comments.

OS said there were two bone fragments and one root tip that showed up on the radiograph from a week ago.
He also confirmed that he was doing both the biopsy and culture; the culture wasn't necessary because neither the X-rays nor the CT images reflected any existing osteomyelitis. He said the present infection was due to the bone fragments and root tip---and that once he removed them, the infection was also gone.
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My observation---the OS wasn't in the best of moods; well get in line! Lol

This surgery seems to have caused more swelling and bleeding than the first two. I don't know what the difference is, but I could tell right afterwards that the expected post-operative recovery routine was going to be different this time around. Maybe that's a good sign? . Every once in a while, I'll gingerly peek inside my mouth, I have to say that it looks like a complete train wreck. When it comes to my pie hole, Mother Nature sure has her work cut out for her!

I respect the OS's feedback as to whether or not there is existing infection/osteomyelitis, however, I feel SO much better being able to lean on the definitive culture results. Thank you again for the very wise suggestion.

Bryanna, on average, how long does it take to get culture results? If I remember right, the biopsy results took a couple of weeks to arrive.

Why do you think the OS give me a 7-day Rx for Clindamyacin (4 pills a day) if he is certain that there isn't an infection?

One thing I wanted to mention is a few times a day, from my neck up, I am getting really flushed and hot---- I haven't taken my temp during those "episodes", so I don't know if it'd be related or not. Could I all of a sudden be allergic to Clindamyacin? This is my 4th Rx over the last 4-5 months and I haven't had these symptoms before...
I am allergic to penicillin and sulfa.

Ok, time for more ice on this chipmunk cheek. . As always, Thank You for listening and for your input, Bryanna. . ~Laughter

Hi Laughter,

I am glad to see that you can keep your sense of humor in spite of all that is going on!!

So just please clarify for me.... the OS did a biopsy AND culture or he just did the biopsy? I hope he did both. Generally the dentist has the results within 7-10 days. If they are emailed to him, he may have them sooner. For the culture they basically put the bacteria in a Petri dish with different antibiotics to see which is most sensitive. The preliminary report can be as soon as 24-48 hours.

He may have prescribed the antibiotic as a precaution but that still does not really negate the need to do the culture.

So there were root tips retained from the extraction! I'm glad he took them out of there. The surgery he did was pretty extensive as he had to open up a large area and spread the bone apart to retrieve everything. This will take some time to heal.

Regarding the flush feeling, I would suggest that you call the pharmacist and ask if that could be a side effect of the clindamycin. Also, are you taking a probiotic supplement to help replenish the good bacteria that the antibiotic is killing off?

Regarding the use of ice.... basically that should only be applied for the first 24 hours. To apply it now could cause the swelling to become hard and more uncomfortable. It may help to apply moist heat. Not hot, just very warm. You can dampen a wash cloth and put it in the microwave for about 15-20 seconds and then apply that cloth to the outside of your face. Cover that cloth with a dry one to keep the heat in. Leave that on for 15 - 20 minutes and repeat 3 times a day. The moist heat encourages blood to flow and can reduce the inflammation which reduces the swelling.

I sure hope your pie hole starts to feel better soon ~'.'~

Keep in touch with us......

Hi Bryanna,

Yes, I always lean on humor when life becomes a challenge in one way or another---I have always found that laughter is a great stress reliever! Thus the nickname.

To answer your question, yes----he did a culture as well as the biopsy. He seemed dismissive while explaining how unnecessary taking a culture would be---but that's ok. Having the results will put my mind (and pie hole) at ease.

Yes, I am taking probiotics twice a day; indefinitely.

The root tips have come up in previous conversations; the first thought was that OS1 left them there on purpose due to them being too close to my facial nerves. Then the root tip conversation was off the table when all those fragments showed up from the first biopsy.
Prior to the surgery Saturday, the OS reminded me of the risks involved in removing the root tip---to me, if that thing is part of my issue---then let's go ahead and get it out as safely as possible.

I won't know for sure what he was or wasn't able to remove until the follow-up appointment with him this Saturday.

Thank you for the information regarding moist heat for my cheek. I'm a fan of things that offer some level of comfort and relief at the moment. Vicodin? Sure. Motrin? Absolutely. Moist heat? Oh yeah. Love from the cats and dogs? Bring it on!

I'll be posting an update once I meet with the OS on Saturday.

Thank you, Bryanna!!! ~Laughter

Hello Bryanna,

I hope that you had a great weekend.

Well, I had my one week follow-up appointment with the OS on Saturday. Neither the culture or biopsy results were available as of that morning, however the OS explained what he came across during the surgery.

He held up his thumb and forefinger. put less than an inch between the two and said that he removed a root nerve (I believe those were his words---he didn't say tip). He said that it caught him by surprise being that it wasn't visible on my
previous scans (right before the surgery he told me that his plan was to go in to remove a couple of bone fragments and a root tip).
Apparently it was right against the nerve; he said he was "looking right at the nerve" (which is when I started feeling clammy (lol).

He asked a number of other questions regarding pain and numbness, etc… Ever since the original extractions took place (mid-January), I've been having occasional tingly numbness from my left lower lip down to right before my chin area.
I explained to him on Saturday that I noticed a decrease in the tingly/numbness area since this most recent surgery. It's actually shrunk down by at least half, which is great news.

On the flip side, I am having pain/discomfort in my mouth. I realize that I am 9 days out from the last surgery, the healing process is going to take quite a while (like you had said), but there is not a moment that goes by that I don't notice
that there's an issue in my pie hole. The OS had mentioned that I've got a lot of scar tissue that's accumulated---and that each time he goes in there, more is created. When I look in the mirror, there is the area where my big honking' teeth once resided.
It kind of resembles a slot of sorts, running from the back of my existing bottom tooth to the back of my mouth. Then from there up into the side of my cheek is this wad of at least 6 "mini caverns" all which contribute to the painful area that never goes away.
The "lumps" that are formed bother me because they don't feel normal; plus anytime I disrupt them (yawn, try to take a bite, talk) they're really painful, ache, sting, hurt and even feel as if I'm pulling muscles….skin….or I don't know what else!

My question to you Bryanna, is will the above go away and become unnoticeable at some point? If so, great. If not, is there anything I can do to help lessen their overall impact? To be candid, my unspoken concern is that this jazz won't let up entirely and this
would then be my new normal. That would be absolutely impossible.

Side note: It took 3 weeks for new granulated tissue to surface following my second surgery. For that reason, he has me coming back in 3 weeks for another check-up, unless something else warrants an earlier appointment.

As always, Thank You!!!!! Laughter & Her Holey Pie Hole

P.S. I am looking forward to getting the biopsy & culture results ASAP.

Hi Laughter and her holey pie hole ~:-0

Your test results should be in like any day now. If you don't hear from the OS by the end of this week, give them a call.

I just want to say that you have been very fortunate to come upon with OS because he is taken a genuine concern in your case. For him to volunteer what he found during the surgery and to explain it to you.... says a lot about his integrity and his concern for you. So I hope you and your pie hole feel some reassurance that so far, you seem to be in good hands ~

Many nerves are microscopic... as those that are inside of the hundreds of tiny canals inside of each tooth. None of which will show up on a scan of any kind unless there is a huge area of gross pathology attached to them. So it's not a surprise for the nerves that he came upon during this debridement to not be visible on the CT scan. My guess is one of two things. One is that the infectious bacteria had formed a cyst(s) that attached itself to this branch or bundle of nerves and when removing the cyst the nerves were intricately connected to it. Or.... was tooth #18 previously root canaled? If so, then the OS may have found necrotic nerve tissue that had been pushed through the root tip of your tooth during the root canal procedure. Another thing that can occur is inflammation from the infection can irritate and inflame surrounding tissue and nerve bundles which can eventually cause these things to take on a new life of their own. I'm sure if you asked him, he would be more specific about his findings. Or you could request the surgical report.

I am very glad that you are experiencing a decrease in the tingling sensations.... yes that is a good sign and hopefully you will have a complete and healthy recovery from all of this.

The descriptive description of your "slots and and mini caverns" can be scar tissue from the multiple surgeries, incisions and various sutured areas. The gum and lower cheek tissue that has been cut can heal lumpy or smooth... depends on the individual. Some people are more prone to developing scar tissue more so than others. Is the OS concerned about these slots and caverns? What does he say about them for the long term? Generally the gum and cheek tissue calm down as the area heals more thoroughly. There has been a lot of traumatic action in that area of your mouth so I would expect it to be a bit lumpy and uncomfortable for awhile.

Some of the symptoms that you have can also be nerve related which hopefully will go away completely. Does the OS have you on any restrictions with food, oral hygiene, yawning... anything? Has he suggested that you exercise your jaw or that you keep it quiet, so to speak ?

Hello Bryanna & her infinitely helpful dental wisdom,

Thank you for the reminder as to when the test results should become available; I'll mark it on my calendar to give them a call. I just hope that I remember to look at my calendar!

I value your feedback regarding my OS. To be honest, he is a very kind, thorough, semi-shy, inquisitive surgeon. He always takes a few moments to think through what might actually be going on with my situation.
His analogy is that its similar to how a person would dissect a puzzle. He mentioned that of his 30-35 years in the OS field, he has had only 1 patient who had to undergo 3 surgeries for the original issue that had brought them to him in the first place.

I feel bad because it seems that he is "cleaning up" OS1's original mess from January. I give him a ton of credit; he's never complained that I wasn't his patient, asked me to go back to OS1, etc.----rather he's stepped up to the plate and is doing his
absolute best. I appreciate him.

To answer your question, yes the molar had been crowned a few years ago. Unfortunately, the tooth fractured under the crown and the dentist discovered the infection between that molar and the horizontally-positioned wisdom tooth. Then it was off to the OS.

I'm sure that if I asked the OS about the details of his findings, he'd try to share what he could before I began crossing my eyes. lol You mentioned the surgical report; I've never seen one before but if I were to guess, it's a review of what took place during the surgery.
Maybe even before and after? Man, I feel like such a lay person.

Slots & Mini Caverns; sounds like a board game. lol At my appointment, the OS only looked into my mouth. He didn't put on gloves, poke around or anything. He only looked---and said that it looked good. We didn't go into any in-depth discussion regarding pain, restrictions,
exercises, etc.---he did want details regarding the numbness and tingling changes that had taken place. He seemed very curious about those things. I have the distinct feeling that his ultimate goal is to get the area healed up once and for all. That would make two of us!

He asked how long it took for the bad tissue to reemerge after the previous debridement and I told him it was 3 weeks. So----he (we) seems to be patiently waiting to see what happens. He did say that if he has to go in again, I'll have even more scar tissue. When he said that,
I think my darn eyes began to cross.

On a side note, the left underside of my tongue started to ache yesterday evening. I hadn't experienced that before now. Also, I am having some pain come around the front of my upper chin and into my lower teeth. That feeling is familiar---I had pain in that area before
I saw the dentist in January. As I'm typing this message, it occurred to me that I ought to keep notes on what I am feeling and where---am I on the right track? It would be helpful to be able to hand my notes to the OS if he wants location details regarding pain and discomfort.

Thank you for listening. Time to let the dogs out. Have a great evening and thank you, Bryanna. ~Laughter

Hi Laughter........

Your OS has performed a lot of oral surgery in his lengthy career and no doubt he's had to repair quite a few "mishaps" over the years. I think he's had more than one patient who required 3 or so surgeries to take care of the original problem but he wants you to be optimistic and he's hopeful that this has taken care of the problem. I agree with you, he is trying very hard and being very diligent with your care. His analogy of dissecting a puzzle is so accurate because that is exactly what he has to do when he goes in to clean up the area and it sounds like he has tried to put you back together as best as he can.

You are right..... this surgeon is cleaning up what the other guy left behind as well as the formation of the new mess caused by the original one. But believe me, he has done this countless of times in his career. I feel badly that you have endured such unnecessary dental trauma and infection but I am SO glad that you did not stick with that original dentist!!

The surgical report is the notes dictated or written by the dentist or his assistant. It gives an accurate and detailed synopsis of the pertinent information pertaining to the procedure. It's a part of your records.

I think it is a good idea to make a journal of this entire experience and it would be helpful to include a daily entry as to what new or different symptoms you are experiencing. Include dates and meds starting from the time it first began because not only will it make some things very clear to you but you may need to reference back to what's taken place at some point in the future. So rather than guess ... just journal it all and keep it with other medical papers.

When you see him in a couple of weeks, you can look at your journal (;-) and explain what has taken place since you last saw him. He will then may be able to offer you some helpful or insightful suggestions.

He wants to avoid going in again, believe me. But he knows how important it is for you to heal completely.

I would not be surprised if you experience some odd discomfort, pain, weird sensations as you go along because there is so much repair going on in that pie hole of yours!! I would not dismiss anything that you feel, I would make note of it in that journal you are keeping (;-) and even make note of when you feel these things. Like when you are talking, chewing, sleeping,,,,,, doing nothing. Be mindful if you are clenching or grinding your teeth as either of those things can cause all sorts of pain in various places in the mouth, jaw, head, neck.....

That tight or pulling feeling that you feel when you move your mouth a certain way could be from the way he had to suture the inside cheek tissue. Pay attention to that and make note (!!) as to the severity of that, even note if you are feeling it less and less or only at certain times. All of this is helpful in understanding what is happening and can be useful information at some point down the road. Not necessarily in a bad way, but in a good way!

Thanks for sharing your dental saga with us and for keeping us informed of your progress. Keep on laughing and no matter what, stay focused on the positive!!

~~~~~ ~'.'~~~~~

Hi again Bryanna,

I hope that this post finds you having a pretty nice week.

I would like to ask for a bit of your constructive guidance.

My follow-up appt to see the OS is this Saturday. Every time I see him, we
Have a certain amount of time to discuss matters and the appt is over in a heartbeat.

I have several different issues that I want to share with him---and it's important that I explain my symptoms thoroughly.

What I am trying to say is that I am worried about having such a small amount of time to explain the several issues that have taken place since my last visit---along with answering his many detailed questions. I don't want to leave his office feeling that I didn't explain things clearly...or that I left something out by accident because I was in a rush.

What would be the most effective approach on Saturday; to have everything written down in detail for him to review...or to have a basic outline of what's been going on? Either way, he'll have his questions, but for everyone's sake, what would be the best route to take?

I forgot to mention that I begin to stammer & stutter (minus any spitting) in these types of situations; even my pie hole refuses to cooperate and just blurts out sentences that don't quite make sense. Kind of embarrassing to be speaking in tongues in a doctor's office, but it is what it is, right?

Thanks for reading this message. I apologize ahead of time....lol.

Take good care, Laughter