Infection that did not clear up after extraction??
 

I am going to try to make this as simple as possible, but I have been battling issues for about 7 months now so I am not sure how brief or lengthy it may get. Last year I cracked the filling in a lower molar #18. I did not get this fixed right away (first huge mistake) and it resulted in an abscessed tooth. Earlier this year I developed Reactive Arthritis, but the cause was unknown. I 100% believe it was due to my abscessed tooth going so long without being treated. I have had a hard time convincing doctors and dentists of this theory though. Anyways, the issue with my mouth got worse after the extraction in April. I will explain, but I would first like to point out that I had a bump appear on my gum behind the molar as it became abscessed. Present day, the bump still exists. It went down some after the extraction, but now it has gotten large again. I went back to my oral surgeon, and he took x-rays. He said the bump was part of my anatomy, but in the x-ray the bump was barely even visible. I also had a dry socket in that area. I have had swelling on that same side of my face, mostly in the jaw area. In the past few days I have had lymph nodes pop up from my neck up. I count 9. One of the lymph nodes is huge and located on the back of my neck just below the hairline. I have ringing in my left ear. After 4 times of going back and forth with my oral surgeon, I decided to see someone else. I saw another oral surgeon today. Luckily, he has agreed to do a bone scan to see if the jaw bone is infected in that area. I go back to see him tomorrow. Also, he ruled out any possible TMJ issues. I am really concerned about this as it may be affecting my overall health. Here are some questions I have for anyone that could help:
Does a bone scan sufficiently show what is going on in that area? To elaborate, is there a better test to determine if there is an infection in the jaw? I am curious as to why he didn’t want to do a CT or MRI scan or possibly a combination of tests i.e. bone scan + CT scan? Should I push to have a CT or MRI scan for this? If it is a bone infection, couldn’t the oral surgeon just cut open the gums and drain the infection? Wouldn’t that take care of the persistent bump that is still there as well?

Hi Kimber,

I am in the dental field and will try to help you. You are wise to have pursued another opinion from a different oral surgeon as the first one sounds like he's blind :/

I will re post your questions and follow with my reply.

<<Does a bone scan sufficiently show what is going on in that area? To elaborate, is there a better test to determine if there is an infection in the jaw? I am curious as to why he didn’t want to do a CT or MRI scan or possibly a combination of tests i.e. bone scan + CT scan? Should I push to have a CT or MRI scan for this?>>

***Some tests that can diagnose bone infection are:
The Gallium Bone Scan.
The Tech-99 Bone Scan.
A CT Scan dentally formatted in 1 mm slices.
To check the sinus a CT of the sinus in 1-3 mm slices.
An MRI depending on the stage of the infection can help determine how long
the infection has been present.
Sometimes a needle biopsy is done to identify the bacteria responsible for the infection so the proper antibiotic, dosage and regimen can be prescribed.

<<if it is a bone infection, couldn’t the oral surgeon just cut open the gums and drain the infection?>>

***No not really. An infection in the bone needs to be surgically removed not drained. The diseased bone needs to be removed and the healthy bone needs to be scraped clean of necrotic tissue.

<<Wouldn’t that take care of the persistent bump that is still there as well?>>

***The goal of the surgery is to physically remove the diseased bone and necrotic tissue which would include whatever is associated with that lump. A culture should also be taken to determine the bacteria present so the proper antibiotic can be prescribed. This culture would be something you should bring up to your oral surgeon because it is not always done and should be.

Bryanna

Bryanna,
Thank you so much for the reply! I met with my oral surgeon today. At his request, I had blood work done to check my white blood count. It did come back normal, but thankfully he still thinks I need a bone scan. I would agree. The issue that I have now is that he is hesitant to order the test. I had 3 other lymph nodes pop up in my neck since last night so he wants me to have a CT scan and/or MRI scan of my whole head & neck. I should be jumping for joy as this is what I have wanted all along, but there is a catch. A few weeks ago I went to an ENT doctor because of the ringing in my ears. My oral surgeon wants me to return to that same ENT doctor to perform the CT scan and/or MRI. I couldn’t believe that a surgeon would suggest/agree that I need all this further testing but just put me off on someone else to do the work. The oral surgeon said after those tests were complete to rule out issues with my lymph nodes swelling THEN he would do a bone scan. Yesterday, he said he would do the bone scan after checking my WBC but today he changed his mind. I don’t get it. I jump through one hurdle, and I can’t even get the bone scan that I was told would happen. So I called the ENT upon leaving the oral surgeons office, and they cannot get me in for a few weeks. I was fuming at that point. I called the oral surgeons office and demanded my bone scan plus the other tests. I finally get a medical professional that accepts my story, but I hit a road block again. It’s a never ending story. So, now I am to see another ENT in 2 days and convince him that I need those tests done. Unbelievable! I read somewhere that biological dentists are the best with my type of problem. I researched and found one that is about 4 hours from me, but it very well may be worth the drive. I am going to make an appointment soon, regardless of the outcome with the above mentioned doctors. I have reached that level where I just don’t trust them anymore. I am really nervous at this point because I am thinking: how long can a bone infection go on before it becomes a serious issue? Hopefully, I will get those tests in a few days.

Maxillofacial ct scan
 

Bryanna,

I am scheduled to have a CT Maxillofacial scan done. Do you know if that is the same thing as what you described "A CT Scan dentally formatted in 1 mm slices"? I meant to ask my doctor if that was the same test but I forgot. Thanks for your help!

Kimber,

There are all sorts of scans. You would have to ask the surgeon or radiologist if this particular scan was going to be formatted in 1mm sclices.

Bryanna