I've been reading this thread for a few months now--am living through a dental nightmare, as it seems are many have who post here. I'm hoping for some advice regarding what to be alert to at this point as my situation is still unfolding. Until last summer I would say I've had very good dental health, and have practiced very consistent dental hygiene, so I have records (X-rays etc) to document that until recently I didn't have any chronic dental problems. Here's my scenario:

In July 2014 I developed a toothache on the upper right side of my mouth. My dentist (biological) took X-rays and pulp tested tooth 2, 3, and 4. All the teeth were alive, and no decay was visible on X-ray. I did have a gold filling in both 3 and 4. I was advised it could be sinus-related, was treated with Amoxicillin, ozone, and a laser. On day six of the TX, I had a reaction to the Amoxicillin and was advised to discontinue it. I sought a second opinion from another biological dentist and he repeated the pulp test, looked at the X-ray, and concurred with the approach. The toothache resolved.

In October 2014 while traveling, I had a second toothache and abscess in the same area. I went to a dentist in an emergency and he pulp tested 2,3, and 4 and took an X-ray. Tooth 3 was dead. He lanced the abscess. I wanted an extraction but he insisted an RC was the better option. I consented. After the RC, I was advised that the tooth was cracked and might need a second root canal by an endodontist.

In mid-November 2014, after returning home, I consulted with my biological dentist about the RC. He looked at the X-ray from October, did an exam, and advised extraction of #3. He was willing to do the procedure but only if I didn’t fly for two weeks. I was preparing to move in a week so I opted to wait until after the move.

In December 2014 I established care with a new biological dentist after moving. He reviewed the X-rays from October, did a visual exam, and advised a mouthguard. He did not take any new X-rays or pulp test any teeth.

In January 2015 I returned to get the mouth guard. I asked about extracting tooth #3. He advised waiting to see if the mouth guard would calm things down and suggested I schedule an extraction a few months out. He did not take any X-rays or pulp test the teeth at the time of this suggestion. I signed a consent in January for extraction, and scheduled it for late March.

On the day of the procedure (March 2015) I told him that I thought I was getting another abscess above #3—as I had recently returned from a trip to San Francisco and flying seemed to have upset things. He did not ask any questions about my symptoms, nor did he take any new X-rays, nor did he pulp test tooth 4 or 2. He extracted #3. After the procedure I asked his assistant if #3 had been infected and she said “yes. That is why you felt all that scraping. He was cleaning it out very thoroughly. “ I asked if he was prescribing antibiotics, and she said “No. He doesn’t like antibiotics.” The assistant gave me a clove oil substance to squirt on the extraction site for pain and cleaning. I had to ask for Tylenol before leaving. There were no written aftercare plans.

The next day the dentist called me to follow up, and I asked about pain meds and antibiotics and was told they were not necessary. The following week I returned for a follow up. When I reported that I was not feeling well, the dentist's response was “that’s probably just the healing process.” He did not ask me any other questions about my symptoms, nor did he take any new X-rays or test any other teeth. He glanced in my mouth for about 10 seconds, said, “Well, it looks a little pus-sy, but I’m not going to over-react.” He then snipped out the stiches, said “just put a little extra clove oil on that and come and see me in 3 months” and left the room.

The next day, I felt very flu-like and by 11 pm my lower right leg was going numb. I went to the emergency room. They evaluated me for a blood clot in my leg, noted that my tooth extraction site appeared infected and recommended that I discuss AB TX with my dentist. I placed several calls to the dentist's office and got voicemail. I didn’t leave a message, assuming that at some point I would reach a live person, but I was unable to do so.

Friday I was ill with flu-like symptoms. Late Friday night/early Saturday morning (4 am) I called the dentist's office and was referred to the dentist on call. I relayed my symptoms to him, told him what the ER doc had said the day before, and stated my concerns about not having antibiotics. This dentist stated “Look, we are conservative in biologic dentistry but if you have an infection we HAVE to treat it.” This was the first time I had heard that a dental infection REQUIRED treatment. He offered to prescribe antibiotics over the phone but I opted to return to the ER because by that time the right side of my face was swelling and I was in severe pain. The ER doc diagnosed cellulitis in my face, an infected tooth extraction site, and prescribed pain meds and clindamycin.

The following Monday, feeling even worse, I requested a referral to an oral surgeon from the dentist who extracted #3. The OS took X-rays on the first visit, did an exam, and recommended watching to see if things would improve. They did not. A week later she suggested that #2 might be cracked. She referred me back to the original dentist's office for concurrence. The doc who was providing care at that point (not the one who pulled #3) took a series of X-rays and pulp tested tooth #2 and tooth #4. (This was the first time any diagnostic images or exams had been done of my mouth since coming to this office in December.) Based on the pulp test, tooth #2 was dead. According to the dentist I saw at that point, there was a black area above #2 on X-ray (cone beam) that according to him, suggested it had been infected for at least 3 months.

I had#2 extracted by the OS the following day and was put on a second course of clindamycin. I was unable to work the rest of the week due to the pain and swelling and spent six days in a dark room with ice on my face praying for this to resolve.

In late April 2015, as the surgical sites appeared to be healing, I developed shortness of breath. I returned to the OS, who referred me to my PCP for a chest X-ray. Upon hearing the full story of what had transpired, my PCP ordered a full battery of tests, including blood cultures (which were negative at that time) and an echo-cardiogram to test for bacteria in my heart valves. I continued to get worse, with shortness of breath, high blood pressure, and pain in my right chest area, right shoulder, and right arm. In May 2015, I was transported to the ER (my third ER visit) with a BP of 188/145 (my BP is normally 110/80). A CT of my chest revealed a nodule on my right lung, another one on my thyroid, and enlarged lymph nodes on my left side of my neck. I was referred to Cardiology and Pulmonary medicine for further workups, all of which have come back normal (thankfully). Throughout May, pain and tenderness in my mouth continued, along with severe aching in my right shoulder, arm, and chest, a low-grade fever, and general malaise. At a certain point, the OS told me I needed to be worked up for auto-immune issues, as none of this had anything to do with my teeth, so being a compliant patient, I did this: all tests were negative, at which time even my PCP began to act like I was a psychiatric case.

In early June, my face began to develop a severe redness on the right side, to swell again, and the pain increased in my right sinus, along with reddening and mucus in my right eye in the mornings and marked stiffness and congestion on the right side of my neck. In desperation, and not wanting to deal with the dentist or the OS again (both of whom seem to be circling the wagons for their colleague who pulled #3 at the outset of this mess), I went to an ENT. He did a CT with contrast and a culture of the extraction site (which is still unhealed) and diagnosed osteomyelitis. He put me on a course of Ceftin (500 mg 2x a day) with plans to follow up in a few weeks, at which time he will decide whether or not to debride the area.

When I reported the ENT diagnosis to the dentist who is treating me at this point, his response was that ENTs often confuse healing with bone infection and that I should think carefully about another surgery. He suggested that perhaps the second graft is being rejected (both were grafted with cadaver bone). When I took the results to the OS, she started off by lecturing me (again) about 'normal healing' and then, when she looked in my mouth she changed tack and insisted I come in the next day for debridement: however, when I objected to that on the grounds that she hadn't seen the CT (her office staff couldn't open the disk) she stated that she wanted to follow up after seeing the scan. However, after seeing the CT, she relayed that she thought things "looked normal" and that other than continuing on the AB, nothing else needed to be done for the time being.

At this time, I am operating at 10% of my normal energy--the pain in my face and mouth is being held at bay by 500mg of Ceftin 2X a day--and I have a sense that both the dentist and the OS are just trying to get rid of me. In contrast, the ENT doc seems genuinely concerned--he told me he will probably need to debride the area, but first he wants me to complete 2 weeks on Ceftin while he consults with an infectious disease doc.

So, after all this background, here are my questions:

It seems to me to be at least possible that #2 was dead before #3 was pulled. If so, it may have been the source of a LOT of bacteria during the 11 days that I walked around with an untreated infection and an open extraction site in my mouth. While I will never know since the dentist who extracted #3 did not do any X-rays or pulp tests, if this had been the case, what is the likelihood that my sinuses are now infected, and are driving this ongoing illness? Is there anything else going on that could be causing these symptoms to recur? What, besides potential debridement, should I be asking the ENT to consider? Are there any other specialists I should be bringing into the picture? (I have a great ND and have been doing liver cleanses, getting Myer's cocktails to sustain my energy, taking probiotics and other supplements, and being very careful about my energy output.)

I am desperate to be well again. Any thoughts would be appreciated--especially from Bryanna--who is clearly very knowledgeable about these types of situations--but I am also open to hearing from anyone else who has been through something similar.

Thank you, in advance.

Hi friendlyd52,

Oh my goodness.... you have been on a horrible journey but I am so glad to hear that you are health conscious and under the care of an ND. Biological dentists have a broader knowledge of the oral and systemic connection but as with most dentists, they often back each other up like a pack of rats. Especially when the dental issue is complicated.

A few things instantly come to my mind....

1- Do you have a clenching and/or grinding habit? In someone who has a healthy dental history but has cracked or fractured teeth it tends to indicate a bruxism habit. This can cause minor or major cracking of the teeth, inflamed periodontal ligaments, abscesses, tooth mobility, unnatural wear patterns on the teeth, misalignment of the bite and even TMJ issues. So if you do have a bruxism habit, then it needs to be evaluated and addressed.

2- Tooth #3 (and most likely #2) was evidently cracked long before it was diagnosed. Initially the crack is a crazing line and does not pose any problems. But if and when that crazing line becomes deeper into the dentin of the tooth, bacteria is able to get into that opening and make its way to the pulp. This tooth would test vital until the pulp becomes infected. At which time an abscess is likely to develop.

3- Root canal therapy simply adds insult to injury in a cracked tooth. The procedure itself is very traumatic and injurious to the tooth causing the crack portion to become more fragile. Add to that the toxicity of the disinfectants and the filling material..... you get the picture.

4- It sounds like the dentist who removed #3 debrided the site and bone thoroughly. Antibiotics are not always prescribed for extractions and he obviously didn't feel it was necessary at that time. I wonder what his findings were when he extracted that tooth... did he mention anything about the tooth being perforated through the apex during the root canal and that there was root canal filling material pushed beyond the apex? Did he mention anything about the sinus or a sinus communication? What were the surgical findings with tooth #2..... the black area on the xray was a cyst, was it removed? Any mention of a sinus communication with that tooth?

5- Bone grafts are very beneficial when they are placed in healthy stable bone as they encourage the growth of new bone cells. However, they are not useful and can be detrimental when placed in unhealthy bone. So I wonder if the either or both sites, #2 and 3, were not stable enough to receive the graft and if this is contributing to the infection??

6- Cellulitis is a serious condition and can spread to the lymph nodes and blood stream. Osteomyelitis is also a serious condition. So no wonder you feel so lousy!!!

7- What is the outcome of the nodules that were found on your lung and thyroid? Do you have any auto immune disorders?

8- Regarding the dentist comment about the ENT mistaking bone healing with infection... if the culture came back osteomyelitis, then there is no mistake, it is infected.

9- There are some considerations about re surgerizing the areas of which are too complicated to get into here. However, your systemic symptoms indicate a serious infection. Oral antibiotics may or may not be sufficient. They also will lower the effectiveness of your immune system so you can feel worse before you feel better.

10- Perhaps your best option is to stick with the ENT and encourage a consult with an infectious disease specialist. Also ask the ENT and ID Dr for a referral to an oral surgeon that they are familiar and comfortable working with. Because you may need complemented care from all of them.

11- It would behoove you to request all pre and post op xrays from all dentists and the surgical notes of every dentist that performed surgery and root canal therapy on you. It would be helpful to see what the written findings were so that the ENT and ID Dr have some clarity on the history of that area of your mouth.

Hopefully your ND has encouraged you to eat healthfully and organically, avoid sugar, sugar substitutes, processed foods, soft drinks, alcohol, etc. Your nutrition is imperative during this time and diligent supplementation of probiotics is essential for the health of your digestive and immune system.

Check back when you can..... not sure how much I can help but I want you to know that you are not dealing with this alone.

Bryanna,

Thank you SO MUCH for your thoughtful observations and especially for the emotional support. This experience has been absolutely devastating, and it really helps to hear your perspective. Thank you for your generosity in both time and insight! Since I'm new here, I'm going to try to reply by highlighting my text after your questions--if that doesn't work, I'll repost. Here goes:


Thank you so much Bryanna. Your support is enormously helpful--what a godsend you are. I have always had great dental care, and I have never had an experience like this...so it very helpful to have your insider POV. I have read many of your posts and they are all very helpful in terms of providing insight and a sense of hope.

I will keep you posted--and thanks again!

friendlyd52,

Thank you for the detailed reply, it was most helpful.

The area of infection above the tooth that oozed pus when pressed on is called a fistula. This is typically seen with infected and with root canaled teeth. The fistula is the end of a tract of infection that has burrowed a path from the tooth, through the bone and out the gum. The fistula on the gum is the outlet from where the infection is draining from the cyst that has formed in the bone at the apex of the tooth. Unfortunately, this path of infection can be difficult to eradicate completely because it hides in the nooks and crannies of the bone. So it is imperative that when the infected tooth is removed, the bone is debrided thoroughly to remove as much visible disease as possible. Bacterial cultures can be obtained at the time of the extraction and sent to a pathologist for testing. That result helps diagnose issues that are not otherwise visible and also determines the proper antibiotic to be prescribed for the specific bacteria that is lurking in there. Unfortunately neither of those steps are routinely performed when extracting teeth.

The more details you offer, the more it sounds like there is some sinus involvement. I really think it would ideal to have on board... the ENT, an oral surgeon and an infectious disease specialist.

It also sounds like you do have a bruxism habit that you may not be aware of most of the time. Teeth are the hardest substance in the body. So for a healthy tooth to fracture, it has had to undergo some tremendous force. The amount of force your body can produce by grinding your teeth while awake is about 250 pounds per square inch, about 800-900 psi when sleeping and about 2000 psi if you take anti depressant or mood altering meds.

I recently came upon this very informational video about muscular related TMJ issues. You may find the information interesting...
https://www.youtube.com/watch?v=Q0xkJNF0l_E

I can understand why the pathologist was reluctant to culture the specimen that the ENT took from your graft. It most likely was contaminated because in order to take a clean specimen, he would have to open up the area to retrieve it rather than swipe it. If he does do the debridement then I assume he would remove the graft because opening up the site means letting in contaminants which disrupts the sterility of the graft. Be sure to get clarification about what his treatment plan will be before you do anything.

Glad to hear that you are eating a clean diet and cleansing your system. Are you noticing any improvement in how you are physically feeling?

Bryanna,

Thanks for the additional information. As for whether I'm feeling better, unfortunately, I have to say no. I feel like I have the flu--and this weekend the cellulitus flared up again, along with a super tender right sinus just above the infected extraction site and around my right eye. I could have fried an egg on my face. I took a panoply of nsaids yesterday and spent the day in cool dark room with ice on my face--today it is less hot and red.

What's confusing it that when I called to report this, instead of scheduling me to be seen sooner (i have a 2-week follow up this Friday) the doc wants to continue the Ceftin for 2 more weeks (current script ends tomorrow) and push out the follow up for at least one more week--in his assistant's words, "to get things under control." Does this make sense to you? From my patient's POV it's very counterintuitive...if things aren't better or at least stable after two weeks, doesn't that mean the TX needs to be readdressed? The assistant also told me that the culture "didn't reveal any surprises" though she wouldn't tell me what was in it--but I'm assuming this means Ceftin is the right thing to be on...but maybe 2 weeks isn't enough time to make a dent (?). I did press for a sooner appointment, and the assistant scheduled me to see the doc tomorrow, in her words, for "reassurance." And maybe that is all I can expect at this point--reassurance.

I am also considering hyperbaric TX or IV ozone--I live about 90 minutes from the Canadian border, and those treatments are available in Canada. Do you have any experience with either, or know of people who obtained relief/healing from using these approaches?

Hi friendlyd,

I am glad that you were persistent with the dental office and will be seen tomorrow! Good for you.... !! :-> From my POV, I find it very careless for him to prescribe another round of ceftin without seeing you. With that said, you probably have been squeezed into his schedule so he may try to be very brief with you. If you find that to be the case, please keep in mind that you are his patient just like everyone else waiting to be seen. He has rendered treatment to you and legally has to take care of you OR refer you to someone else who can. Be mindful of his busy schedule and have your questions and concerns written down concisely so nothing goes unspoken. But also expect his undivided attention when you are in the chair.

Regarding the second rx of ceftin.... another round of it may or may not be advantageous. I hope when he sent the biopsy to the pathologist that he also had it cultured because that would determine what the proper antibiotic should be. As far as the receptionist saying the results didn't reveal any surprises.... that could mean any number of things but it generally means as with all root canaled teeth, this one is not going to have been without problems. Please request a copy of the pathology report. It behooves you to have that record in your possession just in case you have complications with this or your sinuses down the road.

I am familiar with ozone and HBOT therapies. Both of which can be extremely helpful but they need to be administered as per the individual needs and at the right time. Meaning, the persons overall health, meds, etc are taken into consideration and the diagnosis and severity of the problem should be determined first in order to proceed with either of those things.

I have witness remarkable healing from both ozone and HBOT ... but also just the opposite when it was given carelessly.

Please make a list of your symptoms, concerns and questions before you see the OS tomorrow as this will help you sort through everything and make it easier for him to get the picture. He should also take an xray of that area to help rule out undiagnosed pathology.

Please keep us posted... I really hope you have a better nights rest tonight.