Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/11/2008

Question
QUESTION: "PRIORITY:HIGH"

Dear DR Spindel:

I had a filling/cavity done 11/5/08 on the lower anterior teeth #22/23. A day or two after I started to have swollen/painful node(s)in my neck same side. Tonight I noticed/felt a very tiny bump/spot right behind my last upper right molar. Not really on the gum though. More on the soft tissue in that area.Not sure if any of this is related to the nodes? What do you feel may be going on? I'm leaning more towards irritation as far as the bump/spot perhaps from the food I eat? I eat salad's with lemon juice/balsamic vinegar,fresh chopped garlic,oil.Some Potatoe chips...I have several teeth missing also upper/lower. And I find myself biting the insides of my mouth/cheek's soft tissue. Which causes some bumps and minor mouth sores. I try to gargle with warm salt water to help.

I'd "greatly" appreciate any suggestions/insight's/treatment options you feel would be helpful in sorting this out and put my mind at ease. I have heard the term fistula. And that acidic foods can cause them as well as more serious things like absesses.

Sure Hope and Pray you can help.

Sincerely Ralph"


ANSWER: Dear Ralph,

It doesn't sound like your symptoms are related to the filling you had done in the front of the mouth. It is unlikely to be the cause of your swollen gland or the sore behind your upper molar.  It is possible that the gland may be related to the shot you may have been given (a mandibular block),but if the swelling in the gland goes away, then there is no cause to worry.  Potato chips can cause small cuts which can become ulcers. Lemon juice and balsamic vinegar would irritate an ulcer.

Warm saline rinses are fine if you have an ulcer. Most ulcers go away with in two weeks and require no action. Your symptoms will most likely resolve on their own.

It does not sound like you have an abcess or a fistula, but the best thing to do is if these do not go away with in a week or two, you should return to the dentist to be examined.

I hope I have answered your questions and please feel free to contact me again with future dental questions.

---------- FOLLOW-UP ----------

QUESTION: DR Spindel,
NEW Questions: Clarity
What do you feel else may be causing the nodes problem? What would a Fistula be more like? Absesses are usually more obvious?!?
The pain seems to moving up alittle from the neck to the bottom area of the jaw bone. It is still in the neck though.
What else may I be able to do to minimize the Ulcers from the teeth biting the insides of my cheeks due to the lack of enough teeth? Which I cant afford to replace now? Is there any OTC/prescription items that could be used to treat this? Other than salt/H2O?
PLEASE be as specific as your able...
An MD suggested at one point that this could be from something as simple as an insect bite,viral sore throat some form of something  that causes inflammations or possible infections perhaps bacterial?!

Hope to hear from you very soon...Is there "anything" that I should be aware of that would indicate immediate care to this condition. I admit I worry too much...

Sincerely Ralph Falzarano

Answer
Dear Ralph, usually lymph node that are swollen in the neck are not secondary to dental or oral problems.  The lymph nodes directly under the mandible can be related to dental infections(under the jaw-the submandibular lymph nodes), but not usually in the front of the neck. I agree with your MD. If your lymph nodes stay swollen for over 30 days, you should consult a physician(Ent or Head and Neck surgeon). You may actually consider a biopsy.  It certainly could be viral in nature, but that should go away in less than a month.

Biting the cheeks can be a hard problem to deal with, because once they have been bitten the cheeks tend to 'pooch' out and get biten again easily. I suggest you make a conscious effort to take your time when eating and try not to injure them again so that they may heal.

I hope I have answered your questions and I welcome future dental inquiries.

Ps: tenderness at the angle of the Jaw could be from your visit or from biting your cheek. It hopefully will go away with in the week, and if it doesn't you should return to your dentist or physician.