I am new to this site. Someone on the New Member forum recommended that I post here also on this dental forum also.

I had an upper molar tooth extracted (it was complicated - did not come out in one piece) on Oct. 2 by a periodontist. He also placed an implant in that spot on the same day. At day 10, I was in pain and saw a different periodontist who said an x-ray of the area showed bone loss. He had me come back every 3-4 days for an x-ray and by the 3 week point, he said the bone was looking better. However, I was still having constant pain and a squeezing feeling and feeling like something was there that wasn't. Finally they removed the implant and did a bone graft in the area. Things got worse after that for about 1 week, then slowly started to get better, but now at the 6 1/2 week point, I am having problems again. I again now have a constant ache in the area, some soreness and maybe "burning," and what I think is some lack of sensation in the area - still feels like something is there that's not. I can feel pain inside my left cheek all the way up to the area where the implant was placed/removed with the worst pain at the extraction site. The pain gets worse when I lie down, bend over, and move around alot. Basically, I "feel" that side of my face all day.

I've been to a neurologist (per the periodontist's request) and he wasn't very helpful - just right off the bat, without talking much or examining me, he said that I had "jaw and nerve pain from the dental surgery," though he wrote Trigeminal Neuralgia on the receipt. I also saw an oral surgeon who did a full x-ray and said the bone looks good. The oral surgeon did not think TN was a good diagnosis as he said I would have much more severe pain than I told him I had.

I also went to see an ENT doctor to confirm I didn't have a sinus perforation from the dental surgery. He used a scope to look in my nose and said that he didn't see any mucous buildup and did not suspect sinus perforation, but to come back in 4 weeks (that would be this upcoming week) if the pain wasn't gone and he would order an x-ray of the nasal cavity.

I know that my mouth has been through alot these past 7 weeks, and I would expect it to take awhile to heal, but the hardest part is that there isn't clear agreement about what is going on at this point. The neuro says TN and the oral surgeon says no. Yesterday was a very bad day in terms of discomfort. Today isn't great, but not quite as bad. I have a high tolerance for pain, but one can only take so much.

The neuro did prescribe Neurontin for me, but I am very hesitant to take this strong med without a firm diagnosis and also because I rarely take meds due to the fact that I am very sensitive to them and have bad reactions and side effects.

I would like to know if anyone else has had similar problems after a dental extraction, implant surgery, bone graft, etc. I'm glad to have found this site and appreciate any advice and/or insight. Thanks.

Sorry to hear you are in such discomfort. Part of your discomfort may be referred from Myofascial Trigger Points (Knots on the muscles of mastication.
For example the masserter-superficial and the temporalis and others) both refer to the upper molars.
Take a look at this web page:
http://www.triggerpoints.net/_sgg/m1m1_1.htm

These musles can be treated by hands on therapy using pressure, ice and specific stretch.
Contact me if you would like additional information.

Also if you have TMJ/TMD I would look at any perpetuating factors like body posture...specifically
Morton foot structure -
The Morton foot structure (MFS) is a foot having, as its most prominent distinguishing feature, a second metatarsal head which is more distally placed than the head of the first. In other words the second toe is longer than the first. Do you shoes wear to the outside heel ?

If so, take a look at this web site: http://www.mortonsfoot.com/mortonsfoot.html

and http://www.mortonsfoot.com/tmjpain.html

You can make or by an insole to correct this problem.
Good Luck

Hi Imcat,
Your chronic symptoms sound like there may be an ongoing infection (perhaps osteomyelitis or something similar to it) that may only be detectable by doing a combination of diagnostic testing. I have seen countless bone infections that have invaded the sinus cavity and they kept getting overlooked by one dentist/doctor after another until finally someone did some thorough diagnostic testing. Some helpful tests would be:

Blood tests:
Complete blood count (CBC) - this test measures the size, number, and maturity of the different blood cells in a specific volume of blood to see if there is an infection.

Erythrocyte sedimentation rate (ESR) - this blood test measures how quickly red blood cells fall to the bottom of a test tube. When there is swelling and inflammation, the blood's proteins clump together and become heavier than normal. These are then measured as to how quickly they fall and settle at the bottom of the test tube. Basically, the faster the blood cells fall, the more severe the inflammation.

C-reactive protein (CRP) - this is a blood test that can help detect the presence of inflammation or an infection.

Other helpful diagnostic tests:
Bone biopsy - this is a surgical procedure where a small sample of bone is taken from the site of the extraction and sent to a lab to help determine if there is an infection in the bone and what type of infection.

Panoramic radiograph- this shows the maxillary and mandible in their entirety. It also shows some of the nasal cavity as well.

Radionuclide bone scans - pictures or x-rays taken of the bone after a dye has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities/infections.

Computed tomography scan (Also called CT or CAT scan.) - this is an imaging procedure that uses both x-rays and computer technology to produce a cross-sectional view/slices both vertically and horizontally. CT scans are more detailed than routine radiographs.

Magnetic resonance imaging (MRI) - this is an imaging procedure that produces very detailed images by using large magnets, various radiofrequencies, and computer technology.

I know this is a tough situation for you and it's hard to get dentists/doctors to cooperate. However, waiting this one out, may not be in your best interest if there is an infection present in the bone. I encourage our dental patients to be persistent in their quest in finding out what is wrong. It is not normal for you to still have pain in that area in spite of all of the trauma that has taken place UNLESS there is something causing you to have chronic inflammation which is what generally will cause the pain and discomfort. You may also have some nerve trauma from the oral surgery, either from the extraction, the injection, or the placement/removal of the implant which causes you to have that "burning" like pain and lack of sensation.

I could literally write a book on how neglectful our healthcare system is when is comes to diagnosing and treating oral infection. I have seen countless people suffer needlesly because implants were placed in infected bone. Be true to your gut feeling that's saying something is not right............ keep pursuing a diagnosis.

Please let us know how you are doing!

Bryanna

Bryanna: Thanks for the reply and helpful information. I am due for bloodwork this week, so that part will mostly be taken care of though I'm not sure the CRP test is included. I had a sinus cat scan this past week, so that will show the nasal cavity. The oral surgeon did a panoramic x-ray two weeks ago and didn't "see anything." I"m glad that I've at least got some of the tests you mentioned covered.

The good news is that the pain in my mouth does seem to be improving alot. I still feel a "weird" feeling - maybe lack of sensation way up in mouth, but it's not as bad either. I have a very mild ache, but it's not constant. The aching is usually only intensified if I exert at all. It does seem now to be some sort of nerve issue. I have been taking some natural supplements and things started improving right after I began taking alpha lipoic acid (which is often used for diabetic neuropathy).

I agree about the neglect in the system for treating and diagnosing oral issues. I find that to be true also with medical conditions - you go round and round in circles, and then have to take charge yourself or you are left out in the cold.

Thanks again!

Londa story, but can anyone give info on how to stop constant burning in my face and gums where implant was placed

Hi Pepginben,

How long ago was the implant placed? Are you sure it's a burning feeling? Could it be tingly like a feeling of pins and needles?

After the placement of a dental implant, there can be a temporary tingling sensation in the face, lips, and gum. But this feeling should go away completely within a couple of days post surgery.

Have you gone back to the surgeon for a post op appointment?

Bryanna

I had two front teeth on the upper left extracted almost 12 days ago. I had a course of flagyl. I currently have a scalded sensation on the roof of my mouth on that side almost from the center to the gumline. It has a bad sulfuric, salty metallic taste and the palate feels hot compared to the other side. I went to the dentist again this morning who took a bite wing and then another more extensive film further back that included part of the sinus. They said they didn't see anything. Something isn't right, though it isn't red and it isn't obviously swollen, but my tongue knows it isn't the same as it was and it is definitely puffy compared to the other (not much though).. there is a sense of pressure that kind of has a pulse to it.

I had a couple of days of the nerve hurting, but that is past.

I see an ENT tomorrow and plan to bring this up. Anything else might help? The extraction site is almost completely healed.

Hi TooTired,
Two things come to mind, one, did the dentist place any graft material in the extraction site and was there any sinus exposure during the extractions? Did he take a panoramic radiograph today or just two spot xrays?

What have you been rinsing with since the extraction? If you are rinsing with salt water that's great, but the water should not be hot, it should be warm only. You should not be rinsing with anything other than warm salt water because any kind of mouthwash, even peroxide, can cause that scalding sensation to the tramatized tissue.

Is that scalding feeling new or has it been like that since the extraction?

It could be a neurological response to the oral surgery, but I don't think you would have a sulfuric, salty metallic taste if that were the case. That generally is indicative of an infection and the salty often means sinus involvement.

Keep us posted on what the ENT tells you. I sure hope it's easily remedied!

Bryanna

I will post again tomorrow after my appointment. No material was placed in the socket, the dentist took two spot xrays although the second extended further into the roof of my mouth and went further toward the back.

Been using lukewarm salt water only, and the salty yucky metallic taste is new since the surgery. I asked if I needed to be back on antibiotics and was told since he saw nothing "no", just to watch it.

Can front incisors extend into a sinus?? I had a feeling in the floor of my nose on that side like there was a sore there after the extraction (but there wasn't). And it still feels kind of raw.

Hi TooTired,

A panoramic xray is unlike a spot xray in that you stand or sit in front of a machine where the camera goes completely around your head. The radiograph shows the upper and lower jaws in their entirety and the sinus cavity along with some other anatomical structures. This is the only type of dental radiograph that will show an accurate view of where the floor of the sinuses are in relation to the roots of the upper teeth. It would show if there was a sinus perforation from an extraction.

Your upper incisors can affect your sinuses depending on your anatomy and/or the biological condition of those teeth and surrounding bone. Infection in those teeth can spread to the sinuses which would cause an opening of the sinus during the extraction. If the upper incisors get root canaled and the instruments and/or gutta percha (filling material inside root canaled teeth) gets pushed through the end of the root into the sinus, then there would be a sinus perforation and ultimately an infection in the sinus.

Treatment will solely depend on what the problem is. Antibiotics may or may not be enough.

Please let us know what the ENT said today!

Bryanna