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Bone Scan vs. MRI for detecting osteomyelitis in jaw? And need help with jaw infection

My basic question is, when trying to detect an osteomyelitis (bone infection) which is the better tool, an MRI or a bone scan? Or a cat scan? Would a bone scan work on the jaw area?

But in addition to that question, I have a VERY complicated situation with this infection, so if anyone has any advice, please help - here is the shortest possible version of my whole story...

I've had a very serious dental infection for 6 months. A failed root canal left infected root in the tooth, which caused a major infection, an abscess, a need for another root canal on a nearby tooth, and eventually the extraction of both teeth. I have had a fever for 6 months, since the onset of this infection. I have no other underlying illnesses, no health problems, no inflammatory illness. Prior to this I was healthy. I don't drink or smoke. The only other thing that's popped up during all this is I have a small cyst on each side of my thyroid. But my thyroid hormones test normal.

Prior to having both teeth extracted, although I was sick from the onset of this infection, I got *extremely* sick for 4-6 weeks of it, when I was on no antibiotics. I was having horrible waves of severe flu-like illness, and I could barely walk, I was unable to even drive or talk on the phone. I had photophobia, mental confusion, memory loss, a rash on my arms and abdomen, and some vomiting. Thank God I was given antibiotics, and that phase finally ended after 4 weeks of oral clindamycin. No one has been able to tell me what that was - why I was SO sick during that time. If I had to guess, I think I had an inflammatory reaction to the infection, and this may have possibly caused something like an aseptic meningitis? But I was never given a lumbar puncture, so there's no way to tell.

Anyway, since then I've had both teeth extracted, under one the bone was mushy and some of it had to be scraped out. But, despite that fact, my MRI and cat scans didn't show any bone damage or bone loss. This has caused my infectious disease doctors to not treat this as seriously - since they couldn't see it on the MRI or cat scan therefore to them it doesn't exist. The 2nd tooth was pulled 3 weeks ago, and although that area on my jaw is definitely better, the other area of my jaw to which the infection spread (up towards my ear, concentrated in my jaw joint) still hurts VERY much. And I still have the fever. I do feel better overall, I no longer feel as ill as I did before having the 2 teeth pulled, but the painful ache in the jaw joint area really concerns me. And the fevers are really frustrating - they are low grade, never higher than 101 F, but when I get them I feel very weak and very tired, and have to drop whatever I'm doing, lay down, and apply ice packs. Otherwise I start to feel like I'm going to pass out and start to feel frantic with heat.

Bacteroides gracilis, strep viridans, haemophilus influenzae and parainfluenzae, and neisseria species were cultured from the actual surgical site in the jawbone. There was moderate growth of all 5 of these bacteria. I was started on Augmentin XR and have had some but very slow success, and I've been on it now for 22 days.

A new recent cat scan revealed "moderate flattening of the anterior superior aspect with anterior osteophyte formation" on the TMJ of the side with the infection. This osteophyte/bone spur is new, I didn't have one there in any of my other scans. From what I've read, a bone spur can be caused by progressed osteomyelitis. This also concerns me! But still (thankfully!) the scan shows no actual bone loss. But, because of that, the infectious disease doctors still aren't taking this seriously.

My infectious disease doctors have actually now suggested that I am having "phantom pains" and have basically blown me off. When I ask them about the fever they tell me "it's only low grade" and totally dismiss it. My oral surgeon who extracted the teeth thinks I probably have an osteomyelitis, but he's constantly contradicted by my infectious disease doctors, and I think at this point is even confused himself. Plus, he wants me to follow up with another medical professional in order to get appropriate antibiotic guidance, which I totally understand.

I am just overwhelmed by this situation. I don't know what kind of doctor to go see, or what to do. I just want to get well. I'd be so grateful for any suggestions, ideas, brainstorming, anything!
12 Responses
Avatar universal
Oh, and the area on my jaw that's had the infection this whole time has been very red, swollen and hot to the touch.
Avatar universal
Keep researching and researching. You are on the right track. One article said a three med combination seemed most affective. Antibiotic, fungal, and viral. Also they may need to go back in surgically. Time for a second opinion and a better surgeon. Make sure they are a Maxillofacial surgeon and have experience with osteomyelitis.
Avatar universal
I too have had a similar experience.  I am seeing an ENT doctor. I was on IV antibiotics for 6 weeks and am scheduled for a bone scan tomorrow; still have pain.
Avatar universal
I am so glad I ran across this post.  I am going thru something very similar and don't know what to do!  I had 3 dental implants put in over 2 years ago but haven't been able to afford the crowns as of yet.  I had two teeth pulled in Sep 2014 and the lower was next to this implant.  For weeks I had this unbearable pain and attributed it to dry socket perhaps, but it would not go away.  After two more visits to a different dentist, and the loss of my dental insurance, and an xray, they determined the implant was infected in my jaw bone.  So they removed it in Nov and here it is Dec and I have now a secondary infection and am on 2nd bout of Amoxillian after Clandamiason.  I am at my wits end.
Avatar universal
I hope you are OK due to the lag time since you last posted. I have been reading a lot about these types of problems because after a few months of gum infections around two root canals, I was finally diagnosed with a verticle fracture of the root on one of my root canals. Anyway, you mentioned your bone infection etc. I read where someone told another that they needed IV antibiotics administered. The lady did that treatment and was very grateful for the advice which solved her problem. Maybe you need that too?
Avatar universal
I am having what sounds like a similar problem.  I had really bad infection behind my last tooth on bottom right---came on quickly.   Abscess drained and not better.  Terrible pains shooting up to temples .   Now lips and chin number.  On 2 antiobiotics since original opening of abscess--Flagyl and Clindomycin.  Area of abscess better but pain in face and numbers lingers on.  Have felt very sick.  WBC was normal but this was after many days on antibiotic.  Sed rate high.  Went to dentist first who thought it was salivary gland infection-def not a tooth.  Went to ENT and she said not salivary gland.  They could see infected area.  Was sent to endodontist who said not a tooth but opened the inflamed area which was full of pus.  Went to oral surgeon and ct will be done if no improvement.  This has been miserable and only a week into it---seen some med/dental professional every day since it started.
Avatar universal
I had a hidden jaw bone infection for three years! Symptoms:, flu like feeling, blurred vision, fatigue, wheezing,  nausea, pressure on my head, major brain fog, dry heaves, swollen lymph nodes  weight loss,  tremors and just felt so out of it, like a zombie I had million test all negative. . My ND told me he has seen people come in wheel chairs to his office because of dental infections., many root canal related infections.  I as shocked when I got so sick I was in wheel chair for one week, prior to that I was runner, super healthy eating health food, I saw over 40 MD and five dentists, four oral surgeons. Finally we researched enough and thank God for the web realized there was so, so many people seriously ill  from dental issues They have a group of people, doctor, and dentist that try to help people. I had an expert Dental cavitation dentist do the  surgery to clean out the my jaw bone I had to have the surgery twice. Then I was on ozone IV, took massive doses of  natural antibiotics I have read about the cavitat and maybe a bone scan might be helpful for some people. I wonder if a high resolutions ultra sound is the answer sad this is you could be dying and suffering and it takes so long to get a doc to agree to give you test  Getting on cleansing detox diet, also helps to mop up toxins. Get your doctor to give you TOXICITY TEST.
Avatar universal
My doctor said a bone scan with radioactive tracer goes through your body and it tags the white blood cell so where ever they see a lot of  white blood cells congregating well there is the site of infection most likely,
The SPECT Is the next test to look deeper at hidden infections. For crying out loud,  why can't it all be done at one time when you sick rather than a long drawn out drama!
There seems to be a big debate about this with people that have jaw infections some believe these tests are useless. that you just need a dental cavitation expert to surgical open the sites and take a look  The reason behind this debate may be that may had this test to told nothing was found only to later hire a dental cavitation expert to say well you have big infection in here.
Avatar universal
Sorry this is not an answer as i tried to comment but there was no button to click to put this in, so had to put this in answer area.......has anyone had any help with jawbone infection - I went to dr # 30 today, a maxilliofacial lsurgion no help at all, he was short and abrupt and dismissive, I waited 3 1/2 months to get in and was out of there in 10 minutes. He didn't even read my history that I wrote up. Am I the only one that keeps meeting dr.s like this? This has been going on for 15 years now and has destroyed my health, yet all my blood work says I am super healthy, so why do I feel like hell. I have had mri, ct scan, and xray and that's all doctors seem, to want to do. Cavitat showed huge area of mushy bone that was removed , yet I felt no better, but no worse either. Brain fog is so bad I feel like I have dementia. This started with braces as a 30 year old and first dentist that saw issue said braces caused my wisdom teeth to shift at an unnatural angle that caused infection to go very deep under them and feels like its in the neck along with jaw. I do lots of oxygen and ozone therapy that I believe without it I would be in a wheel chair or dead. Any suggestions would be greatly appreciated thanks !!
What pain do you get? I am going through a smiling experience after having braces a year and a half ago. I had a painful ulcer over a year ago and a subsequent wisdom tooth out 6 months ago due to a possible jaw infection which has only exasperated the pain. All my scans are showing as normal and I am on a course of clindamycin. I am told my incorrect bite after such poor orthodontics is causing the pain and next step is a splint and possibly more ortho wok. My gums and bone under and around the extraction are still so painful and I have terrible constant ear and throat pain. I don't know who to believe as there has not been a clear diagnosis or answers
Hi. If your blood work and scans and all show no infection, then you def do NOT have some infection going all the way back into your neck. You're having serious pain and your mind is locked into the mode and idea of infection = pain and pain= infection. Bad braces can cause pain in all the musculature around there. Injuries dont continue to hurt. You get cut. Even if it heals huge acar stops hurtong. What KEEPS hurting is unnatural loading like a suntle head-forward posture from changed mouth and changed breathing etc. Or your lower jaw is more back now and everytime you chew more pain coming later. There are many tiny sensitive muscles in your mouth. I went to a doctor with last name of hang in LA area who undid the bad part of the braces I had with a saggital. Agora area. He pioneered the method and might know someone near you. I had infected tonsil for a couple years. Then for EVER I thought painful internal pterygoid muscle was my tonsil or gum infected. If its in your neck it's muscle. Get a saggital to push your teeth back forward. I bet someone pulled some teeth to make it "fit". Well it's not fitting.
Avatar universal
If comprehensive medical exam does not reveal any underlying pathology, you may need to see a periodontist to rule out gum infection. In addition, seeing a gatroenterologist to check out gut microbiology, since you have taken a long period of antibiotics , gut normal bacteria may be well imbalanced.
Did the author of this post die? He posted this in 2008 and there's been no update since?  I hope he/she is OK! My jaw infections/TMJ are out of control also.  I had all 4 cavitation sites cleaned out in Switzerland with Piezo electric to make sure all the infected bone was cleared but I'm still MISERABLE! Both sides of my jaw are internally inflamed and I've lost so much muscle mass in my face after these infections were left for so long. Ozone/Oxygen therapies can be bad for you in the long run because of oxidative stress.  I've had chronic gut problems and health issues forever. I'm beginning to feel like diet and detox is really the only thing that helps any of these related issues. Western lifestyle and diet are the real killer here in my opinion. I've changed everything about my life over the past 6 years and I'm still not well.   Surgery has barely helped me. Western life has done the damage already. Still, there's got to be a way to turn this around! I don't believe in surgery anymore. Root canal extractions and cleaning out cavitation infections can only do so much.  Many people are still left sick as a dog!
scottma, all the treatments you mentioned are good, but this person has a serious, new, excruciating problem in the jaw neck and temple. Yet was healthy before braces at age 30. Thats not a poor microbiome. So many people are gettong screwed by orthodontists who pull teeth to solve overcrowding. It should all be expanded out to where the teeth would have grown without poor breathing or childhood food allergies or poor oral posture. When they take teeth out and cram the rest back in, youre in trouble. Less room for the tongue means less air in the head-up military posture. That means neck pain from head poked forward. Jaw pain from chewing. Mandible being off - well the least forgiving dimension for that chewing pain is backwards. If they pulled teeth and pushed stuff back your mandible is too far back, not left or right. And if infection is ruled out then its not that either. Usually a big surprise when people not overweight also discover they have sleep apena because there is less room for the tongue through to the soft palate making bad nightime breathing.
Avatar universal
If you are here and you had braces, then check the hypothesis that the prior braces are part of the problem. They actually moved and changed the bone in your mouth and jaw. (That's especially true if you had the head thing that pushes your teeth back with rubber bands btw). That moving of bone underneath gum and face and maxilla bone and mandible bone made some hollow spots. Infection followed. Bad stuff. Now if your jaw joints hurt and the spaces goimg STRAIGHT BACK between your teeth to that muscle between top and bottom molars hurts thats probably the muscle which mouth muscles are much more innervated and can hurt a lot. And not just going straight back. The internal pterygoids go across way back there. And if the bone where you teeth go on is ok. (Or went in). Then thats not infection. Trust me you dont have infection all the way up past you jaw joints wothout any WBC count signs. And you CERTAINLY dont have infection all the way to your NECK. All those teeny muscles around the TM joints did hurt me more than my infection. Now. Dont make it worse. Just get it fixed. Call the guy I went to name of hang. Or in norcal its hockel. And theres others. In case u think Im an ad for hang, hes old almost retired rich as can be gonna be on tv soon with it treated pro athletes hes not even gonna sed you probably esp if you live elswhere or arent serious. Other thing is, this is only as bad as your overcrowding was. Pnly as bad as your jaws were already retruded. Many people had these exact braces dont hurt. In my case I had naturaly retruded jaws that would have been minor inconvenience and my braces pushed it into awful. Yours is whatever. Caryy it well and get it fixed. mma sirgery might help. But better to do the saggital device that pushes it all forward. If you stand just super straight in your upper cervical spine. Chin tucked, head and shoulders back,  you should still BE. ABLE. TO BREATH. People who never had braces cannot put their head and neck in any possible way that they can barely breath. No matter how strong your middle back is, you wont stand a way you cant easily breath. Your cutting off your cerebral spinal fluid with that posture. It has to drain some time. And Head forward your whole life. While sleeping, walking, sitting lifting eating. Kills your back. Only cuz its unnatural loading. Most injuries heal. They dont just hurt forever. Unless: 1. Deep paychic conflict causing REAL physical pain (the pain is real it's just the CAUSE of it thats from the unconscious or 2. No blood flow (then you imagine heat there and get EECP NAC methyl folate etc) 3. Unnatural loading (like carrying you head poled forward everywhere, chewing with mandible bacl or very far forward maybe idk). 4. Yes, infection will continue to hurt forever. 5. Maybe something I dont know of but I doubt it. But find some drinakble food for two days and see if your tmj "infection" isnt suddenly hurting a lot less. Anyway good luck. I feel sure this is happening to three of the last five posters based on what I heard. If the mod takes names out you want an orthodontist who uses a sagittal or other to fix the bad "extraction/retraction" orthodontics that someone had long ago or even mma surgery if you find someone whos done many of them.
Avatar universal
70% of  mystery illnesses  are dental related according to the top chronic ill specialist in the world.

Look up Dr. Shanklands site it shows the NICO pain patterns caused from dental issues

Before and after dental work my MD put me on vitamin C IV's and eventually I was on ozone IV's weekly and took plant based natural antibiotics . For some reason I was not getting  well

I had three  head/jaw MRI's , panoramic, CAT scan , high resolution CAT scan   all these tests showed nothing...zero. I was very sick a long torturous  5 years One day I had  tooth ache  the scan showed nothing so my old dentist goes let's  do the VITALITY Test.  I was like why did you not do that  before when he knew I had a mystery illness.

I had a dead tooth. It was extract by a new dentist  and the infection was bad it had eaten through the bone and the periodontal ligament was removed it was badly infected. The tooth behind it was infected as well and two were fractured so my old dentist just let the fractures slide. New dentist believe there was infection in the fractured tooth

I saw seven dentist they all told me different things. Not one told me that I had super serious dental infection that was the cause of my mystery illness.

I already noted the bone scan test one would take  that is where they take the blood out spin it take the white blood cells and tag them , they inject it back into your body they they wait awhile and begin taking scanning the white blood cell go to where the infection is.  Another test is the Cavitat, but it hard to find. Then of course the Vitality test.

I was  taking daily hot sauna the one with where you pour water on the rock  and within a few days I had a major toothache. Heat makes poison rise to the surface within no time my tooth was aching  I had tooth extracted.I was amazed that the tooth did not show up as infected on the scan. but it was .  
I have brain fog so bad that I totally forgot about this post.....have you solved your jaw problems yet? I did the cavitat 8 years ago and it showed a huge section in the mandible that was dead, dentist went in and the area was all mush, none of this showed up on xray, ct, mri, ultra sound, and the one that measures heat, thermal imaging I think they call it. It was removed and 9 stitches were needed in the area as was so large, unfortunately I never felt any better. I do lots of detoxing as it seems to be the only thing that helps somewhat. Im curious if you have gotten any answers to your mystery illness and jaw issues? Thanks
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