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Forum Name: Bone infections

Question: Osteomyleitis in tooth socket/jaw?


 Musicman - Sat Apr 04, 2009 10:33 am

Hello- I am 56 year old male, totally healthy and no major problems ever. In 2005 I had my 2 left wisdom teeth pulled along with the molar next to the upper wisdom tooth. Both upper extractions perforated my sinus floor. The dentist who pulled the molar talked me into letting him "debreid" the area after extraction with a dental burr. I have had permanent recurring burning and pain ever since, and a sensation of liquid seepage from the upper site area. I have had numerous dentists and oral surgeons and TMJ guys look at me. I have had x-rays which they all say look great and healed. I had CT scan of sinus (normal & floor healed) but last year had an MRI which the oral surgeon/doctor said showed "bone marrow edema" in the sites. I am aware that osteomyletis/necrosis of the jaw/tooth sockets is a controversial subject. Some dentists recognize this and some do not. I believe the dentist who scraped the molar socket traumatized the area deeply and it hasn't recovered in some way,although a panoramic x-ray from 3 weeks ago looked fine according to my local dentist.
Is it possible to have a low grade osteomyleitis situation around empty tooth sockets from the dental trauma which lingers for years and causes the burning and referred pain?? I have had 3 rounds of bone specific antibiotics which didn't seem to make any difference. I have had some recent success with the herb goldenseal (antiinflammatory and antiinfection). According to some dentists the only recourse is to re-open the gums and re-clean the area. Before I would do anything like this I would like to be positive that it's a necessary procedure.Plus the success rate of these types of surgeries isn't good enough for me, and many people require repeat surgeries after that. Is there a definitive way or scan to tell if there's a problem in the site because many websites say x-rays and traditional scans don't show these things well on the jaw area?

 John Kenyon, CNA - Sat Apr 04, 2009 9:40 pm

User avatar Hello --

This is a fairly complex problem, but it may not be as complex as it first appears. It depends. First, the best imaging method for a clear look is probably MRI. All others will run into varying degrees of difficulty. MRI may not be possible, however, depending upon the possible presence of any metal in your teeth.

What may have happened is there has developed some edema of the marrow due to a rather slow healing process (which might be considered a form of low-grade osteomyelitis), and this may be affecting a distant branch of the facial nerve. A good way to test this theory would be to try a course of medication intended to block nerve pain. If it is effective this is probably the case. Since there appears to be no evidence of current infection it may not be justifiable to re-disturb the area, especially if the symptoms can be managed medically until the problem resolves.

This is far from a definitive answer, but as you've already learned, the area is obscure enough to make the matter highly controversial. You can almost choose your approach via the doctor you decide seems most agreeable. Personally I'd hope for symptomatic relief until and unless infection shows a definite presence via positive blood cultures, elevated white count, fever and local pain and swelling. It sounds as though this could be a long term, chronic problem without any acute manifestation, so if blocking the pain works this may be your best bet.

I hope this is helpful. Good luck to you and please follow up with us as needed.
 Musicman - Mon Apr 06, 2009 9:46 am

Thank you for the response,Dr. Is there anything you can recommend to speed up healing process besides the supplements I take? How long can bone traumas like the socket being debreded take to recover? After all this happened in late 2005. I realize everyone heals at different rates but as I read different online forums there are thousands of folks who have the same type of problem and some for many many years. I read that one gentleman had to go on intravenous antibiotic for 12 weeks.
The only swelling in the area I ever had was right after the upper molar was pulled and I used a hot wet washcloth all evening and awoke with a swollen parotid area like a chipmunk, which only lasted one day.My temperature is usually LOW(96.7), never have any fevers.Weather fronts affect the pain too.

 Musicman - Thu May 07, 2009 6:31 pm

I found the answer. I visited a TMJ/Pain expert/oral surgeon and after some exams he ground down the top of one of the lower molars a bit. It appears the upper and lower teeth were coming together with too much pressure, like having a high filling, causing inflammatory process in my cheek muscles,bone, and surrounding upper teeth.A massage therapist had mentioned to me this might be the cause. It's been four weeks and the area is 99% pain free and resolving nicely. It will take a while, since the area was inflammed for almost 4 years.
 Tom Plamondon PA-C - Thu May 14, 2009 8:44 pm

User avatar Thanks for the update. Good to hear things are working out and pain levels are down.

Take care.

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