Large tooth abscess spread to jaw (gulp)
 

Hi all,
Grateful to have found this forum.
A little back-story, which could serve as a cautionary tale.
Please feel free to skip ahead.
About 15 years ago I had only 1 small cavity on #19 molar
I managed to scrape the money to do the proper thing and go to the dentist.
I was shocked told that I had 14 cavities. Being more naive and timid then I did not ask to see the x-ray or anything but I knew enough to know this did not seem right.
So I paid for the x-rays but did not get the cavity fixed.
This incidence kept me from taking care of the cavity when it was small.
Finally about 5 years ago it had grown so large that I had to over come my issues and find a honest reputable dentist. Upon carefully examine my teeth it was confirmed I had only 1 cavity which was now quite large and he put a composite filling on it . My suspicions were confirmed, my previous dentist had lied when he told me I had 14 cavities.

Which bring us up to date.

Tooth #19 with the large filling gave some slight discomfort recently with mild soreness on my jaw line. The panoramic x-rayed reveled a large abscess under the filling the oral surgeon commented that the abscess had started eating away at the jaw. X-ray attached below.
The soreness on jaw line went away after I was given some amoxcillian and the tooth was pulled a few days later. I’m supposed to go in for a post op Monday and start taking Keflex (Cephalexin).
I have read quite a bit online about Osteomyelitis along with the info Bryanna has shared here. Some places say it’s very rare other sources say it is quite common. If this is in fact Osteomyelitis then is it “usually” successfully treated by oral antibiotics alone? I voiced my concern to my oral surgeon and he said there shouldn’t be any complications as long as I have a healthy immune system, which I think I do (barring the resent stressful events). I wonder if he’s not taking a aggressive enough approach in the treatment.
I’m not against the idea of IV antibiotics or even surgery as long as it will rid me off the infection. I have read that infections in the jaw are difficult to treat cause it hard for the antibiotics to reach that area but he seemed fairly confident the oral antibiotics would take care of it.
Only good thing to come out of this so far is I stopped my 2 cigarettes a day habit for good.

Any thoughts input would be greatly appreciated.


Jay

Hi Jay,

Thank you for posting the xray. It is a bit skewed but the area of #19 is very evident. I am going to assume that you interjected the comments on their describing the situation? If so, very clever ;)

Okay so yes #19 whoa infection! If this is osteomyelitis then you may require long term oral or IV antibiotics. Whether it is or not OR whether you do the long term meds or not.... this area should be monitored periodically with a periapical radiograph ad jaw bone infection can be difficult to eradicate even with additional surgery.

Yes, your immune system plays a part in this but your immune system is also busy dealing with whatever else comes along. So it is not reasonable to think a bone infection is going to clear up because the patient has a healthy immune system. Also, antibiotics (and other meds) compromise the immune system because in order for those meds to take effect, they have to reduce and destroy the healing cells that our immune system naturally produces to kill the bad bacteria.

On that note... if you are not already taking one ... you would benefit from supplementing with a probiotic. Do you know what that is? Do you want information on it?

Bryanna

hi Bryanna,

Thank you for your comments greatly appreciated.
Glad the comments I interjected helped clarify.
Yes, thanks I read a previous post in which you mention antibiotics. In your experience is the success rate pretty high with just oral antibiotics? I'll update on Monday after the oral surgeon.

Kind regards

Jay

Typo meant * probiotic :o

Hi Jay,

I have seen many patients with varying degrees of Osteomyelitis of their jaw bone. Some had oral medication, some had IV.... some had the combination of both at different times. I also have had patients who were diagnosed with Osteomyelitis by their orthopedic surgeon after having surgery on their spine, their knee, etc. I've had patients who had artificial joints fail due to Osteomyelitis. The commonality of "these" people were root canaled teeth, or long standing infected teeth and/or uncontrolled periodontal disease. So the theory was that the infection originated from their jaw bone and spread through the blood stream to a weak or compromised area. Some had compromised health prior to the orthopedic diagnosis ..... others did not.

There is no way to gauge if oral antibiotics will cure Osteomyelitis. I have known patients to become well after being treated. However, I also know patients who have had long term health problems associated with the infection. Lingering sinus problems are the most commonly seen with the upper teeth. Of course, if we lost touch with the patient or if they died, we never knew if their infection had been eradicated or if their infection was a contributing factor to their demise.

Osteomyelitis is a serious infection and needs to be taken seriously. Hopefully you don't have it!

The probiotic..... this is a nutritional supplement that helps to replace the healthy bacteria that are destroyed by the antibiotic. Once the intestinal flora becomes abundant with bad bacteria, physical illness will occur. Common ailments that are often the result of this are .... all chronic digestive disorders any place in the intestinal tract from the mouth to the ****, skin disorders, inflammation, fatigue, etc.

Bryanna

Thank you for such a through response Bryanna.
Hopefully since the tooth was removed it will make healing less complicated.

Many thanks

Jay

Jay,

You are welcome :)

Removing the tooth is always imperative and the first step in dealing with this type of infection. So glad no one tried to talk you into keeping that tooth!!

Wish you a perfect healing.... please keep us posted!

Bryanna

Thank you kindly for the well wishes Bryanna,

Actually the endodontist thought he might be able to save the tooth, that's what there trained to do I suppose.
Well I'm back from seeing my oral surgeon for a quick visit, nice guy. The site of the extraction is healing well.
Again I addressed my concern whether or not the extraction and the course of amoxcillian (which I just finished) would be enough to
wipe the infection that had made its way into my jaw. He said 99% of the time the extraction is enough to cause total healing. He compared it to
removing a splinter in a finger.
I asked if I could have another x-ray to help reassure myself, but he said a xray would not show enough changes so soon, and that a xray might be a good idea 3 months down the road.

Now I will start taking the Keflex as prescribed. I'm wondering if I should ask my regular Dr if he can write me a percription for Clindamycin or perhaps Penicillin
to take along side with the Keflex as a added precaution. I've read that Clindamycin is good with bone penetration.
Keflex seems kinda light weight considering the size of the abscess and its spreading to the jawline.

Is there anyway to confirm the infection is truly gone rather then waiting 3 months to have a xray?
Thanks for all your help. Hope to start a thread about emerging technologies on the fight against dental caries.

Best wishes

Jay

Hi Jay,

Yes, endodontists earn a magnificent living doing root canals and rarely explain anything about the risks associated with this procedure. I really hope that someday dentists will exchange their marketing statement from "save the tooth" to "retain the tooth". Big difference between the two!

Regarding the 99% comment by the OS about extractions being the cure all for bone infection....... he was being optimistic with you which is not a bad thing. But the percentage was a bit over zealous! The healing from removing a tooth that recently became infected or a tooth that had no infection but had broken down beyond repair is probably 99%. The healing from the removal of an infected tooth, one in which has infected the jaw bone is not in the 90 percentile. There are many issues that affect the healing and the patients overall health is a huge factor. His comparison between the tooth and the splinter makes me laugh out loud because I use that here and at work all the time when I explain the comparison between a root canaled tooth and a splinter in the finger. Both can be festering infections if the culprit is not removed!

He is right in that removing the tooth is imperative as this gives the immune system the opportunity to deal with the residual infection.

Regarding the antibiotic Keflex.... I don't know if it would be okay to take this with clindamycin or penicillin. You would need to discuss that with your OS and physician.

There is no real way to know if the site is healing in the bone or not at this point. It is wise to be aware of any unusual symptoms that suddenly occur that indicate a bacterial infection. Definitely get an xray at the 3 month mark even if all remains quiet. I would get another xray every 3 months for the first year to monitor the healing because it is always best to intervene early if necessary.

And yea.... by all means start a thread on the battle of tooth decay!!!

Take care,
Bryanna

hi Bryanna,

I really appreciate your advise. If there was a donate button I'd hit it now. I look forward to reading more threads here and your input.

Kind regards

Jay

Just to clarify it was extraction along with a course of amox.

Jay!

Request they add a donate button!!! Only kidding :)
Sometimes I spend more time on this site than I do with anything else! But I have the need to help and I know I scare the bejeebers out of people sometimes but at least I speak the truth!

I hope you will stay in touch with us here.... :)

Bryanna

hi Bryanna,

I'm still around though I don't comment much since Dentistry is not my field of expertise :winky:

Well its been abt 2 months since I had the tooth extracted the one that had spread into the jaw (at least that's what the xray indicated). So far no symptoms at all except the ridge on the gum has two slightly raised bumps which might be cause I have a habit of chewing on that side. The bumps are like tiny canker sores, they don't feel sharp like a sliver of bone trying to make its way out(I wouldn't rule it out). I wondered if perhaps it is a residual infection from before except there's no pain or swelling of the jaw or socket. Thought it would be a good idea to get yr input on it.
Pic attached.

PS: Never did take anything beyond the initial course of amoxicillin

Best regards

Thanks

J

Hi Jay,

Thanks for posting the pic.... but it was a bit blurry :( So I cannot tell what those bumps are. Although they look too raised to be canker sores. Do they feel tender or sore? How long have they been there?

I would advise that you avoid eating on that side as much as possible. Let that surgical hole close over more.

Glad you have no pain or swelling!

Bony fragments that are covered by gum tissue will not fee sharp. They will feel that way once they break completely through the gum.

If you were to press on one of those bumps gently with a q tip (not your finger) does anything come out of it like pus or blood? Does it move at all or feel squishy?

Bryanna

Antibiotics?
 

HI Jay-

Why would you want to take PCN along w/ Keflex? I know they usually give clinda if a pt. is PCN allergic. I am/was an OR nurse. I agree w/ Bryanna w/ taking a probiotic.

Starting a new thread sounds like a terrific idea!
:hug:

Bryanna,

Sorry about the blurry pic reposted a better one. The bumps feel slightly tender and sore mostly when I press on them. I noticed them about 2 weeks ago. They don't move and feel kinda firm. Tried q-tip test, nothing.
Do you think its a unresolved infection from before or simply some bone fragments trying to make there way to the surface?

Many thanks for all you do

J

hi Stacy,

Thank for asking. My OS felt the keflex wasn't necessary after the 10 course of amox I was on . I still wonder if I should not have taken some clindamycin or penicillin as a added precaution after the initial course of amox since the infection was spread into the jaw.

I hope to start a thread once I'm less scattered brain. Of particular interest to me is new better types of filling materials since the most common type of filling material white composite resin is far from satisfactory . The average life span of this type of filling of a chewing molar tooth is 5-7 years. These types of fillings are the most prone to marginal leakage, which causes cavities under the fillings. This kicks off the cycle of filling, root canal, tooth loss. Silver amalgam fillings fair much better with a average span of 15 + years, though there are some health concerns with silver amalgam fillings, white composite resin fillings are not with out health concerns either since they contain bisphenol a.

Best wishes :hug:

J

Hi Jay,

Well that pic is a bit blurry too. But... I think it's either slivers of bone trying to break through.....or you've grown horns!! :) Sorry.... :/

Once they break through they will fee sharp. They may work themselves out on their own or they may need to be removed by the surgeon. Usually the patient is told to wait until they break through as they may come out on thei own soon after that. If at that time they are tender or painful then see the surgeon. If you find that they are growing in size, see the surgeon.

Bryanna

Haha they do look like tiny horns !:D

hi Bryanna,

Got back from seeing my OS and indeed those were bone slivers. He offered to remove them but I opted to let them work there way out naturally.

He also did a pan x-ray today which is the 2 month mark since the extraction. Attached are the results, not much of a difference if you ask me.
Upon zooming in he thought he saw some "honeycomb" of bone filling in. Wish I would have looked at it closer then, the copy I have doesn't seem to allow that level of zoom.
He said that at the very least it has "not gotten worse", which is a good thing I suppose... Perhaps I should have waited the full 3 - 4 months to get the x-ray then I might have seen a more noticeable improvement.

Since there doesn't seem to be additional bone loss does that mean the infection is gone?

Should I get a follow up x-ray 3 months from now? My OS said he didn't feel I needed anymore x-rays of the area that the infection was resolved in his opinion.

Thank you once again

J

Hi Jay,

Well..... not much bone has filled in. But it is very early in the healing phase.
What happened to this tooth that resulted in an abscess?

Question.... does the gum along the bony ridge down into the vestibule of the inside of your cheek look normal? Did you have a fistula there?? I can't remember.

Bryanna

Yeah I seemed to have jumped the gun on getting the x-ray it's been only 42 days not even 2 months. Basically a small cavity ended up becoming a large cavity. I should have taken care of it much sooner but the first dentist I went to claimed I had 14 cavities! Something didn't seem right :mad:. Years later when I could not longer ignore the cavity which was quite large by then I found a reputable dentist who put a composite filling on it he also confirmed that it was the only cavity I had, hah! That held up for about six years until I got decay under the filling. Gum bony ridge vestibule area seems normal slight swelling possibly from extraction, bone slivers.

I don't think I had any fistulas, I did have a hard,immovable, flattish pea size lump when I ran my finger along my jawline.
This disappeared shortly after the extraction.

Hi Jay,

That hard, movable, flattish pea size lump.... was most likely a fistula or a cyst. Does the area along the jawbone still seem swollen? Do you have any unpleasant taste coming from that site? If you gently press on the outside of your jawbone at the area of that site, is it tender or lumpy or anything? Does it feel different than when you press on the other side of your face in the same location?

I have to be honest Jay .... I don't want you to be alarmed but I'm not loving the look of the post op xray so much. It could be the angle of the xray or the fact that I cannot alter the gray scale to define the pathology.... but I think you should have this xrayed again in 4 weeks unless it acts up before then. This was a nasty infection and needs to be monitored.

Are you able to brush real well around this area? If not then buy a small child's size tooth brush to have easier access there. Are you still rinsing with warm salt water? If not you should continue with that. Are you taking a probiotic?? No?... why not??

Bryanna

Thank you for your response Bryanna,

Both sides of my jawline feel the same now. No tenderness, lumpyness, bad taste or swelling. I check it every few days.

Oh thought the salt water rinse was only for the first week or two, will get back to doing that thank you.

I was not taking any probiotic since ultimately I ended up taking only the initial 10 course of amox 5 days pre extraction and 5 days post.

Jay,

Okay, so both sides of your face feel and look the same. No swelling of any kind.... right?

The salt water rinses keep the bacteria level down during the healing phase. This site is still considered a partially open wound because you have loose bone protruding from it trying to make it's way out. So bacteria can get in there.

The probiotic is something that ideally everyone should take on a daily basis. The immune system (which is predominantly our digestive tract) is subjected to all sorts of irritants, stress, bacteria,...... you name it. One way to help restore the immune system and keep the intestinal flora in check is to make sure that we provide it with plenty of beneficial bacteria on a daily basis. Most diets do not provide enough beneficial bacteria. In fact many diets deplete it due to the chemical processing of many foods which remove most of the nutrients.

Any time you've been on an antibiotic you end up with no beneficial bacteria irrelevant of how long you were on the meds. Diet alone cannot restore enough beneficial bacteria to restore a healthy balance. Unless of course you consume mostly wholesome, unprocessd fermented foods and ocean based plants called microalgae.

In order for an antibiotic to work properly, it first has to kill off all of the good bacteria that is there to intentionally kill off any offenders. Once the meds break down that healthy bacterial barrier in order for the barrier to be built up again it has to be put there in some way. Either by diet or supplementation.

Also any time we have an infection, especially long standing and/or in the bone, we need all the help we can get to keep our immune system functioning optimally. A diet as I described about or probiotics are the only two ways to accomplish that.

So give it some thought and of course decide what you feel is best for you!

Bryanna

Bryanna,

So far so good.
Makes perfect sense about the salt water rinses and probiotics, once you explained it :) thank you. I will give the probiotics a try.

Best wishes

J

hi Bryanna and fellow board members,

Sorry I’ve been away had to do some damage control since I let this whole issue set me back more then necessary.

Update and summary

Had tooth number 19 pulled on 7/5/13
Decay under filling which spread to the jaw. Small pea sized lump on outer jaw line. 7 days on amoxicillin before extraction and 7 more days after.

Pea sized lump gone only symptom was two very small bone fragments a month later, which are gone now.

Follow up x-ray taken 40 days after extraction (should have waited longer to see more definitive progress in the pan xray). OS says it’s resolved and in his opinion has not worsened.

I checked and rechecked for any of the symptoms or signs you mentioned, nothing unusual to be found.

I’m reposting both the x-rays with the contrast bumped up. Of course it probably would be ideal to have a current x-ray but funds are tight at the moment and it seems if there were any problems they would have been made apparent by now.

Is that just wishful thinking?

Wishing everyone health and happiness in the New Year

J

Hi youngatart,

Based on the comparison of these two x-rays which are dated about a month apart .... the jaw bone appears to be in a similar condition in both x-rays..... just minus the tooth in the later one.

Without question, I think another x-ray of this area should be taken 6 months from the original one.

Bryanna