Oral and Maxillofacial Surgery Expert Forum
Pain in lower right jaw - PART 1
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Pain in lower right jaw - PART 1

Dear Sirs,

I asking a question on behalf of my mother.

October - She had two back molars removed on her right lower jaw. Both had fillings. She broke them (one crumbled) while she was eating.

She tells me the dentist had trouble removing the remains, something to do with a "dry socket"? They came out in pieces and over the course of a month she had bits of bone protruding through her gum. The dentist took x-rays and found a black shadow on the jaw line (bacteria). He prescribed Metronidazole.

November 2007 - She continued to have pain in her lower right jaw. The dentist removed a third tooth (very back one). This was an awkward extraction, which took over an hour to complete. The root or the tooth was "hooked"? in to the jaw bone. The dentist claims he had to remove part of the jaw bone to complete the extraction.

Over the next four months (December 07 - March 08) she was in severe pain. The surgery performed on her jaw would not heal. She had to visit the dentist three or four times a week. He had to frequently clean the area and apply Corsodol (oral antiseptic strips).

Throughout this period she still had bits of bone protruding from her gum. Due to the amount pain she was suffering, the dentist referred her to an oral surgeon. Over a course of three visits they "chomped" these bits of bone away.

In addition to the jaw pains, in March 2008 she started with chest pains too. The oral surgeon suggested she see a cardiologist. To cut to the chase she went to the ER room had x-rays and they found a shadow. She was prescribed (at different times) Erythomicin, Amoxicillin, Amoxiclav and Clarithromyicin. Over the course of three - four months she overcame the chest infection, however, the jaw pain still remained.
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The first thought I have is that your mother may be suffering from osteomyelitis which is an infection in the bone marrow of the jaw.  There many other explanations for her continued signs and symptoms.  

It is difficult to say with any certainity and without a complete medical and surgical history and clinical examination.  Certain medical conditions and medications may have contributed to her condition.

CT scans, bone scans, PET scans and MRI are all radiological tests which may help to identify the pathology.  Each test has their own advantages and weakness.  The surgeon should be able to prescribe the most appropriate depending on his/her impression.  

I would have hope that someone would have obtained cultures and antibiotic sensitivity tests to determine what antibiotic should be prescribed.  This information would be important to the surgeon.

Your "theory" of an infection would be the first on my list.  More importantly is what exactly is causing the infection and specifically what anatomic area(s).

Don't give up and you should continue to be an advocate for your mother.  I strongly suggest you accompany her to her appointments so you can question the Oral and Maxillofacial Surgeon directly.  I would also suggest that you obtain copies of all treatment records and radiographs of your mother and bring them to the appointment with the surgeon.

Keep me posted.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.

5 Comments
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Avatar_m_tn
She continued taking painkillers on a daily basis, rinsing her mouth out with Listerine, Corsodol and Peroxyl. She would rub toothpaste on the area which would numb it.

In September 2008 she went to see a new dentist who dealt with “special cases”. He found a hole in her gum and a considerable amount of bacteria. She describes it that he pressed her gum and “yellow puss” came out. He also removed a spur and other debris from the wound and stitched it up.

Initially the pain subsided but over the course of the last eight months it has crept back. She usually has painkillers on a daily basis. She goes in peaks and troughs. One day she’ll manage to cope with the pain, it doesn’t interfere with her daily routine, other days it will floor her. Two days ago she had taken 10 strong pain killers which basically knocked her out. Yesterday she was in so much pain we had to visit the ER again. We saw a GP. He couldn’t answer anything with any certainty. He simply said he could prescribe an antibiotic (Augmentin) and strong painkillers. He suggested that we go back to the oral surgeon.

The difference now is that the pain is extending behind her right ear and up in to her right temple.

Questions…

Between us all we’ve got questions and I will be putting them to the oral surgeon when I next see him.

Do you have any theories as to why this pain will not subside?

Since the initial x-rays which showed the bacteria, all subsequent ones have been unremarkable. Is it possible for bacteria to exist in her gum / jaw and it not show up on an x-ray?

If so, would an MRI / CT Scan offer anything an x-ray couldn’t?

Can the jawbone itself carry an infection?

Do you think this could be nerve damage? It has been suggested, but owing to the “yellow puss” which was removed in September 2008, I’m still leaning towards the theory that there is still an infection in her gum.

What would you suggest as a next plan of action?

Thank you for any advice,

Mike
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Avatar_m_tn
Thank you for your reply.

Would osteomyelitis show up on an x-ray? The most recent ones she has had have been clear.

If it's not an x-ray, what tests would be able to give a more definitive answer?

Thanks again,

Mike
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Avatar_m_tn
Thank you for your reply.

Would osteomyelitis show up on an x-ray? The most recent ones she has had have been clear.

If it's not an x-ray, what tests would be able to give a more definitive answer?

Thanks again,

Mike
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