Hi Laughter!!

How is your pie hole feeling??

First let me tell you that it is not uncommon for dental patients to stammer and studder their words..... spit, sweat and even physically shake all over when in the dental chair. Those of us on the "other" side of the chair are very use to all of that and can usually decipher the garbled words. With that said.... some dentists will try to make the appointment very short because they know how uncomfortable that patient is and they do not want to make them sit any longer than necessary. So it is best to have all of your concerns, etc. written down so that you can review them with him. Keep in mind that this is your appointment time and your concerns are important. As a matter of fact, you can begin the conversation by saying....<< I have some concerns that I want to ask you about and I even wrote them down so that I don't take up too much of your time.>> This shows the dentist that you are concerned and need his attention. He may ask you to read it to him or he may want to read it himself. So just prepare the notes with the facts and what you feel is pertinent. Make sure that you and the dentist address every item on the list. So bring a pen to jot notes down next to your concerns

The best way to come up with a list of things......
Write everything down. Then go over what you wrote and see where you can condense it without leaving out the facts.

When in the chair, do not be concerned about the time. Just focus on going over your concerns and getting a clear response from him. You can cover a lot of stuff in a short amount of time if you are well prepared :P

If there is anything you think I can help you with here, let me know. Or if you need me to explain that further....just holler :-0

Temp

Hi Bryanna,

I hope that you're doing well. I wanted to bug you and update you on
My pie hole saga. 😁.

Saturday I went to see the OS. He made a comment about having removed
A root tip during the last procedure. He examined the area and said that he was happy that it's healing and that it would take another 2-3 months to finish up. When I asked what the culture results were, he said that he didn't do one "because there wasn't any pus present." I am disappointed that he skipped the culture; I just wanted to make sure that there wasn't anything to worry about in my ol' cavern.

I did get a copy of the biopsy results. Here they are:

Clinical History:
Pre-operative diagnosis; Granulation tissue

Gross description:
Source of specimen: area #17
The specimen consists of a 2.2 x 2.2 x 0.3 cm aggregate of tan-gray hard bone,
Tooth and rubbery tissue. The specimen is filtered.

Diagnosis:
Area 17 (after decalcification): sub acutely inflamed granulation tissue, fragments
Of vital and non-vital bone and radicular tooth fragment.

He was glad to look over the list (a very condensed version) that you had suggested (thank you!). It was a luxury for him to have most of his questions answered.

I listed several things, among them being that I'm having occasional tingling on the outside of my cheek; there are varying levels of pain from my lower lip down to my chin (from feeling a little uncomfortable and "bloated (lol), all the way to where the pain gets so bad in the lip/chin area that my bottom teeth ache as well. I told him about the "cramps" under & on the side of my tongue; and I described the deep ache I get down in the surgery site (would that be considered my surgery hole? Lol) all the way down my neck. Come to think of it, my neck hurts where the lymph nodes were acting up earlier on...

The OS said that he wasn't an expert in whatever is going on and he wants me to see a doctor involved in pain management. He said that he would call my Internist, explain what's going on and ask him if he can refer me to the right specialist. End of visit.

OS left a voice message yesterday. Said he was having a hard time getting through to my doctor and that he has not been able to get him on the phone. He also said that he wants me to see a neurologist---and that he wants to see me in a month for follow-up.

I called the OS's office today, made an appointment for a month from now and asked that they leave a message that I had received his message and will call my doctors office on Monday, since they are closed Friday-Sunday.

I'm not sure how all of this will fall into place, but somehow, some way....I will get through to my elusive Internist and follow his lead regarding him speaking with the OS, deciding on a pain management Dr., a Neurologist, all the above....

Bryanna, am I getting close to the finish line with this whole experience? Do you have any wisdom/viewpoint that you're willing to share? I am all ears........and all pie hole.

Have a terrific weekend. As always, much appreciation. Laughter

Hi Laughter,

Nice to hear from you and your pie hole ;-0

I'm miffed that he didn't do the culture too. Ugh.... what can I say :/
But thanks for posting the biopsy report!

<<Pre-operative diagnosis; Granulation tissue>>
OKAY, MAKES SENSE.

<Gross description:
Source of specimen: area #17
The specimen consists of a 2.2 x 2.2 x 0.3 cm aggregate of tan-gray hard bone,
Tooth and rubbery tissue. The specimen is filtered. >>

THE BONE TISSUE IS TYPICALLY TAN AND GRAY. OBVIOUSLY THERE WAS A PIECE OF TOOTH REMOVED WHICH WAS PROBABLY WEDGED IN PRETTY DEEP AND HE WAS ABLE TO REACH IT WITH THIS LAST DEBRIDEMENT. RUBBERY TISSUE.... IS CONNECTIVE TISSUE THAT HAS A RUBBER CONSISTENCY AND CAN BE FROM REPEATED SCRAPINGS, INJURY, WEIRD HEALING.

<<Diagnosis:
Area 17 (after decalcification): sub acutely inflamed granulation tissue, fragments
Of vital and non-vital bone and radicular tooth fragment.>>

OKAY, SO YOU HAD INFLAMED TISSUE AND BOTH DEAD AND HEALTHY BONE AND THAT PIECE OF TOOTH. OTHER THAN THE TOOTH FRAGMENT, IT IS TYPICAL TO FIND THE BONE IN THIS CONDITION AFTER TOOTH EXTRACTION AND REPEATED SURGERIES. SO HOPEFULLY THE BONE IS HEALING BETTER NOW THAT THE IRRITANTS ARE REMOVED!!

<< I listed several things, among them being that I'm having occasional tingling on the outside of my cheek; there are varying levels of pain from my lower lip down to my chin (from feeling a little uncomfortable and "bloated (lol), all the way to where the pain gets so bad in the lip/chin area that my bottom teeth ache as well. I told him about the "cramps" under & on the side of my tongue; and I described the deep ache I get down in the surgery site (would that be considered my surgery hole? Lol {{ YES!!}}) all the way down my neck. Come to think of it, my neck hurts where the lymph nodes were acting up earlier on...>>

IS THE AREA NEAR YOUR LYMPH NODE ON YOUR NECK TENDER? SOMETIMES IT CAN TAKE MONTHS FOR THE LYMPHATIC SYSTEM TO CALM DOWN ESPECIALLY WHEN THE IMMUNE SYSTEM HAS HAD TO DEAL WITH REPETITIVE TRAUMAS, MEDICATIONS, ETC.

<< The OS said that he wasn't an expert in whatever is going on and he wants me to see a doctor involved in pain management. He said that he would call my Internist, explain what's going on and ask him if he can refer me to the right specialist. End of visit.>>

THE OS CANNOT BE SURE OF WHAT YOUR CONTINUED SYMPTOMS ARE RELATED TO. HE KNOWS THEY HAVE SOMETHING TO DO WITH THE EXTRACTION OF THE TOOTH, THE REPEATED SURGERIES AND INJECTIONS... BUT HE CANNOT PINPOINT WHICH ONES ARE THE CULPRIT. HE SOUNDS LIKE HE'S HOPEFUL THAT YOU WILL RECOVER COMPLETELY AND PERHAPS SEEING A PAIN SPECIALIST AND YOUR INTERNIST WILL GET YOU THROUGH THE TIME PERIOD BETWEEN NOW AND COMPLETE HEALING. YOU JUST NEED TO BE CAREFUL ABOUT TAKING MEDICATIONS AS THEY CAN BECOME ADDICTIVE AND ARE USUALLY NOT WITHOUT SIDE EFFECTS. BUT IT'S IMPORTANT TO RULE OUT PATHOLOGY IN THE LYMPHATIC SYSTEM AND THEN PERHAPS MASSAGE THERAPY WOULD BE HELPFUL...?? THE TYPE OF CARE THAT YOU WILL RECEIVE FROM PAIN DOCTORS IS REALLY UP TO YOU. MEANING IF YOU WANT TO BE TREATED HOLISTICALLY, WITHOUT MEDS, THEN STATE THAT'S WHAT YOU WANT. OTHERWISE MEDS WILL MOST LIKELY BE THE WAY THEY WILL TREAT YOU.

<< OS left a voice message yesterday. Said he was having a hard time getting through to my doctor and that he has not been able to get him on the phone. He also said that he wants me to see a neurologist---and that he wants to see me in a month for follow-up.>>

YEA, TELL YOU DR TO GET WITH THE PROGRAM !! YES, FOLLOW UP WITH THE OS IN ONE MONTH, GOOD. HOPEFULLY BY THEN YOU WILL BE ALL BETTER!

<< I'm not sure how all of this will fall into place, but somehow, some way....I will get through to my elusive Internist and follow his lead regarding him speaking with the OS, deciding on a pain management Dr., a Neurologist, all the above......>>

THINK SERIOUSLY ABOUT NON MEDICATED ROUTES FIRST BECAUSE THE BENEFITS MAY BE LONG SERVING WHEREAS MEDICATIONS ARE NOT. NEUROLOGISTS GENERALLY DO THE MEDICINE ROUTE AS THAT IS USUALLY ALL THEY KNOW. BUT YOU COULD GO FOR THE CONSULT AND SAY... NO MEDS, OTHER OPTIONS.

<< Bryanna, am I getting close to the finish line with this whole experience? Do you have any wisdom/viewpoint that you're willing to share? I am all ears........and all pie hole. >>

I WANT TO SAY OPTIMISTICALLY ........ YES!! BUT I REALLY DON'T KNOW. I HAVE SEEN THIS SITUATION MANY TIMES IN VARYING DEGREES AND MOST OF THE TIME THE PATIENT ENDS UP OKAY. BUT IT IS BEST TO CONTINUE TO BE YOUR OWN ADVOCATE AND NOT JUST GO ALONG WITH WHATEVER IS PRESCRIBED. GET ALL YOUR OPTIONS SO YOU CAN DECIDE WHAT IS BEST FOR YOU.

We may have talked about this already, but my mind CRS sometimes. Are you into taking any homeopathy or supplements? Would you be comfortable seeing a massage therapist or biofeedback person?

Thanks for the update... thanks for hanging in there and keeping your humor about everything. I think it's helping you to cope I pray you will be just fine in no time and this will all just be a blur of an experience for you.

Hope you and your pie hole have a good weekend...... may the pain be gone........... !!!!

-------------------------------------------------------

Hi Bryanna!

How have you been? A belated Happy Thanksgiving, H’ween, Happy Holidays & Happy New Year!

My pie hole and I wanted to reach out to you to purge several dental-related thoughts & frustrations. I hope you don’t mind…I’ll jump to the present day situation...

It’s been 11 months since the 3rd and final pie hole surgery. I am so thankful to say that the surgery site itself is in great shape; my OS was able to once and for all get that area to heal. YAY!

On the flipside, I haven’t been as fortunate as I’d hoped with the facial nerve(s) healing. I still have issues on the lower left part of my face. From my lip down to under my chin & also on the inside of my mouth (backside of my lip (and space between it and my gums), the gum area and what feels like 2-3 lower teeth). I have constant numbness and tingly sensations in the area from my lower left lip down to under my chin and about an inch or so toward my cheek as well. Couple of quick examples: I can touch the side of my chin and the area beneath my lower lip tingles. When my toothbrush moves around on the left lower inside area of my mouth, I get wave after wave of numbness and tingling. My chin is itchy in one small area most of the time as well.

Worse than the above is the stinging that goes on with my lower left lip. It bothers me on and off, every day; I can’t tell how long it’ll last or what, if anything, causes it to flare up. The damn thing is bothering me right now---it stings from the front of that lip and surrounding area and it extends through to the inside of my mouth. It's accompanied by a burning sensation as well, which really hurts. I’ve described the pain that goes through my lower lip back into my mouth as a burning sensation which radiates right through to the teeth behind that area. Those symptoms also occur daily (or for days at a time) and the amount of time they are on a rampage varies; the symptoms I am having at the moment have lasted for well over 2 days straight.

I’ve given a name to the most evil of all symptoms---the holy muther zing. It’s a sickening, quick feeling of electricity-like zings/zaps that hit the area of my teeth, gums & lip. The zing freaking hurts (thus the name holy muther) and it also makes me feel as if I've bitten down on a piece of aluminum foil!!!! Man…makes my skin crawl!!! The zings happen without warning, lasting less than 10 seconds or so----and they drop into my daily life at east 3 times a day. After all these months of waiting for my nerves to heal and go back to normal, I'm beginning to lose hope that this will get any better...........I don't care where it's located, chronic pain and discomfort suck BIG TIME.

I want to mention that I began seeing an exceptional neurologist (at the request of my OS) to evaluate/treat the nerve issues in my pie hole. She has prescribed a couple of different meds that would theoretically help with the pain; the one med didn’t agree with my system (If I am remembering correctly, it caused intense gastric issues) and the other was a pain medication that I didn’t want to take for any amount of time. It might sound odd, but I had to give that exact same med to my old lab/coon hound dog and his dosage kept increasing over and over as time went on....

Besides the Rx med ideas, the neurologist recommended that I try an over the counter external cream on my face (I can't recall the brand name) when the area flared up. After giving the idea some thought it didn’t make sense to walk around with a tube of cream to apply to my face whenever I was having aches/pain---because it happens so frequently throughout the day and not to mention, the external layer of pain is just the first layer of many that freaking hurt. For a while I used Ambesol (I hope that is the correct name) to apply directly to the front of my teeth and gums located right behind my left lip. It helped numb the area, which helped, but after so much time, I stopped using it. If the issues were going to continue for x-amount of time, I didn't want to be ingesting that stuff day after day (also there was the possibility that these symptoms and damage could be permanent so I was curious about finding another way to cope).

A quick bit of candid background. My neurologist is super but there is sometimes a language barrier between us. I do listen closely to what she is saying and I do believe I understand her but I think she may have trouble understanding me and my "Pennsylvania, WV" expressions. Ex: the last time I went to see her, she asked how the issue with my facial nerves was coming along and I replied “things are holding steady”,meaning that they are the same as they were since my last visit. She seemed very pleased that I was feeling better, etc.---???---but it’s my fault that I didn’t take the time to try and rephrase my answer to her…. In all fairness to her, she wanted to review other issues that have arisen from the CT she had ordered for the facial nerve issues (severe stenosis in my neck), so the discussion regarding the face/mouth pain was only part of my visit. I know, I know, next time I go to an appointment, I will definitely clarify what I meant by that expression and I'll fill her in on any progress (still hoping) or not. She probably thinks that I suck as a patient being that I am not a fan of using Rx meds for pain...

I have developed a few different ways of handling my pie hole issues. One is that I bite down on my lip and space below it---similar to what you might do if you stub your toe---push on it because it hurts. I press my tongue against the inside of the lip area and below. I scratch the infamous itchy chin area when I can't stand it any longer and I try to get through the holy mother zings without making it obvious to those around me. Probably some of the neighbors/friends who I see from time to time think I'm turning into an orangatang; between biting my lip, pushing my tongue against the inside of my lip, scratching my chin and looking like I just chewed on a piece of foil... LOL

What's the old saying about either laughing or crying? Thank you for listening and reading my ramblings. I hope that you and your loved ones are doing great. ~Laughter

A quick P.S. My regular dentist said that she thinks some of my issues stem from the mental nerve.

Nerve injury is a known complication that occurs with molar extraction. Not much can be done once it happens. The healing process can be painfully long or permanent.

Hi Cleo, I appreciate your post.

A few questions come to mind---

At what point is nerve damage deemed permanent?

Are there ways to pinpoint which nerve(s) are causing an issue?

If so, are there tests available that could determine the percentage of damage that's taken place?

I'm thinking that if the above things are possible, then perhaps a "customized treatment plan" could be effective in relieving some of the pain & overall discomfort.

Thanks again and have a great day!

Laughter

The area in distress is the only indicator of which nerve is involved.

I just read your other comments here and i saw you were made aware of these risks and told by your OS that the nerve was seen during a 3rd attempted surgery to remove a root tip.

What nerve did they see.. did they say what condition the nerve was in?

Are you under treatment for the cervical stenosis?

Hi there Cleo,

So the symptoms can narrow down which nerve has been aggravated? How is it determined that someone is a candidate to have a procedure done to "fix" the nerve to minimize the daily aches/pains, etc.?

The OS had mentioned to me on a few of my office visits that he himself has facial numbness on one side (can't recall which one). I just assumed it was from having oral surgery---and I can sympathize with him because it feels foreign to have numbness, tingling, etc. in the face. Period. It feels as if you're perpetually recovering from the stuff they numb you with prior to having a cavity filled.

The OS did say at one point that there was a possibility of winding up with facial numbness but that he was going to do everything within his power to prevent that from happening. In an odd, kind of candid way, whenever he'd mention that he had permanent numbness in part of his face---it made me kind of think that he wanted me to realize that other people have the same issue and you wouldn't even know it......kind of like, hey, I have it as well. Again----that's how I felt when he'd bring up his numbness issue---he didn't explain it like that at all.
Regarding the aching, pain, zings, itchiness and so on---he never spoke about any of them as a potential issue. I think that if he had rambled off all those scary long term symptoms---I probably would have felt like running out the freaking door!!! Lol. Anyhow, I can only imagine being super-concerned and even more frightened than I already was because of everything that had been taking place. To be honest...even if he had shared the above, I would have still agreed to undergo additional surgery because what would my other choices be?

To answer your question about the nerve that the OS saw---I have no idea. I didn't think to ask which one it was, etc... I get a bit queasy during any conversation that include the topic of veins, needles, blood, and so on. When he brought up that he had seen my nerve---I had to keep from thinking any further about it. Lol. Even typing the last sentence just made my hands begin to sweat!
Now that you've asked..........I am curious which one he laid eyes on as well. . He didn't mention anything else about the nerve, including it's condition.

Regarding the stenosis. I have an order for physical therapy; the neurologist said that she wanted to begin with a basic treatment plan and then go from there, as needed. I'm looking forward to therapy---It'll be great to be able to help my neck area, even if I don't notice a difference.

Thanks for reading this post. Have a great day! Laughter.

It's the AREA of abnormal symptoms that dictates which nerve (s) are involved. I've been in a similar situation for several years. You should go back to that OS for a check up on the situation. A neurologist can only medically treat it and that's why you were sent there. I have heard physical therapy may help in certain situations.