Can extensive dental implant work cause reactive lymph nodes?


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Sep 2, 2020
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I have been going through dental implant placement since last November 2019 which was with a surgical guide placement for 4 implants 5 hours in dental chair and had to have two of those removed in February due to the fact that more bone needed to be grafted in. We went back in end of April to replace the ones that were removed. I had normal dental pain of course for a couple of days not bad but at the end of fourth day I had a very painful spot in the back of the right side of lower jaw radiating down to my gland. Almost like a side effect of the novacaine needle shot. I took 800 mgs. of Ibuprofen for it and it basically subsided for the time being. In June, it wasn't getting better with the gland and I went in to see my dentist and he said the swelling was no way near the implant and that I would ordinarily see the ENT but he would only send me back to them hmmmmmm....and prescribed clindamycin for 7 days - took x-ray and then said I am booking you for periodontist for possible removal of that implant in three days. So we did that and the periodontist said swelling would improve which it gradually did. I did have a very sore salivary gland after that especially after eating. Eventually that resolved but I continued to have a sore spot where in the back where I believe again the needle was placed. I went to see ENT and he said that there was a small skin absence there and it was draining like a boil. Most likely due to needle insertion. He prescribed clindymycin for 10 days and it helped it drain. In the meantime he sent me for CT scan.

At followup the results surprisingly the results did not show anything in the infected area, clearing up nicely and no further antibiotics needed but he told me that I had a 1.5 cm mass in the submandibular region on the LEFT (Incidental finding) that would need further investigation and booked me for U/S. We also did my thyroid as I have benign nodules that needed followup - last U/S was seven years ago along with a negative biopsy back then.

I had another follow-up of U/S results with ENT - thyroid ok - check in another year. However, the radiologist was unsure of the node in the submandibular area whether it is just enlarged gland 1.5 cm or abnormal gland - same as on original CT and said FNA should be scheduled. Said it could be tricky to get into the area. ENT said well we just go in normally and remove it. I said I would prefer biopsy first as this was discovered incidentally and has not bothered me before. (I'm thinking with all my dental work of course this could be a side effect). My periodontist said I just think the ENT is being extra cautious.

I had a followup with periodontist following week and the boil was still draining - he prescribed levoquin for 10 days and said that would knock it right out.
Yes it did even though I was hesitate to take this antibiotic with all the side effects listed I took it anyway. Fine - it cleared but after about 2 weeks I noticed the draining again. I am seeing my perio next week.

I had biopsy this week. Radiologist was an expert at his technique along with guided U/S and was able to get three good samples both superiorly and anteriorly to another smaller node which had a fatty hilum (good) and then was able to get inside the node. I heard him say to technician is it 1 cm and she said yes. (I remember seeing on report it was 1.5 cm originally so it may have gone down and may have been reactive. My followup is September 22 - i figure if anything bad they will call but still like everyone on here I am stressing.

Seeing periodontist next week to see if anything further needs to be done for site where I had injection for novacaine. Some days it looks good - other days like it still has a little infection in it.

So I have had full dental CT scan when I started this journey and no nodes showed up on these and what I am thinking is that all this dental trauma and implant surgery and removal and more bone having to be put in can of course cause lymph gland swelling in the floor of the mouth. Because I did have reactive nodes under chin which cleared as I healed over the weeks.

My upper few implants are fine and that is complete - it's the bottom that has had complications since more bone was needed and that takes 6 months to get to the point where the implant will be able to osseointegrate into the bone.

So was it a good time to get CT scan and U/S when my body was reacting to all the dental work? I think probably not - because of lymph node reactions.

Thoughts?

 
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Dr M

Verified Dentist
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May 31, 2019
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Good day

Lymph nodes can sometimes swell up if there was an acute or chronic infection.
Was the implant on the affected side removed by the periodontist or is it still in situ? How is the bone looking around the implant? Did the additional bone augmentation integrate well? If it is not healing, the bone graft or implant might be failing and this " infectious" and inflammatory process might be contributing to the lymph nodes that feel palpable.
If there is infection in the bone, it could lead to areas of necrotic bone and osteomyelitis which will need to be scraped clean after implants were removed. I have seen cases with osteomyelitis which also have small draining areas.
Unfortunately without and post op x-rays or CT scan it is difficult to give an opinion about if this could be a possible cause.
It doesn't always take 6 months for implants to integrate with bone. I have restored cases where implants were ready for loading in about 10-12 weeks. This might be longer in your case, because of additional bone grafts.
Based on you past medical history of benign lesions, I think it is prudent that the ENT is being over-cautious about the submandibular mass.
 

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