HomeAnswersDentistryjaw painWhat causes pain and pressure in the jaw and gums, respectively?

What happens if a tooth infection spreads to the bone?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At August 22, 2022
Reviewed AtJune 23, 2023

Patient's Query

Hi doctor,

I have been experience pain on the left side of my jaw and pressure in my gums for the past three weeks. I wanted an opinion about what is visible on the left side. I am attaching an X-ray taken two months ago. Is this type of scan sufficient to determine cavities?

Hi,

Welcome to icliniq.com.

I read your query and will be answering it shortly.

Patient's Query

Hi doctor,

Thank you doctor for the reply.

Kindly have a look on the attached reports.

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern. Let me know if your gums are bleeding or if you need a prescription for pain and pressure.

Patient's Query

Hi doctor,

Can you tell me if the infection is visible? My dentist performed an incision two months ago to drain the infection. I have been on antibiotics for ten days. Unfortunately, the pain is still persistent. I had a painful surgery in that area a year ago, and the dentist planned to fix missing teeth with an implant. Hopefully, the infection will subside.

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern. I was also thinking of a deep gum infection. The infection of the gums will not be visible on an X-ray. It is just a two-dimensional view of your teeth and jawbone. However, I can see a lot of bone loss from the attached image (attachment removed to protect the patient's identity) because you have lost several teeth, like the upper molars and the lower second molar, so there will be bone loss. This bone loss can lead to granulomas or gum infections because the gums are constantly exposed to the outer environment.

Please start lukewarm salt water rinsing five to six times a day. That will help reduce your swelling. Also, if you are already on antibiotics, then this pain indicates you still are not rid of the infection. I suggest Metrohex gel (Metronidazole oral gel) for gum application. Start Chlorhexidine mouthwash regularly. Consult a specialist doctor, discuss with them, and take medications with their consent.

You can also consult your dentist about cast partial dentures (CPD) instead of getting an implant in the left jaw's upper or lower arch. That is because you have a high risk of implant failure from my point of view. After all, you have a persisting gum infection. A CPD is better than a removable denture, so you can go for that. You can ask me anytime if you have any further doubts or queries about implants, dentures, or gum infections.

I hope it helps.

Patient's Query

Hi doctor,

Thank you for the reply,

The plan my dentist proposed is indeed a hybrid bridge and not an implant, as there is plenty of trauma there. I am glad to hear that you support his opinion. I had sinus and flap surgery in that area a year ago. Also, is this scan suitable for determining cavities? Should I be asking for more checks?

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Do you have any reports of sinus floor elevation or flap surgery? Because if your bone density is fine there, then there is no issue in going for an implant. But a hybrid bridge is better because now you are having another round of gum infection.

Visual inspection is always better in determinig cavities. If you have any cone beam computed tomography (CBCT) scans or any three-dimensional (3-D) scans, check and let me know. That would be a more helpful record in determining your tooth condition than the orthopantomogram (OPG). You can ask the dentist to check your teeth once again when you visit next time for cavities.

If you have any previous records of your sinus surgery in written form or X-rays like CBCT, you can forward me that, and I can give you the exact picture of what you need.

Patient's Query

Hi doctor,

Yes, I had a CT scan as well to check if the sinus is okay. I will ask for this copy too.

Hi,

Welcome back to icliniq.com.

I will study the reports and get back to you shortly.

Patient's Query

Hi doctor,

The pain unfortunately has returned. There are no cavities in the region visible? Indeed the dentist recommends having a hybrid bridge and avoiding implants as they are very traumatic. If there's no infection I wonder why the pain has returned.

Hi,

Welcome back to icliniq.

The sinus looks fine and the OPG too. Can you exactly let me know from which upper or lower right or left tooth you are now getting this relapse in pain? can you pinpoint the tooth that is paining or you are just getting generalized pain in that area? Let me analyze your OPG again and then tell you if any tooth is pending for root canal. Let me know the region of tooth pain.

Patient's Query

Hi doctor,

I am attaching an X-ray from this morning. The pain is always on the upper left side. No one can identify the cause. It has been like this since the surgery which took place one year ago.

Hi,

Welcome back to icliniq.com.

Yes, it may be because there is no problem with your tooth as such, now that I am again restudying the boundaries of the sinus in the upper left side, looks like a mild gum infection there. In fact, you even said you got an incision drainage done there right? For some reason of unknown origin, the infection there is relapsing. You will need to consult a maxillofacial surgeon specifically in the clinic if this keeps repeating again and again. But I would suggest that the best remedy is you start with a 3-day course of antibiotics and painkillers every time you get pain in that area. Take a capsule of Augmed 625 mg (Augmentin) and a tablet of Dolokind plus twice a day after breakfast and after dinner. But in my opinion as a surgeon, you should not go for a dental implant till this Infection subsides completely. So I would suggest you right now to start with the antibiotic course for three days and then consult your surgeon in the clinic so that he will examine the area in the clinic because the infection of the gum is clearly seen on the upper left side where the molar is missing. Only after the infection subsides go for a dental implant for the upper left molar.

I hope this helps.

Patient's Query

Hello doctor,

Can you see the infection on the X-ray I sent today to you?

Hi,

Welcome back to icliniq.com.

On the X-ray today, it seems very mild or negligible (attachment removed to protect the patient's identity). I can see clearly on the OPG and also your symptom of pain on the upper left side is matching with the small-sized ball of infection there. So it looks like a recurrent infection. Please start with the antibiotic course and then visit the maxillofacial surgeon. After you get the implant done or before, do let me know what steps they have suggested so you have a second opinion for safety.

I hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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