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Oral Surgery/Upper gum and palate numbness

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Question
A little background: 3 years ago I had a Lefort 1, BSSO and sliding genio to correct my bite (widen upper, advanced lower 5mm, and setback the chin) I healed well and regained all the feeling back in my face. A month ago, I had a small chip repaired in my front tooth, so small I did not need to be anesthesised. Then I had a bad cold a few days later.  I developed a small spot on my upper gum in between my front tooth (the one that was repaired) and the lateral incisor that was numb. The numbness has now progressed to include my upper jaw from canine to canine more or less, and my anterior palate. I also get occasional pain from the next to the base of my nose, it feels like an irritated nerve where a plate and dome screws are. My frontal teeth on the right side feel like they did after the surgery, half numb and very weird.

About month after this started, I went to see my dentist. My dentist took close up x rays of the roots of the teeth involved and said there was no infection or bone issues apparent. On the x Ray there was a tiny black spot behind a front tooth, on my palate, but he didn't seemed concerned about it, he said it was very small, and he wasn't sure what it was, frankly. He tested all the teeth in the front and there was no problem with cold or pressure, although the front teeth are slightly tender. The dentist said I might need a root canal, the numbness may be from that, but he suggested I wait for now. He figured that all problems are caused by my repaired front tooth possible dying, but he doesn't want to do anything until x rays show something. He didn't think the screws could be responsible, it's been so long from the surgery they should be settled.

I have taken antibiotics for a possible sinus infection and the numbness did not respond, although I had pain and pressure on my cheek which disappeared. I do not have a fever. The skin on my face is not numb, just my palate and upper gum. My family doctor is very confused. I am waiting on full face x Ray results.

Questions:

1. I had symptoms for 3 weeks before I saw the dentist. If I had a dying root for that long, wouldn't it be fairly visible on the x Ray?
2. Could my screws have shifted so long after surgery and be responsible for this?
3. My dentist said that my face might interpret a dying root weirdly and hence I feel numbness instead of pain. Is this correct?
4. If the numbness is due to cranial nerve issues, which nerves would be involved?

I would really appreciate having some idea of what this is all about.
Thank you!

Answer
Eleanor - The xray appearance of the bone and teeth around the type of surgery is not always normal.  There can be changes of both the bone and the teeth.  The dentist is not knowledgeable or skilled to determine if there are changes in screw position.  The numbness you feel can be due to the teeth or the bone.  The localized changes in the numbness definitely does not appear to be due to a cranial nerve.  

So my suggestion is that, rather than a simple xray taken by the dentist, I suggest you get back to the surgeon to evaluate the surgical site to properly determine if the situation is due to the teeth or the bone.

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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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