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Oral Surgery/Ongoing problems after wisdom tooth extraction

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QUESTION: My daughter had her wisdom teeth out August 1.  She had ongoing pain and swelling on the lower right and a debridement Sept 5.  (She is allergic to penicillin and took clindamycin for several weeks both before and after the debridement.) She still had pain and swelling and had another debridement Sept 24.  At that time the oral surgeon found a hole through her jawbone and diagnosed her with osteomyelitis.  She has been on an antibiotic called avelox ever since and still has pain and swelling.  A CT scan, x-rays and blood testing don't show any active infection or fractures. (The CT scan and blood testing was done Oct 4.)  The doctor thinks the ongoing pain and swelling may be muscle or nerve related.  Does that sound right to you?

ANSWER: Shar - That is a difficult question for me to answer without examining your daughter.  As far as the pain, if it is due to muscular problems, she would have difficulty opening and closing her jaw, she would have headaches in the temple region, she might have earaches and she might have sore shoulders and neck.  The above are symptoms of muscular problem.  If the problem is muscular the doctor should be giving her specific treatments and exercises to relax the muscles.  If the doctor does not come up with a specific treatment plan, it might be best to have her examined by a different board certified oral and maxillofacial surgeon.  If for some reason you cannot find one, get back to me and tell me where in NY you live and I will send you names of knowledgeable surgeons to examine her.

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QUESTION: Thank you for that advice.  The doctor did give her some exercises that have relaxed the muscle somewhat, but that hasn't helped with the pain and swelling.  Can you tell me what might indicate that the pain is nerve related?  
p.s. We had an MRI done yesterday (with contrast) and just got the results, which don't show any infection or fluid collection.

Answer
Shar - It does not seem that your daughter actually has nerve problems.  Nerve problems would be numbness, burning sensations, shock sensations or severe shooting pains.  If none of the symptoms I described are what she is enduring, then muscular seems more appropriate.  Especially since the MRI shows no evidence of a pathological problem, the muscular cause seems more appropriate.  The use of a muscle relaxer help to differentiate nerve vs muscular.  I wish I could be more specific as to the cause, but it is a little difficult with the symptoms alone.  Like I said the last last, getting a second opinion might be best.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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 Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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