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Dentistry/swollen retromolar pad, operculum?

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QUESTION: Hi,
I am in a quandary. I had all my wisdom teeth removed over 30 years ago. they were impacted. I had lock jaw last year due to a muscle spasm in my masseter muscle, right side.Have been diagnosed with myofascial pain syndrome.

Now I have pain, mainly in the retromolar pad area, lower right side, and on the pad itself for many months. The doctor feels it is due to an irritated operculum, and that the area had experienced trauma before, maybe something got caught between tooth and gum, but it looks like it healed, with a white line. advise me to keep the area very clean. Helps a little, but not 100%.It feels like the area swells from time to time, and I feel like the masseter has swollen too, especially after eating or a stressful day. He does not feel it is infected, and does not understand why i should feel such pain,as it is not hign enough to feel he said. The top tooth is not hitting it. I wonder if it is being caused by clenching?
He said if he lazers it down, it could be worse. Any thoughts? Thanks for your help.

ANSWER: Kathy -  I am so sorry to hear that you are suffering the way you are.  Often people with myofacial pain are bruxing or grinding their teeth without realizing it.  That can produce the irritation you describe.  The first thing to do is to keep the area completely clean.  That means brushing 2-3 times a day, flossing of the teeth and rinsing with an antibacterial mouthrinse, like Listerine for 30 seconds twice a day.  In the morning after breakfast and at night before bed.  Nothing to eat or drink for 1 hour after rinsing.  

The area should be evaluated by a more knowledgeable doctor.  I suggest that you either see a board certified oral and maxillofacial surgeon or a periodontist to evaluate the area.  The area can easily be recontoured with minimal discomfort.

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

QUESTION: Thank you so much for your answer.I feel like that is what this could be. I get relief mostly from wearing a small mouth guard I bought at CvS...keeps my teeth apart enough to get relief during the day. Without it, I feel like I am right on the irritated area, although I am very conscious of keeping my lips together/ teeth apart, to the point of being obsessive, which is not helping. I have seen maxiofacial surgeons (2), one periodonist,  one TMJd specialist who wants to fit me with a $3,000 repositioning splint,who could see that i had linea alba, but said that was not an issue, and who wanted me to go to a periodontist. He did not link the two, but I feel they could be related.  The area did bleed when he probed it. the pain is a throbbing aching type pain, but not all the time. Funny, when I eat, or such on a candy it feels fine. When I sleep,it feels fine, but when I wake up, and start the day, I can feel it begin to swell. I want to take an antibiotic to rule out an infection? a good idea? I am meeting with a periodontist and a maxilofascial doctor (3rd one) in 2 weeks...they are consulting together on this...I will talk to them about your answer. If any other suggestions,please let me know. I would be most grateful.

Answer
Kathy -  From your symptoms it does not sound like an infection.  For that reason antibiotics are probably not necessary.  Getting another opinion at this time is a good idea and if the doctors are patient and skilled should be able to arrive at a recovery.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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