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Dentistry/Jaw Bone Protruding Through Gums

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Hi.  This past Nov (2012) I had a dental abscess, which my dentist originally thought was a "clenching issue", despite my having had trouble with this same tooth #30 on the R# for a few months now.  Anyway, two nights later I was in emergency with my R eye, ear, face and neck swollen....CT showed dense infection in soft tissue.  I have Crohns Disease and Lupus...on baseline dose of Prednisone #2.5mg daily#...I have a port device due to Crohns...so dehydrated that I infuse 2 liters of fluids ever other night.  Anyway...terrible abscess...sent to oral surgeon who removed the tooth #2 vertical cracks present# and since oral antibiotics were not helping, began RX with Clindamycin and Flagyl IV #in the end I have had 15 days of IV antibiotics now#.  Infection got under my tongue and chin and into my airway.  Oral Surgeon, after seeing that the infection was not clearing, inserted a drain inside my mouth along my jaw bone which I had for 1 week.  Now I'm having an issue where my jawbone is coming up through my gum...at first it started at the site of the drain #the surgeon removed that piece of bone# and now the bone "shearing" is happening all along my bottom jaw bone to the very back.  Jaw bone is also coming up through the socket where the tooth was removed.  Dentist says there's really nothing to do but wait this out...he did give me some kind of medicated rinse to try.  It is VERY painful!  I can't believe how much it hurts.  I am really no stranger to pain being ill and all, but this puppy aches and throbs and my ear and eye ache as well.  Surgeon says it's because of all of the nerve endings there.  Says they see it all the time in their office and seems totally unconcerned.  Seems to be telling me that "eventually" the gum with grow back over those exposed areas, or they will break off and that's that.  Said once it starts it sometimes will follow the jaw line, and sometimes this is a process that takes MONTHS???!!!  Any informed information you could give me about this condition would be greatly appreciated!  The infection I had was SO bad that I worry that the infection has actually gotten inside my jaw bone.  My CTs as of the end of Dec have not shown that, only the infection in soft tissue.  Surgeon did also do blood counts and inflammatory markers all of which came back wnl.  No fever or other signs of infection are present so surgeon thinks we have warded off that dilemma. I just don't understand how my gum will be able to heal over the bone there now that almost the entire back right of my jawbone is becoming exposed.  It kinda scares me that I'm turning into a "skeleton" and will be facing some kind of surgery to rectify this condition.  Thanks so much for being there, giving your time and listening.  Thanks in advance for any information you can give me. I look forward to your answer.

Answer
Tracy - the exposure of the bone you describe is prone to degeneration, since blood is not actually feeding the bone, since it is exposed.  This exposure decreased dramatically oxygen to the bone area.  Without oxygen, soft tissue coverage will not occur and a portion of the bone might be rejected and might separate from the rest of the jaw bone.

I don't know what options the doctor has suggested, but in this type of problem, flooding the area with oxygen can often quiet the area dn make is more prone to healing.  This increase oxygen is done via a treatment called hyperbaric oxygen treatment.  It is done in a chamber with high levels of oxygen delivered at high pressure.  So I suggest that you speak with the surgeon and ask him to send you for hyperbaric oxygen to speed the healing.  The hyperbaric can often reduce the need for surgery.

Any more questions, feel free to contact me again.  

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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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