Jaw Pain Worse at Night After Cleaning

[edge10]

I had not been to the dentist for over 10 years (I know this is much too long) and was experiencing pain on one lower side of my gums at night.  The hygienist performed a deep cleaning (FMD)  and a root planning soon after, since deep pockets were found on some teeth.  I also had fillings on the same jaw soon after as well. The gum pain worsened after 3 weeks from the initial deep cleaning and is now also in the jaw. However, initially after the deep cleaning the pain was reduced for a couple of days.

The dentist believes this is cause by night teeth grinding, but don't think so. The pain starts at night while I am still awake and becomes worse when I lay down. After rinsing with Listerine Antiseptic for the past two days it seems to reduce the pain somewhat.   What would be recommended treatment for this pain?

[edge10]

It turns out I had a piece of food caught between gum and a tooth, which had a large filling during the recent dental work.  The food was removed and no infection was found, but the gum had swelled quite a bit with fluid and some numbness occurred in the lip.  After almost three weeks a small amount of swelling still remains and the fluid continues to drain slowly. The numbness is improving slowly also.  I am rinsing will a water and salt solution.

However, the tooth is a little loose if I press my tongue against it and it cannot take full bite pressure. Is this normal healing for this type of condition?  What would be recommended at this point?

[Jerome Tsang, DDS]

Probably another deep cleaning would be recommended.  If they can't get down far enough, then surgery may be needed in which they flap down the gums and clean underneath.  I believe for now though, they would probably put you on antibiotics initially.

[edge10]

It turns out I probably have a gum infection with some swelling, bleeding and a discharge.  What would be the best course of treatment?  I realize there are a lot of variables, but maybe an "if -then" might be the best way to approach this subject.

[Jerome Tsang, DDS]

You can adjust any part of the filling or tooth to fix the bite.  I don't think they'd adjust the tooth too much since that should fit fine.  The filling, on the other hand, is a new addition and most likely to have a problem.

[edge10]

A quick question on the bite adjustment:  Is it possible to just reduce the height of the filling and a small area of  surrounding enamel to adjust the bite or must the top of the tooth contact surfaces always be contoured?  I am not meaning to over-simplify, but filling height reduction be the be the best first method adjust the bite,  since I felt the height after the new and replacement fillings.

[Jerome Tsang, DDS]

Hm.  I suppose the filling may have some excess material from the bonding agent we apply to bond the filling to the tooth that may have coated the tooth during the process.  I would continue the same treatment that you are applying that seems to alleviate the pain.  

[edge10]

OK thanks, I will get the bite adjusted.  Am I correct that the fillings have a coating that dissolves over a short period of time?  The bite certainly felt different in the first 24 -48 hr period and visually I could see a difference in the fillings.

I am continuing the antiseptic rinse and gums have little or no pain.  Should I see a specialist now or only if the pain returns?

I have been using an ice pack on the jaw and joint for the second day this has reduced the pain.  Should I continue the ice pack?

[Jerome Tsang, DDS]

Get your bite adjusted again one more time to see if that'll resolve the issue.

[edge10]

As of this post, after using the antiseptic rinses the gum pain is nearly gone. I started to use an ice pack for the jaw and the pain seems to be less.

Yes, the bite was adjusted for my teeth.  For the first 24 - 48 hrs the bite felt high, but afterward it seemed like the excess filling material dissolved so that the bite is now correct. There is really no pain in the teeth when chewing or eating, but I am only using about 75% pressure since the fillings still tender.  There is no pain in the jaw when chewing or eating, but there may be random occasional twinges of pain during the day.

After this dental work home cleaning routine is brushing 2 times a day with a antiseptic rinse and flossing once per day at night.  2 salt water rinses per day. Usually a water rinse after eating sweets.    Before this dental work the only difference is an enzyme rinse was used instead of the antiseptic rinse and no salt water rinses.

[Jerome Tsang, DDS]

Did you get the bite adjusted for your teeth?  Any pain when chewing or eating?  If rinsing seems to help, there may be another gum infection starting since rinsing removes the irritant.  Whats your cleaning routine at home and with your dentist?  Maybe a referral to a specialist?