Dental Health Expert Forum
osteomylitis?
About This Forum:

Questions in the Dental Health forum are answered by Dr. Jerome Tsang. Topics covered include bridges, cavities, crowns, and x-rays.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

osteomylitis?

Hi, I posted a few weeks ago.  I'm 35 yrs old, 4 years ago I had my upper right first molar re-filled after the filling broke,  and ever since then  (on and off) I've had severe pain issues spreading to my right maxillary sinus and jaw, and sometimes down the front of my neck.    Right now the area just above and behind the tooth in question is very painful to the touch, and I have pain spreading.   I plan to go to a university emergency clinic as soon as I can.  i am very worried that i may have osteomylitis or something bad going on.  If I'm not having a fever, just the pain,  does this seem likely?    Also I was wondering,  will the routine x-rays they willl do for me ever miss osteomylitis or something similar?   I have wondered also if I"m getting an abscess, but I can't see any major swelling in my gum.
540545_tn?1377626518
Have you seen an endodontist (root canal specialist)?  They may be able to determine if the tooth is the source of the problem.  Again, I'm assuming its a tooth issue only because of the timing of your discomfort.  

Yes, routine x-rays may miss an osteomyelitis. Unfortunately x-rays are 2-D images of a 3-D object (your mouth).  It can't see from all angles.  

15 Comments
Blank
Avatar_m_tn
By the way, I do not have a sinus infection.  I had an ENT look in my sinuses with an endoscope.
Blank
Avatar_m_tn
I appreciate your replies.  I think that since I don't have dental insurance I'm probably going to have to go to a dental school emergency clinic with pain as my complaint.

This leads me to another question that I was wondering if you might have some insight to...a logistical question, if you will.  I am actually disabled with original Medicare, and I know medicare doesn't generally cover Dental (which I find baffling considering the cost of treating cardiac disease)... A extraction or something routine isn't a big deal, but I am petrified at the prospect of facing something big.  At what point would Medicare step in and cover your treatment for issues of a dental origin?  Would they do it if it's medically necessary?
Blank
Avatar_m_tn
Actually, what are the odds the bone would be infected if the plain xrays are normal and I haven't had a fever recently?
Blank
540545_tn?1377626518
Kind of hard to say about the osteomyelitis and x-rays.  I think its a thorough diagnosis that's made with x-rays, discussion with you and the clinical findings as well as what they may learn about previous treatment and their tests they run.

Yes, medicare does stink in that regard.  They don't actually cover any dental procedures at this point.  Its mostly on a state by state basis but most states do cover kids I believe but not adults.  Not 100% sure though.  May want to discuss with your medicare provider but that's my understanding.  If its a medical emergency they may cover some of it.  Dental insurance and medical insurance are billed differently with different codes, etc.  

If its something significant and cost is an issue, extraction may be the only option.  You can ask the dental school if they know of any free clinics that may provide care.  You can also contact your local dental society.

Blank
Avatar_m_tn
Hey again, thanks for the additional reply.
I went to UAB dental school and they pulled it out for me  (quite an ordeal...it seemed much worse than my wisdom teeth 10 years ago).  I was given a LOT of lidocane and then some other kind of injection as well, since I will still feeling pain.

Anyway , the student dentist told me there was an infection, but not quite an abscess.   At this point , there is massive swelling in my gum and my lymph nodes under my jaw are swollen are sore.  

The one thing that surprised me is that I wasn't prescribed any antiobiotics,  I even asked to be sure and they said I didn't need them.   Is this normal even when I have an infection?  

  I do have some amoxicillin (500 x 3 times per day) here that was given to me by my Doctor a couple months ago and I'm awfully tempted to take it just to be sure.  Will it hurt anything if I do?
Blank
Avatar_m_tn
Looking at the socket this morning in the mirror, I see what looks like this white-ish looking "sludge" all inside it and around the edges.  Is this the infection I'm seeing?

Here is a picture of the socket:   http://i50.tinypic.com/35je6xh.jpg

Blank
540545_tn?1377626518
No its probably a combination of either some minor food entrapment and some  formation of collagen in the socket from healing.

I'm pretty sure they're thorough and didn't feel you need the antibiotics.  Once the source of infection is removed, your immune system should take over and clear it up.  See how you feel in another day or so and if it gets better without any other symptoms, you should be fine.  If you start to feel worse, give them a call.

Blank
Avatar_m_tn
At this point, the pain is considerably better, still some swelling and tenderness in my lymph nodes.  How long does it take for the swelling in your gum to go down after an extraction?   The day of the extraction (5 days ago) my gum was already swollen and painful from infection, then after the extraction it became much more swollen and has only gone down slightly.  I can't figure out if it's leftover infection or just from the trauma, and when it will go away?
Blank
540545_tn?1377626518
Usually around now actually.  If it was a tough extraction, it may take some more time.  With wisdom teeth extractions, which are generally tough in nature, it can take some time to be completely pain free.

I had 4 taken out. With 3 of them, the pain and swelling was gone in about a week or so.  But I had one that bugged me for a couple of months but nothing unbearable.  Just an annoyance when food got stuck in there or something like that.

I didn't take any pain medications besides ibuprofen and antibiotics.
Blank
Avatar_m_tn
I have another question if I may..

I think pretty much all the swelling is gone now, but I'm 2 weeks out now and the socket area, are the area especially above the socket on the outside of my gum still hurts, especially if you touch it wrong.  It feels like some kind of jagged flap of bone sticks down and hurts the inside of my gum,  plus right above the socket,  the gum area feels rough under the gum.   It's definitely still all very tender if you press down on it.  Is this normal 2 weeks out?   I have some other , less pressing issues like cavities, but I'm still trying to motivate myself to return to a regular clinic instead of the emergency clinic
Blank
Avatar_m_tn
The socket doesn't hurt when I press in it with my tongue.  Just with area on the outside of my gum above the socket...it feels shaped different or something.  Like the bone is lumpy under it or something...and it really hurts when you press on it, when I move my face a certain way, and sometimes it hurts randomly.
Blank
540545_tn?1377626518
Possibly a bony spicule or the jaw bone around that area is a little sharp from the extraction trauma.  It'll heal on its own or if its a spicule, it'll push its way out eventually.  

If its too painful to wait, you can have the dentist go back into the area and remove the bone or smooth it out.

Blank
Avatar_m_tn
I was wondering, is there anything about an extraction that might lead someone to have hypothyroid-like symptoms and an odd breathless feeling starting a week or 2 later?   Or anything to do with the septocaine i was given?   I have been feeling sluggish with a slow pulse lately, and thought maybe I was exercising too much, but thought I'd ask you?
Blank
540545_tn?1377626518
Not that I'm aware of.  The septocaine should be completely gone by this time.  I would say it would be gone within a day or two after its use.  

Maybe ask your primary care doctor?
Blank
Continue discussion Blank
This Forum's Experts
540545_tn?1377626518
Jerome Tsang, DDSBlank
Irvine Modern Dentistry
Irvine, CA
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank