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Oral Surgery/Nerve injury, terrible pain in right lower molar region

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Hi Doctor,

During end of year 2008, I went for a normal dental checkup in India, where the doctor found slight discoloration in my first right lower molar tooth. So the doctor recommended for a root canal treatment which I have undergone, but unfortunately during the treatment the doctor broke the instrument/files resulting into four or five small broken pieces got stuck in the root of tooth. I was having slight pain due to the broken pieces stuck in the root. So I went for another treatment after 6 months at a different hospital. This time doctor started with re-root canal treatment and removed 2 broken files but he could not remove all of them. Now, it started slight pricking/insect biting sensation at first right lower molar region. I did follow up with the doctor and after 15 days the doctor removed the tooth and re-implanted the same after cutting the portion of root where instruments were stuck. Immediately following this surgery, the intensity of pricking/insect biting/burning sensation got increased. The pain is localized and did not cause any numbness in mouth.

After 10 days, due to increased pricking sensation the doctor removed the re-implanted tooth. But the pain continued to exist.

Later I consulted many neurologists and dentists I was prescribed all sort of neurological medicines (tegretol, gabapentin, gabaneuron, nuroday, fluoxetine, lyrica, Amitriptyline and many more). Unfortunately I was allergic to neurological medicines and developed symptoms like vomiting, skin rashes, chest pain, difficult to breath and got completely bed ridden.

Meanwhile I was trying alternate medicines like Indian Ayurvedic, Accupunture and Homeopathy and I was switched between neurologists and oral surgeons. But nothing could resolve and no one could help me.

Few oral surgeons tried with blocks, and it use to work sometimes but not always. Few surgeons suspected it could be long buccal nerve injury and few suspected IAN injury.

In 2012 December, I went under long buccal neurectomy which was not successful. Later doctor informed me that long buccal nerve was not trackable practically.

In June 2014, I underwent another surgery, during which the doctor made a deep pocket in the bone and cut the IAN nerve nearby first right lower molar region. I had only 15% to 20% numbness on my lip and chin. Immediately following this surgery, I caught infection which turned out to be osteomyelitis; pus started flowing from my mouth. I was on antibiotics for four months which included one month of IV antibiotics. I got cured from the infection but prolonged usage of antibiotics resulted into severe joint pains and I was not even able to stand on my feet. Also this surgery resulted into unbearable pain in complete right lower jaw which is 5 times worst than previous pain. Pricking sensation got increased 5 times more than earlier.

After multiple follow-ups with doctor and extensive study on x-rays and CBCT, I was told by my doctor that I have multiple canals. So doctor was very unsure which canal is causing this pain.

Now from past 15 days there is a bad tingling sensation nearby lower lip and chin which are newly added.

Currently I am undergoing the worst days of my life. The pain is so severe that I cannot perform my regular activities and cannot work in office. I cannot even sleep due to severe pain.  Tramadol is reducing jaw pain a little, but no effect on pricking and tingling sensation.

I look forward for a solution to this problem. This problem has totally ruined my life and I sincerely want my life back. Please kindly help me

I am hereby attaching my recent x-rays and CBCT

Thanks,
Mehel

Answer
Mehel, All of the procedures you are describing that you went through are not acceptable treatments in the US for the problem you are describing. It sounds as though you might have had osteomyelitis from the onset which was causing the pain. Extracting the tooth for apicoectomy and re-implaning the same tooth will most likely fail  especially in an infected area. Cutting the IAN and long buccal neurectomy for what you are experiencing is also not consistent with acceptable forms of therapy. Injections for the IAN should be performed first and if no relief from that therapy, this would make the IAN cutting contraindicated. It sounds like you should be on IV antibiotics for osteomyelitis for a min of 6 months. The bacterial in the bone need to be cultured and sensitivity test need to be performed to determine which for mod antibiotic you should be on. Radiographs would be very helpful for me to take a look at. I hope that helps.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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