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Migrating Infection - Viral or Bacterial?


I am not comfortable with my dentist's assessment of a recurring problem in tooth #3. FYI - #1 (the wisdom tooth) was extracted 30 years ago, and #2 shares a common crown with #3. I am pretty sure both teeth had root canals.

For the second time in 4 months, I have had severe pain start underneath the shared two-tooth crown, in exactly the same spot under #3. In both cases, this has begun during an extremely stressful period. As the pain progresses, there is initially no gum inflammation at all - just an ever-increasing pain that shoots from under the surface of the tooth right through the roots into the upper palate.

The first thing I have noticed in both instances is that the tooth or crown itself feels like it is being pushed downward by internal swelling. The space between #3 and #4 gets bigger, and the #2/3 crown descends just enough to become the sole point of contact with the lower teeth on that side.

There is no sensitivity to hot or cold, and tapping on the crowned molars in front of and behind this specific crowned tooth causes no direct pain - it is extremely tooth (and possibly even root) specific. Within 24 hours of the onset of the pain (during which I can't chew anything on that side of my mouth)  the gum next to the tooth adjacent to the cheek becomes more and more inflamed, forming what looks like the photos I see online of an aphthous ulcer, red with a white point or center.

Even though most of those images show them forming on the inner lip or cheek, mine are on the gum, just above the tooth. The difference in the inflammation between the inner gum (closest to the tongue) and the outer gum (touching the cheek) is dramatic - there is virtually no inflammation or pain in the inner gum.

There is a 48 - 72-hour period where the pain is severe, and during this time, the infection seems to migrate to the outer surface of the gum, forming a white-colored lump. My dentist attributed this to impacted food under the gum.

The first time, after a few days of severe pain, this lump became extremely soft in a matter of hours, took on the the appearance of a water blister and burst on its own, releasing clear, tasteless fluid. From that point on, the pain and swelling subsided very quickly, leaving an open sore that healed over several days.

This time, the infection has traveled all over that side of my face, again with the pain starting under the same crown, then forming a painful sore on the outer side of the gum.

However, this time, even after 5 days of amox 500mg, the infection has spread into the adjacent cheek, making it heavy and swollen, to the extent that it appeared I had several cotton balls stuffed into my mouth.

Within 24 hours of this cheek swelling, it began to recede, and the firmness in the cheek and facial skin moved up my face, forming a long, leathery red mark along one side of my nose. This mark became very sensitive, and again overnight, decreased into a small pimple-like red spot to the side of my nostril. This spot looks like it could erupt similar to how a cold sore might erupt on a lip. Meanwhile, other parts of my face, including my lips and other skin areas have the tingly feeling that comes before the onset of a cold sore.

FYI - I never get typical cold sores on the outside of my lips - I do, however, get occasional canker-type sores on my gums, and occasionally on the inside surfaces of my cheeks or lips. Because I get these from time to time, I feel this is a similar, non-bacterial occurrence.

The dentist is one one hand treating this as a bacterial infection, but also suggesting removing the crown from the molar, determining if there is a need to repeat the endo on that tooth, and at the same time, expects to see evidence of impacted food.

I am feeling that after six days of amox 500mg (2x/day) with this amount of migration around my face, combined with the itchy, tingly sensations I associate with viral infections, that the dentist may be barking up the wrong tree.

Today, 6 days after this episode began, the pain under the tooth is 70% gone, still throbbing, though. The inflammation on the gum from my incisor all the way to the back of my mouth is still very present, very soft and palpable, and there is inflammation along the inner surface of my cheek as well as numerous facial tingling areas, plus the "pimple" spot which seems to have concentrated in the exact center of where the red line extended along my nose overnight.

Is this still worth pursuing as a bacterial infection or is this more likely a virus that just needs to run its course?
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