post third molar extraction insanity -- help!

Factual Questions
1

First off, let me say that I am visiting my dental surgeon regularly, and will do so again as soon as humanly possible. However, I am wondering if I should seek out another dentist for consultation, and of course I am wondering what the hell is wrong with my face.

I am 41 y. o. and have enteropathic arthritis, for which I inject myself weekly with Methotrexate, an immunosuppressant. On December 4th, I had three third molars extracted. The lower left one was (I think) horizontally impacted, and required a big nasty hole. Two weeks of nastiness followed. I received Dexamethasone to help with the swelling for the first few days, and after that stopped, I really crashed. Nothing seemed to do much for the pain – I had Ibuprofen and Tylenol #3 – so I just sort of muddled through each day until gradually things got better. At the end of three weeks, I visited my dental surgeon, and he said that there appeared to be a bone spicule at the site of the lower left extraction, and that if it did not heal over on its own, he would need to go in and grind it down. This didn’t appeal to me much, so I tried to rest over Christmas as much as possible, in between cooking and cleaning for seven all week. But I digress.

On January 15th I visited the surgeon again, since he was back from holidays and wanted to check out the lower left extraction site. He felt around the area, which was improving with virtually no remaining swelling and ever-diminishing pain. Though I was still pretty tender, he said that the area felt normal, there was no further sign of the spicule (I had flushed out a few bits rinsing here and there), and that all should be well with the normal extended healing time for someone of my age and immunosuppression. He also gave me some Clindamycin for ten days, since I had developed my first-ever case of sinusitis directly subsequent to the extraction – he expressed doubt that the two were related, and I expressed doubt about his doubt, and went off with my Clindamycin (which later my GP said was not a good choice for either sinusitis or someone with a GI like mine). But I digress.

It was at that point that the problems really started. The next day, I was eating a rice krispie square, heard/felt some cracking, and later that day noticed visible swelling to the left lower side of my face. Since I wasn’t sure if it was caused by the previous evening’s palpation, or what, I carried on.

By Saturday I made an emergency visit to the dental surgeon. The swelling and discomfort were pretty well scaling right back up to post-extraction degrees. He flushed out the small wound that remained at the left lower site using saline and suction, said he got out a bit of white matter but no pus or signs of infection existed, and gave me the syringe to use at home with a short lecture on how some people have the bad luck to have more difficult recoveries than others. I asked about possible fracture, telling him about the rice krispie incident, and he declined to do an X-ray, saying the possibility was extremely remote. I actually felt a little better following the flushing, and went home hopeful.

Since then, I have gone from an Angelina Jolie jaw to a Karl Malden jaw on that side, very visible, very tender to touch externally, and periodically I have throbbing, exquisite pain that subsides with warm saline flushing and Tylenol. I am having increasing difficulty opening my mouth past a slot to insert food in. For periods throughout the day, however, the throbbing pain disappears entirely – unless of course I nudge that side of my face or eat something. I find the difference between the bouts of pain and its relative absence bizarre – almost like trigeminal neuralgia in nature (I forgot to mention I still have some numbness down the left side of my lip/chin, but who gives a flying fig about that).

I have not missed a day or even an hour of work. Just had to put that in there because I’m getting pretty cranky. I started a new job January 8th, and the last thing I need is some stupid dental absence. Also, I have increasing mistrust regarding my dental surgeon.

ANY sort of advice at this point would be welcome. Well, maybe not neutraceuticals.

2

See another dentist. If you don’t have trust in your doctor/dentist I firmly believe you should at least get a second opinion. Even with a suppressed immune system it seems to me you should not be in this much pain after extractions.

Standard disclaimers apply: I am not a doctor, dentist or lawyer. nor do I play one on TV. Wash hands after applying. Do not allow children to play with this advice. Do not allow this advice to become wet.

3

I’ll need to find someone who can do sedation, because I don’t think anyone could even get a good look in there right now without it.

4

In early 1992 I got an excruciating pain in my chest. The doctors were useless.

In early 1993, I visited my dentist, it turned out that my left lower wisdom tooth was rotton. First he root filled it, the chest pain disappeared, but the tooth was sensitive so he extracted it. Naturally it broke up and had to be cut out.

It healed fine, but a pain in the socket built up - a constant knawing pain that can get sharp, but is never bearable - and does not go away. It feels like an electric current.

I’ve been to numerous doctors and dentists - doctors just send me to dentists, and dentists are not much use when there is no tooth - not that it prevents them prescribing lethal things like Carbamazepine (Tegretol), diagnosing ‘stress’ (?) and hacking it open.

I’ve had it cut open three times, twice they froze the nerve physically, another time they froze the nerve using Glycerol.

I’ve been informed by Eastmans that I have ‘Atypical Facial Pain’ and the treatment is a combination of mild antidepressants and placebos (??), I’ve also been told that I have ‘Neuralgia of the Trigeminal’ but the UK’s topmost neurosurgeon for Trigeminal Neuralgia said it was not his type of Trigeminal Neuralgia - and shipped me off to yet another dental consultant.

MRIs either show nothing, or curiously one showed signs of infection acording to one radiologist and the same film showed five minute fragments of metal according to another radiologist.

I finally found that the people who hack around with jaws are called Maxillo Facial Surgeons - I went to one in late 2003 - the guy just lied to me, both about the time it takes to get an MRI read (he said 2 weeks - it was ‘always within 48 hours’ according to the staff) and about the treatment - what he told me was directly contradictory to what he wrote in the letter to my dentist and doctor.

He told me that hypobaric treatment (sit in a pressure tank to force in oxygen) would fix it, but in the letter it was quite clear that he had no clue whether it would work, and his main concern was that the treatment should be as ‘cheep’ (sic) as possible as I was self funding.

In Jan 2004 I went to another Maxillo Facial surgeon, he cut the thing open, I had another hyper expensive MRI - and then the b/stard gave up and sent me an appointment with a pain clinic.

Basically you need to see a good Maxillo Facial surgeon, and as fast as possible, don’t worry about your job, if you follow the same route as me, you’ll be barely capable of working and your life will disintegrate.

I wish you the very best of luck, and urge you to get the thing sorted out regardless of any consideration - also watch out, there are cranks in the market who talk about ‘cavitations’ and use scientology like equipment to locate it. You can find them on the net - I visited one in July 2001 - a memorable experience.

Follow this link:
http://answers.google.com/answers/threadview?id=495044

The original poster is obviously nuts, probably due to medication, but the attitude of the doctor (ChineseCroupier) is a warning of what can happen.

Best of luck - and please keep us informed.