any dentists / dental surgeons out there?

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rockermike

Trad climber
Berkeley
Topic Author's Original Post - Apr 30, 2011 - 12:20pm PT
Health problem;
First of all, I'm living in India.
I had a lower wisdom tooth pulled about two weeks ago.
Came out relatively easily and seemed to heal up in 4 days or so.
But after about a week I realized I couldn't open my mouth properly, and its been getting worse. In the morning I can just barely get one finger between my upper and lower teeth. If I work on stretching my jaw all day, maybe 1 1/2 fingers. Maybe two fingers if I really stretch it and ignore the pain.

Am I going to die? Am I going to have to eat through a straw the rest of my life? Or is this normal?

I called my dental surgeon back and he said go to a physical therapist who will apply ultrasound and give me exercises, but I'm having a problem finding an English speaking physical therapist. Otherwise he said he can put me to sleep and force it open with a crank. That sounds painful. What's your suggestion. (by the way, I don't have dental insurance (hell, I don't have any insurance), so I'd like to take care of it before heading back to the USA).

tia
bluering

Trad climber
Santa Clara, CA
Apr 30, 2011 - 01:09pm PT
Micronut. Talk to him.
jstan

climber
Apr 30, 2011 - 01:24pm PT
Quite a bit on the net.

http://en.allexperts.com/q/Oral-Surgery-3405/Lock-Jaw-wisdom-tooth-1.htm

http://www.medhelp.org/posts/Dental-Health/Lock-Jaw-after-wisdom-tooth-extraction/show/453856

https://healthcaremagic.com/healthpage/locked-jaw-after-wisdom-tooth-extraction

Try "tooth pulled jaw locked"

I would expect you will get a response from an ST dentist soon. Worrisome but seems to happen a bit.
FireIntheCity

Mountain climber
from t'Hate-haunted canyon of human despair
Apr 30, 2011 - 04:29pm PT
^^^ anyone? bump
neebee

Social climber
calif/texas
Apr 30, 2011 - 04:43pm PT
hey there say.... oh my, rockermike/tia... how awful... i will be praying you get help with this soon... just saw jstan has a lot of links, at least, to give info, til you get help...


jstan:

wow, never heard of that... thanks for all the info jstan...
rockermike

Trad climber
Berkeley
Topic Author's Reply - May 1, 2011 - 02:54pm PT
bump

Is micronut out there?

The internet is not that encouraging. Some articles seem to say, "not that uncommon, tends to clear up in 10 to 12 days". Others say, "get it taken care of immediately before the scar tissue sets up"? Meanwhile the jaw stretching exercises are painful and getting old. Well I'm 18 days in and its not getting better. Finally found a phys-therapist I'll see tomorrow but I have no idea what he'll do or recommend. Meanwhile stuffing small bits of food between my teeth isn't a fun way to eat. ha
BooDawg

Social climber
Butterfly Town
May 1, 2011 - 03:07pm PT
P.M. Guido.
jstan

climber
May 1, 2011 - 06:59pm PT
See two good Medical Doctors, now.
Lovegasoline

Trad climber
Sh#t Hole, Brooklyn, NY
May 1, 2011 - 07:29pm PT
I have a cousin who is a dental surgeon and who performed oral surgery on another cousin of mine. Something went wrong during the surgery and as a result my cousin emerged with lockjaw, she was in her fifties and from the wealthy side of the family. I was a teenager and had never heard of lockjaw. It was freaky to see my elegant distinguished cousin in her fine clothes and jewels (her husband was a jeweler), her mouth permanently closed, while she talked through gritted teeth sounding like Edgar G. Robinson. I think a nerve was damaged, though it may have been something else and I was shocked to discover that wealth could not reverse this. My mother told me the dentist wasn't sued because he was family, although he must have felt terrible. In any case it was my entrée into the world of botched surgery and it was the only time I ever thought about the ramifications of a dentist's screw up. My cousin was never healed of her lockjaw and she always spoke a bit like Edgar G.


A couple years after my cousin's lockjaw I had four wisdom teeth pulled using sodium pentothal: afterwards I recall swelling, soreness, and painkillers which I'd think is normal after such a procedure, but it only lasted days not weeks. I second the advice about seeing a medical doctor ASAP. Hopefully you just have some post surgery swelling and stiffness, but you should confirm this with a doctor. In the event that it is something else, or more serious like an infection that could result in permanent damage if left untreated, time is of the essence. Don't rely on physical therapists or Supertopo, see a real doctor.

The dentist, "said he can put me to sleep and force it open with a crank". Well it's a step up from using a crowbar.

Edit:
Did you have a tetanus booster shot?
http://en.wikipedia.org/wiki/Tetanus, states that the incubation period for tetanus is usually about eight days which is consistent with the timeframe in your post.

Just my 2 cents from the peanut gallery.
Good luck.
johntp

Trad climber
socal
May 1, 2011 - 09:22pm PT
I've sent an email to a dentist friend of mine; hopefully he will respond.

Hope it can be fixed; sounds freaking scary.
Hummerchine

Trad climber
East Wenatchee, WA
May 1, 2011 - 11:09pm PT
The TMJ (jaw joint) can get inflamed or even permanently damaged during a lower wisdom tooth extraction, but this typically occurs when the patient is put to sleep for the procedure. It could certainly happen when conscious, but I would think you would have been aware of either rad torquing on the jaw, or having the jaw forced too far open. It does not sound like any of this happened from your description. The fact that it started a week after the extraction leads me to suspect a spreading infection; this is an educated guess after nearly 30 years of dental practice and thousands of extractions. I'd get back in to see the dentist, or even go to a hospital, immediately for likely antibiotics. If it is what I'm guessing it could be life threatening; if it's too dicey over there and gets any worse, fly to the USA (that is what I, personally, would do if it was me). On the other hand, it could be an unusual reaction to being open for a while and may settle down with high doses of ibuprofen and/or physical therapy. This is the best advice that I can give without seeing you as my own patient; if it's bad enough for you to be posting here and getting worse, I would assume the worst and get medical help immediately!

Best wishes, please let me know how it turns out.

Tom K. Michael, D.D.S.
rockermike

Trad climber
Berkeley
Topic Author's Reply - May 2, 2011 - 10:52am PT
thanks everyone for advice, especially Tom.

Going to see PT later today but in the meantime some more info

I'm pretty sure its not a joint problem. Everything feels in place. And I've been taking a lot of antibiotics (recent course of Cefixime and Metrogyl). And earlier (at time of extraction) a couple of others including Flagyl. And there is no sign of infection as far as I can tell. It feels like the jaw muscle is just frozen. Mouth opens for the first inch just fine, then pain and limited further motion on the side of the extraction. Something I read said he may have injected into the muscle, or directly into the nerve (not sure), which I guess is bad. There was no cutting involved in the extraction, just a Novocaine injection or two.

I guess unless the PT is real sure he can fix it I'll go see a doctor tomorrow, (there are good doctors here, you just have to find them). Leaving to Thailand on Saturday which complicates the whole thing a bit, but not back in the USA for a month.

"The dentist, "said he can put me to sleep and force it open with a crank". Well it's a step up from using a crowbar."

I put that in rather crude language for the sake of a little humor, but he was serious. I guess there is a good chance that the muscles have just tightened up due to scare tissue. I had that happen to my shoulder once. Had it in a sling for 3 weeks, then it wouldn't move. But forceful and painful movement eventually loosened it up. I'm hoping that is what is going on with my jaw.
micronut

Trad climber
fresno, ca
May 2, 2011 - 11:41am PT
Hey Mike,
This could be a big deal or a fully self resolving problem.

Tom had some good insight, but here's a couple questions for you. I might be able to help once we find out what is exactly going on here. Please answer each of these. The first seven hint toward infection, the next few towards inflammation. That's the crux here.

1. Is there any swelling on the outside of your face?

2. When you look inside, is there much swelling of the tissues down near the root of the tooth? Like a soft golf ball or larger swelling of the cheek and gum?

3. Do you have a history of this happening before?

4. Are you using any "street drugs" or controlled substances? (pm me if yes)

5. Are you feverish, even a little bit?

6. Is your cheek hot or red to the touch?

7. Do you have a sore throat on that side?

---- IF NO TO ALL OF THESE, I'm fairly optimistic that we're dealing with trismus, a fairly common post-op problem that can range from mild to severe. We usually treat it like a joint/athletic injury. It usually resolves with time and stretching...but I have a few more questions.

8. Are you having ringing in your ear on the affected side?

9. any facial paralysis, drooping of the eyelid, corner of your mouth?

10. Any pain when not trying to open?

11. Is it getting worse daily? Better? Staying the same...the range of opening, that is?

Answer these for me and I'll have a better idea of how I can help.
A few observations. Those antibiotics are not the standard of care if you do have an infection. Do you have a Penicillin allergy?
DO NOT LET AN INDIAN DOCTOR DO ANY MAJOR TREATMENT FOR THIS!!!!!!
Ive been to bangladesh and Nepal and lectured there in dental schools and medical clinics. The training is inferior and scary. Some great doctors come out of there, but GET TO THE US if this thing turns downhill. Your future health depends on it. Don't try to save a buck. Get this taken care of if it gets worse.

E-mail me, or I'll check in here. I hope its no big deal and that a little heat and stretching and possibly a steroid can fix this.

Scott

Hummerchine

Trad climber
East Wenatchee, WA
May 2, 2011 - 12:03pm PT
Well put, micronut...
rockermike

Trad climber
Berkeley
Topic Author's Reply - May 2, 2011 - 01:19pm PT
thanks Scott,
the answer to all but the last question is no.
on number 11, well, not getting better. Its very stiff first thing in the morning, (one finger gap), then I work it for awhile and it gets a little better, 1 and 1/2 finger gap (between teeth). this is a little less then some days back, but I think I've been doing less vigorous stretching over the days so that may explain it.

The PT (doctor of phys therapy (physiatrist as they call it) and an MD and a professor at Kolkata hospital (of course being a professor may not mean much here??), anyway, he didn't seem to be too concerned. No sign of infection, joint in place. A few other things he checked for. then he ordered 10 days of ultrasound treatment to effected area. He thinks its just a spasm in the muscle.

Good news is he checked for pretty much all the things you listed - so hopefully he knows something.
micronut

Trad climber
fresno, ca
May 2, 2011 - 02:34pm PT
Those are all good signs. Most likely, the joint and its associated muscles are responding either due to the general irritation of being opened wide during the procedure or from injection of the local anesthetic into the muscle or possibly the joint capsule area. Its pretty common. As long as the joint itself is in place, we don't call it "lock jaw." Its mostly a muscular phenomenon.

1. 800mg advil twice daily for 7-10 days

2. warm compress 10 on 10 off twice or three times daily.

3. gentle passive stretching....with your thumb down, head tilted back...for 20-30 seconds several timest throughout the day. I go 10 seconds stretch...rest 15 seconds...20 seconds stretch...rest....30 seconds stretch....rest....30 seconds stretch....then firmly massage both "cheek" masseter muscles

4. you can also massage your temporalis muscles (flat thin muscle above your ears and around the temples)

5. I believe in massaging the trapezius/shoulder and scalene/neck muscles as well. Its all connected.

6. SOFT FOODS. Really SOFT for ONE WEEK. no exceptions. NO NAN FOR YOU!!!!

7. A medrol dose pack can really help too...solumedrol, a steroid in a particular exact dosing pack. But somebody with a thorough and accurate diagnosis needs to prescribe this.

8. Hydrate well. lots of water. cut down on tea and coffee and stimulants, they make the muscles fire on an almost microscopic level...that tremor at the muscle fiber level is not what you want going on when the muscles need to relax.

9. (Muscle relaxants are sometimes used but I have no experience with them and I usually see relief with the above treatment.)

Good luck. Here's a few shots from my last trip over to that part of the world. I miss good tea and the smiles of villagers. Let me know how it ends up.

Credit: micronut
Credit: micronut
Credit: micronut
Credit: micronut

altelis

Mountain climber
DC
May 2, 2011 - 02:43pm PT
Micro- you ever see this short film?
http://www.youtube.com/watch?v=WR8tIjTykbE

I was about to go on a mission last summer- I forget the program's name- but it was for medical, nursing and dental students. Small group, about 15 ppl, including the students and MD's & DDS's. Travel throughout extremely rural northern India, doing standard medical mission work. Tried to get my dad (DDS) to come along as well. However, I heard through the grape-vine it was more "medical-tourism" than "medical-mission", and given the cost, decided not to go. Sounds like your trip was really great!
micronut

Trad climber
fresno, ca
May 2, 2011 - 02:55pm PT
Altelis, that film was awesome! Thanks. It made my day. My wife and I have been to Nepal three times in the past year and a half, by ourselves with a small team, while partnering with some local Nepali Christians who are dedicated to spreading Christ's love to the untouched, unreached, outcast of that country. Its heavy duty work and a great blessing to be a part of.

Credit: micronut
Credit: micronut
Credit: micronut
couchmaster

climber
pdx
May 2, 2011 - 03:26pm PT
Good luck Mike!
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