Another adventure that I did not — and would not — choose is upon me. Something is up with my lower jaw, and so far I’ve stumped four dentists and an endodontist. Funny; I had never even heard of Endodontics until yesterday when a friend who happens to be a dentist referred me to one.
The whole affair began last year… I had been having some tooth sensitivity on the lower left side of my mouth for a while, and brought it up with my dentist during a checkup. The x-rays didn’t show anything at all, and a visual examination didn’t show anything out of the ordinary either. The sensitivity was a bit vague; I couldn’t say definitively which tooth it was, so he did some testing with a cold probe in an attempt to pinpoint the culprit. Still nothing definitive, so he surmised it might be soreness resulting from nighttime teeth clenching, or bruxism, and suggested I consider buying a night guard dental appliance. I didn’t think that was it; if I were grinding my teeth, would it have come up suddenly? Wouldn’t I have pain on both sides? Why only one specific area affected? Too many questions and doubts on my part to drop $400 on a piece of custom-fitted plastic that may or may not do the trick. At that visit he also checked the bite, where the upper teeth contact the lower teeth, and thought a bite adjustment would help, so did some grinding.
That seemed to help a bit, but about six weeks later I woke in the middle of the night with some really severe pain in that same area that wouldn’t go away. Pain like I hadn’t ever experienced before; maybe an 7 or 8 on a scale of 1-10. I tried flossing, thinking something was jammed between the teeth; nothing. I popped an ice cube in my mouth and put an ice pack on my cheek; still hurt like crazy. It was a really long night waiting for the morning. Between the times trying to get back to sleep I spent time doing web searches for mouth pain, tooth pain, remedies, and the like. Also spent a lot of time gazing at my dentist’s website, wondering how long it would be too early to call; this happened to be a Friday night/Saturday morning, so the office wouldn’t be open at all, so when I did call and dug through the phone menu, I ended up with my dentist’s cell phone number. I called him about 8 am, and wouldn’t you know it, he was out of town. From my description to him, it sounded like an abscess, so he gave me the number of one of his partners, so I called & lined up a time to meet at the office.
Once there, any hope for a quick resolution was shot down right away; he didn’t see anything that would indicate an abscess, and like his partner chalked it up to me grinding my teeth at night. He also checked the bite and made a small adjustment, but again recommended the appliance. He understood my reluctance to spend the money on it, and suggested that I maybe try a football player’s mouth guard; he said that might give me some idea of whether the idea would work, so I stopped and picked one up on the way home. I used it for a while, and didn’t have a return of the intense mouth pain for a while afterward, so I figured either the bite adjustment or the mouth guard was doing some good. I stopped using the mouth guard to see how things went, and… Nothing. The sensitivity in that corner of my mouth was still there though.
Things went ok for a while, except that the tooth sensitivity seemed to be getting worse, in fact it got to the point where it was becoming increasingly difficult to chew anything hard on that side of my mouth. Even chewing on the other side, bits would sometimes find their way to that side, and bringing those teeth together with something even relatively soft would shoot pain down my lower jaw. I decided to try using the mouth guard again, but that seemed to be pushing my teeth around as I slept; when I took it out in the morning my bite felt different somehow. The lower teeth would meet up with the top teeth goofy. I tried trimming parts from that mouth guard to keep that from happening, which didn’t really help. Then I did some research online to see what alternatives there were to the expensive appliances, and bought a couple of things to try.
I had only used one of them for a couple of nights when I first noticed there was a distinct swelling or lump on the gum below the teeth that had been giving me trouble. I thought finally I had something definitive that the dentist could go after; an enemy to battle. I would visit the dentist, he would say something like, “I can fix that,” and I could finally move past this nasty chapter of life. That same night was another sleepless, pain-filled night. This time though was different in that the pain started before I went to bed. There was no way I was clenching my teeth during the day, as doing so would be painful by itself. Night time maybe, but with the mouth guard, that shouldn’t have been possible.
The morning couldn’t come soon enough. It had snowed quite a bit overnight, so I was outside earlier than I should have been shoveling & snowblowing & clearing snow off of cars. I called as soon as the office was open, and wouldn’t you know it, my dentist wasn’t there again. One of his parnters — his daughter actually — was filling in for him, and had an early appointment available, so I took it. When I got there, the assistant took another x-ray of the area, and she came in to check things out. After I explained things to her as best I could, she said that it was probably me clenching & grinding my teeth. I couldn’t believe it. What about the swelling? What about the teeth that seemed to be moving on their own? What about the night guard? Did none of that change her diagnosis? Nope. She was adamant that it was grinding, so she suggested yet another type of dental appliance to keep it from happening. Of course, this one was also $400, and would take two weeks to get. Two weeks?!?! I just about lost it. There was no way I could last another two weeks if pain like this persisted. I asked questions about the appliance and getting it fitted properly and was feeling a bit panicky, but she held her line and offered no alternatives, even produced a form that she wanted me to sign, acknowledging that I understood what she had told me about this appliance. I wanted badly to wad the thing up and stuff it in her mouth, but just refused to sign it. I left in a huff and went back home.
I nearly cried on the way home; I went into that appointment filled with hope that there was light at the end of the tunnel, but afterward it felt like I’d been run over by an oncoming train. I realized that there wasn’t much use in returning to that office; all three of the dentists there had come to the same conclusion and offered the same solution. I didn’t see how they would come up with any other diagnosis — everything looks like a nail when the only tool you have is a hammer — so I started to think of other routes to a solution. Over the next couple of weeks I asked other people’s opinions and did a lot of digging around online, and had the pleasure of a few more sleepless nights as well.
The last straw came a week ago tonight when the pain cranked up an hour or so before I went to bed, and persisted through the night. I finally got to sleep around 5 am, and got a few hours in, then called our family doctor first thing when I awoke. Thankfully they had an early appointment open. The MD was concerned about the swelling below the teeth and noticed that it was even causing some swelling on the outside of my mouth as well. Something wasn’t right. He thought it was likely an abscess even though the dentist had pretty much ruled that out a week earlier, so prescribed a round of antibiotics and told me to give him a call on Monday if things hadn’t improved. That was Wednesday.
Thursday night/Friday morning was another sleepless night. This time though it was pushing up to an 8 or higher; the first time in memory that pain brought me to tears. It was bad. Called the doctor’s office right away on Friday morning, but that’s the doc’s day off, so the nurse promised to contact him and figure out what to do. I finally got a call back mid-afternoon; they wanted me to go in for a CT scan of my head. Great. Oh, and by the way, can you be there in 15 minutes? So I hustled over to the hospital, got checked in, and… waited. Finally the CT tech/nurse came out & said they needed to administer a dye in order to allow the soft tissues to be examined more closely, and for that they needed to first do a blood test. So back to another department to get an IV inserted and blood drawn. And more waiting.
When I finally got into the scanner, it took all of five minutes. But then the doctors needed to examine the results. And it was Friday. So I resigned myself to the fact that I wouldn’t hear anything until Monday, and waited until then to call the office. Friday, Saturday & Sunday nights were relatively uneventful (thanks to ample doses of acetaminophen and ibuprofen) so it was ok. But the news on Monday was discouraging; nothing out of the ordinary on the CT scan, and the doc said I should go to another dentist for a second opinion. Great. There are probably a thousand dentists in Sioux Falls; do I just pull one out of a hat? The answer came at my Bible Study Fellowship meeting that night; one of the guys in my small group is a dentist. Probably a bit of a bother to him, but I hit him up that night & asked if he’d be open to having a look. He was game, so I called his office in the morning and set up a time. That was yesterday (Tuesday.)
The visit with him went well; he had a couple of x-rays taken, then poked around with a probe and checked cold sensitivity on the affected teeth. He was concerned about the swelling on the gum, but didn’t see any other evidence of an abscess, but didn’t want to rule that out, so he referred me to the endodontist. His assistant (actually his wife!) set up an appointment for me for the next day, and that brings us to today. If anybody has made it this far through my long, boring story, thank you! If not, that’s ok too; it’s cathartic just getting this all out.
Today’s appointment was for 3:40; they needed to have all my particulars like any other medical/dentistry office, but instead of having me fill out a form, they have a laptop computer facing the patient side of the reception desk for that task; what a great idea! I hate filling out forms like that by hand because I know some poor soul is going to have to read my poor handwriting and type all of that into a computer at some point, so it makes perfect sense to skip that middle step.
Once past that and the wait, another x-ray was taken of the affected area. The doctor pops in, looks in my mouth and at the x-ray, and doesn’t see what he’s expecting; the swelling tells him it’s likely an abscess, but the x-ray doesn’t, so he does more tapping and cold tests on my teeth, as well as heat tests. The hot & cold tests all point to normal, healthy teeth and nerves, but the pressure sensitivity and the swelling tell him something is wrong, so he opted for a micro-CT scan which is without a doubt the coolest thing I’ve seen all week. The operator had me stand in the machine and put my mouth on a stationary plastic plate, then placed a couple of clamps alongside my head to help steady it. The scanner spun around my head several times capturing the images, and that was it. But the results were impressive. The scans are assembled as layers of images that comprised a 3-dimensional model of the lower left part of my jaw. The doctor could push the model around to view it from various angles. The model first appeared in color, but when he changed it to grayscale, the detail was nothing short of incredible. The software allowed him to view layer by layer through the scanned area from any angle; unfortunately the software was not being cooperative today, and we weren’t able to see much more than the external 3D model, but that was impressive.
What the doctor was able to determine was that it’s definitely not an abscess. There’s no dark spot near the root of any of the teeth involved, but he did notice that the bone in that area appeared “mushy” (his word); the rest of the bone in my jaw looked normal, but in the area behind where the swelling is located looked gray and, not right. He wasn’t sure what to think of it, but didn’t want to make any snap judgments based on what he was seeing, so he was going to get his IT guy to work on things and promised to call me in the morning. What will likely happen from here is a referral to & appointment with an oral surgeon for a biopsy and further diagnostics. I don’t like to think of the possibile results… but we will see. What I do know is that I finally got to a point where I’m seeing the right people who have the right equipment to make the right calls. As for what happens next, stay tuned!
Thank God for modern medicine!