Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 2/8/2010

Question
QUESTION: In hospital, dental surgeon extracted four, two upper left side of face, one lower left side one upper right side of face Sept 15thm 2009. I have had severe pain in my face, and jaw ever since.The entire area from ear to ear, across my face,upper and lower jaw areas, and as high as my nose, and bottom of my chin.

The pain and aching today is still severe. I was in such pain and discomfort following this surgery, I could not eat, and barely ate anything for months, resulting in weight loss of 25 or more lbs. Also during this time my potassium level dropped significantly, to a dangerous level. I still have to take 4 tabs a day to keep it in the normal range. I assume the potassium loss was from my not eating properly. I still have difficulty eating sufficiently due to the pain.

Any idea what's going on and what I might do to get this pain to end? I have a history of very touchy sensitive trigenimal nerves in my face.

ANSWER: Carolyn - Wow!  I hate to hear of stories like yours.  You don't say specifically the type of pain (throbbing, burning, shocks, headaches, earaches, etc) to better define the cause.  Often with teeth, like yours that were removed, the bite can change.  This alteration of the bite (especially if the teeth removed were the foundations of the bite) could produce severe spasms of the jaw muscles.  These spasms can produce severe pain in the face, the temples, the ear, the throat, the neck along with other areas.  Without examining you I cannot define the cause of the pain.  Another possibility is sinus infections.  I wish I could be more specific, but that would require me examining you.

My suggestion is for you to see a board certified oral and maxillofacial surgeon.  I know there are quite a few in Canada.  If you wish, you can get back to me, tell me where you live and I could send you names of the board certified surgeons closest to you.

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

QUESTION: Dr. Teig, you are marvellous, sometimes the answer is right in front of us and we don't see it. You have it right !!!  My doctors as well as myself kept thinking "infection". My ear, nose, throat specialist ordered a CT scan of my sinuses because I've had all the symptoms of a sinus infection but... the symptoms were a bit skewed that should have ruled that out. My family doctor was concerned that I had an infection or other problem in my head and ordered a CT scan of my head, which all came back NORMAL . (At 72 one has to be happy about that!!) I have so much pain in the centre of my face/head, and pain from ear to ear in my jaws, and had noticed my lower jaw seems to go to the left when I relax my face.

Looking in the mirrow its incredible how far to the left my lower jaw does go when allowed to do its own thing. I thought that given the extractions maybe my upper and lower teeth just didn't "meet" the way they used to, but didn't think past that. Your answer fills in the missing elements. I have much more pain in the left part of my face in front of the ear, sort of like a toothache or earache pain.

But the lab tests of all kinds showed no infection anywhere, we were at the bottom of the barrel of finding an answer.

When your reply came, of course the "How could we have missed it" response came, there has been no signs of infection, no fever, no discharge, no inflammation, all the antibiotics made no change.

I now have an appointment next week to see the oral surgeon who did the extractions ( which was done in hospital, as there were four molats that had to be extracted and with serious cervical nect problems and my age )
and will see my own family doctor on Friday.

And one short email to you and you knew right away what the problem was. If I relax my face, my lower jaw moves to the left, quite disctinctly. I try to keep it in place, centred, but as soon as I stop concentrating on it, the lower jaw moves to the left again, and the pain in the jaw gets worse. Maybe a pile driver would fix it!!!

Thank you again, neither I nor my doctor thought of going back to Dr. Morawetz the oral surgeon, didn't think it was related. Dr Morawetz's vehicle licence plate is:  I YANK M ". Thank you again, very much. Having pain from the shift by my lower jaw really is the best answer / cause, because its not an infection, not a disease, now where did I put my crow bar !!!

All the best, thank you from Burlington Ontario Canada, again.
Carolyn Forbes

Answer
Carolyn -  I yank them also, but my license plate is not so vocal.  In the meantime, before you see the surgeon, I suggest you begin the following simple treatments that should begin to relax the muscles.

1)  Begin warm salt water rinses, concentrating the water to the back of your mouth on the sides.  Do this for about 5 minutes, 4-5 times a day.  

2) Use a warm moist compress, like a wash cloth, and place it from the temple region, on both sides at the same time, down to the bottom of your jaw on both sides at the same time.  Do this for about 5-10 minutes, 4-5 times a day.  Keep dipping the wash clothes in the warm water to keep them warm after they cool off in a minute or so.  

I wish you well and hope the surgeon you see really knows about this type of problem.  If you have any additional questions, feel free to contact me again.