QUESTION: Hello Dr. Teig, Thank you for being here.
HX: I am a 63 y.o. woman. On Feb 14th I contacted my regular dentist re: Dental pain intermittent upper and lower L side. He was out of town but via cell phone looked at my x rays taken this past Oct. He sounded surprised the pain was coming from the L side as he recently got insurance approval for 2 crown restorations and told me I would also need to have a wisdom tooth extracted from the R side. He called in a prescription for Amox 500 mg double first dose 3x day thereafter 10 days. After 5 days still experiencing the pain on the amox so in desperation I called him again and he said to see an endodontist. Saw endodontist and he did x ray and diagnostic to try and find out source of pain. Difficulty locating because of so many crowns in my mouth and referred pain but he found what he thought might be an internal tooth abscess (apologize for not using proper dental term) on lower L jaw tooth next to the wisdom tooth. He did RCT on Feb 23rd. Sure enough there was an abscess. He gave me 6 more amox capsules to the 2 I had left to take. He advised the wisdom tooth on top would need extraction ASAP. Was referred to an oral surgeon and I had upper L wisdom tooth extract on Feb 25th. Extraction was without a problem. Asked about antibiotic and told I didn't need anymore. March 1st and still having upper and lower pain. Saw associate of oral surgeon who said clot was intact. He used a q tip to clean out socket which he said was dirty. (Please note, I have been rinsing diligently with warm salt water following meals and at least 5 or 6 times a day/ brushing and flossing the other areas#. He said he couldn't evaluate where the pain was coming from because I am in the middle of a multiple treatment. He was going to give me an antibiotic. I advised that I had been on amox for 13 days and he did NOT give me further antibiotics. Today is March 2 and still having pain. There is a horrible taste in my mouth. My husband told me my breath stinks worse than ever. #Please note: This past summer my dentist crowned my lower left wisdom tooth. I had many crowns done and this was the only one that kept giving me an ongoing pain nightmare. It feels very much like what I am currently experiencing. Finally my dentist put some kind of clove med in glue. Better with permanent crown but temperamental. Also a different crown on the L side fell out and dentist simply glued it back saying the stuff in the glue would kill any bacteria).
Current concern and question: Is this normal? Why isn't the pain going away? What could be wrong? Any advise appreciated. Thank you.
ANSWER: Joy - I hate to tell you this, but it seems that the doctors you have seen have no idea what is the cause of the problem. First of all, using clove in a cement will have no effect on the tooth, unless the nerve was exposed.
Why is there still pain there? That is a little difficult for me to tell you without examining you, but initially you state that you had pain and the endodontist who you were referred to was unsure about the source and chose one tooth, which alledgedly found a tooth with an internal abscess. The problem with diagnosing with so many crowns is difficult. Just because the nerve died in one tooth, it doesn't mean that there might be others as the source of the pain. There is a possibility of another source. The bad breath you state is an indication of a low grade inflammatory condition.
I cannot be sure without examining you, but the bad breath usually indicates a periodontal problem located between the teeth. You don't state what precipitates the pain or if it is always present. Does it get worse with cold or hot food? When you bite down is there soreness? Do you have pain in the temple area? Do you have tightness when you open you mouth or when you chew? Do you have stuffiness in your nose? Do you get headaches in the temple area?
So try to answer my questions and tell me as much as possible about your pain. What do you do to make it better and worse. So get back to me and let me see if I can help diagnose the cause. Also, I may have to ask you more questions.
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QUESTION: Thank you for your response. I have been waiting to reply after appointment with Oral Surgeon today so I can provide the most current info. I appreciate your help. What your telling me makes sense. I have so many crowns that there could be an abscess in an other tooth causing pain.
Hx: Re: Indication of Periodontal Problem: I do not notice bleeding when I floss. I have been going to my current dentist for over 10 years. Prior to that I did see a Periodontist for bleeding gums. When I asked my dentist if I needed to go to a Peridontist he said he could take care of everything in his office. I see his hygenist for a cleanning every 3-6 mths and do notice what seems to me a lot of blood when I rinse. I asked the hygenist about it and she told me I have deep pockets. Now that I am thinking more about it, could there be a periodontal issue lurking deep below where the cleanings are being done and the dentist has not been aware of the problem?
Re:Past pain problems. Following the pain problem with the crown that was put on my lower L wisdom tooth this past summer. Should I be aware of anything for future care regarding a nerve being exposed?
Re: Current Pain: The pain is intermittent. I don't know what precipites it. Last couple of days lower L has got less problematic and pain mostly upper L. Sometimes it radiates to L side of nose and L eye. I am currently not allowed to eat hot food per instructions post wisdom tooth extraction so I haven't tried hot yet. Also haven't chewed on the left side yet. Prior to the extraction cold water seemed to bother my teeth when I rinsed. Now I use warm. I do not seem to have tightness when I open my mouth or when I chew. I have noticed that my nose is a bit stuffy L nostril when I woke. It feels like there is stuff sitting in my throat but it quickly resolves. Once I get up I feel fine in my nose and throat(No recent cold or anything like that) but my mouth is horrible dispite brushing, flossing and warm salt water rinse. Brushing my teeth just seems to cover it up and the awful taste comes back. I continue with salt water rinse throughout the day to heal the extraction.
Please note: I have been getting headaches for over 10 years or so. Seemed to start after menapause. At the time I went to a neurologist, ENT, and dentist. Tests from the neurologist came out negative. Referred to ENT who found some kind of growth or nodule which he said was not causing my headaches. He said it was not cancer and not something to be concerned about. He said it was in a spot in my sinus that would be very difficult to remove. He said to do nothing about it and I did not need follow up on it. I then consulted the dentist who said my headaches were not from my teeth.
Appointment with Surgeon today: Removed stiches. Says extraction looks fine. Told him about pain and bad breath. Said to give it another week and if not resolved to go see my family doctor. Says no need for further antibiotics.
This is all so confusing. Feels dental pain not medical. Your help is appreciated. I don't mind questions. I am just thankful you are helping me out. Your insight and practice wisdom is very appreciated.
Joy - This is such a difficult situation to diagnose with the information you have provided. I don't understand why the surgeon is willing to send you to another doctor, when you seem to indicate that the problem is orally involved.
I do not know where you live, but from your description of what you have endured and the lack of an ability of the doctors you have seen to diagnose it or help you, it is probably best that you be examined and evaluated at a major medical center. Such a facility has doctors, who together, should have a higher chance of diagnosing your situation.
If you wish, get back to me and tell me where you live. I will then provide you with facilities as close as possible to you that should be more likely to arrive at a diagnosis.