Toothache in the right side of the mouth with swelling in the jaw under the ears

[Du_deleted]

I had some fillings on the left side last year. I will get regular cleanings done.I have toothache in the right side for past 2 days.it started after I take fish and chicken after a long time.means I didn't eat those past 2 months. I did chew those a lot.it started off with dull toothache on the right side.it was there on top side first. then I felt some pain on the down side too.it was like needle pain and the whole right end side is not comfortable. I avoided eating on that side past 2 days. today I see some swelling on the end of the right down side.its close to my ears and end of the jaw. I have already taken wisdom tooth on the lower side and upper wisdom tooth is still there. I have bad breadth and smells very bad. the Swelling is at the end of the lower jaw. does it related to any tooth or sinus issue?I have sinus issue and never had any swelling like this before. I am in US. what could be the issue? upper wisdom tooth has small cavity. Lower ones doesn't have any cavity as per last x-ray. The swelling is little but feels very uncomfortable inside the mouth. But not very continuous pain in the tooth. I am able to eat and drink hot liquids. What could be the reason? The little swelling is on the upper and lower jaw side. Exactly under the ears. No pain when I touch any tooth or gums. Only the jaw hurts while I touch.what could be the reason? I am in the US and feel scared to go to dentist. That too in this current covid-19 situation, I am very nervous.
Whenever I open my mouth,it hurts on that side and hear some scratchy noise in there. The swelling is small only. Will it go away on its own.

Please share your inputs.

Edit to add: it gives a sharp pinch like pain in the right side sometimes lower and sometimes on the upper side. I see swelling only today. The pain was there for past 2 days. I feel like shiver and chill along with bad breath. Checked my temp and it's normal.

 

[Du_deleted]

Is it related to my tooth or ears? Anyone have any inputs?
I feel some discomfort inside the ear and under the ears where I see some little swelling. Should I check with dentist or general physician?

 

[honestdoc]

It's impossible to diagnose your problem. You may need to get a pano xray to check LR wisdom tooth. I don't think it is related to your sinuses. If you have pain on your upper teeth when you bend forward or going up & downstairs, then your sinuses are the likely problem. You may need to go to the dentist first to rule out any teeth problems before you go to the physician.

 

[Du_deleted]

It's impossible to diagnose your problem. You may need to get a pano xray to check LR wisdom tooth. I don't think it is related to your sinuses. If you have pain on your upper teeth when you bend forward or going up & downstairs, then your sinuses are the likely problem. You may need to go to the dentist first to rule out any teeth problems before you go to the physician.

Thank you doctor for the reply.
I tried bending down. I feel some pinching feel pain in the upper side of the mouth, ears, under the ears. Nose and head feels very heavy.
What is LR wisdom tooth? I had my last x-ray on July 2019. No cavities deducted on lower side of the right side teeth. Only cavity in upper wisdom tooth.
Whether the pinching needle pain in the lower end of the jaw under the ears is because of tooth issue or sinus or ear ? I also feel some scratchy pain inside the ear from this morning. It's inside the ear.nose and ears completely blocked.

 

[honestdoc]

Sorry, I missed your lower wisdom teeth were previously removed. Just make sure you have no urgent dental problems by seeing the dentist and have your physician check you ears.

 

[Du_deleted]

Sorry, I missed your lower wisdom teeth were previously removed. Just make sure you have no urgent dental problems by seeing the dentist and have your physician check you ears.

Thank you doctor. I will check if any dentist office opens in my area. Most of them were closed for a long time. I am able to chew and swallow food. I am not sure why I get this all of a sudden.
Thanks for your reply.

 

[Du_deleted]

I just have another quick question doctor.
After removing the wisdom tooth, will it grow again? I removed my both lower wisdom tooth a decade back.
Yesterday, since I had swelling my husband checked all of my tooth on the right side if any gums are red in color. And he said he can see something like white spots on that spot where I had wisdom tooth before. When I run over my tongue there, I couldn't feel anything apart from some hard surface there.
We couldn't get a clear picture of it when we take it from camera. Whether we get the tooth back?
Also, I have TMJ problem I think. I haven't diagnosed yet. My dentist once told me that I am grinding my teeth a lot during sleep and he can see the edges.
I hear some popping , stretchy sound whenever I open my mouth and swallow something.

 

[honestdoc]

Your wisdom teeth won't grow back. You may be experiencing stress and grinding and clenching. That could deteriorate your TMJ. In the US, dentists are opening up. I have been seeing emergencies only since the closures so you should find a dentist to get it checked. You could go to the drug store and pick up an OTC night guard and try it out. If indicated you may need to consider custom bite guard (very expensive though).

 

[Du_deleted]

Your wisdom teeth won't grow back. You may be experiencing stress and grinding and clenching. That could deteriorate your TMJ. In the US, dentists are opening up. I have been seeing emergencies only since the closures so you should find a dentist to get it checked. You could go to the drug store and pick up an OTC night guard and try it out. If indicated you may need to consider custom bite guard (very expensive though).

Thanks doctor.
I do check the otc night guard. I will check for the custom ones later. Am not planning for any new treatments during this covid crisis.
I didn't check with my dental office yet. They were closed till may 1st. I have to call them and check. My pain is mostly inside the ear from yesterday. And also near the lower jaw end under the ears. My ear is completely blocked and scratchy pain all the time. I am not sure if it's dental or sinus or ear issue.

Thank you!!

 

[Du_deleted]

Just an update here.

I have the same ear pain, lower jaw pain, swelling under the ear and top of the neck area along with nose and ear congestion. Finished the amoxicillin antibiotics 2 weeks back. I have severe ear and jaw pain with swelling.

So, I went to an ENT today to check if it's ear or sinus issue.

I thought of checking with ENT before going to a dentist. I told them the history. I am prone to cold , sinus infection and strep throat throughout the year. I get almost one infection in 2 or 3 months. So I told them about that too. I have not tested any allergies before.

ENT checked my ears with an otoscope and did nasopharyngoscopy with Endo to check my sinus. He said my ears are completely fine and no sign of any infection. He said my sinus also looks clear and no pus.

He said may be the swelling a secondary infection from sinusitis or TMJ. He was not sure. He told me to get an x-ray and CT scan after 2 weeks just to check if any infection present. He prescribed cefdinir for 2 weeks.

The doctor was not sure why I have the jaw pain and the swelling. My sinus and ear is clear now as per the scope examination. He prescribed the antibiotics for 2 weeks and imaging after that.

It could be TMJ or any tooth issue? I don't have any gum redness.
I have called my dentist today to check this out. He is booked up today and till July 2nd. So they put me with another dentist tomorrow. I am planning to go in and check this out. I don't know if I am assumed this swelling as ear and sinus pain so far(more than 3 weeks). I am going to the dentist tomorrow. This is going to be a new dentist and I am not sure how he is going to check.
What should I ask for? Just posting here to get some information on hand. Do I need to ask for full mouth panaromic x-ray? Or normal x-ray? What else do we need to check since this involves my jaw area under he ear.

Please help if you have any inputs. Thank you.

 

[honestdoc]

I'm suspecting TMJ problem. Have the dentist clear you of any dental problem. If you have medical insurance, it may cover TMJ treatments because dental doesn't. After getting cleared by your dentist, get referred to TMJ specialist and inquire about accepting your insurance because treatment can be very costly.

 

[Du_deleted]

I'm suspecting TMJ problem. Have the dentist clear you of any dental problem. If you have medical insurance, it may cover TMJ treatments because dental doesn't. After getting cleared by your dentist, get referred to TMJ specialist and inquire about accepting your insurance because treatment can be very costly.

Thank you so much @honestdoc. I really appreciate it. I will ask for all x-rays they can take there in their office.
Btw, what's the treatment for tmjd? You have mentioned it's expensive. Whether it's need to be treated asap or wait and see approach? Just asking this to know if I can postpone till covid situation gets better.

 

[honestdoc]

There are many treatment modalities depending on your specific TMJ problem. Most common are bite appliances and physical therapy. Alternative may be acupuncture. Last resort may be surgery but it is too traumatic and the results are unpredictable (I would avoid it almost totally). I wouldn't wait too long because your TMJ can further deteriorate. Try to get seen as soon as you can.

 

[Du_deleted]

There are many treatment modalities depending on your specific TMJ problem. Most common are bite appliances and physical therapy. Alternative may be acupuncture. Last resort may be surgery but it is too traumatic and the results are unpredictable (I would avoid it almost totally). I wouldn't wait too long because your TMJ can further deteriorate. Try to get seen as soon as you can.

Thank you so much @honestdoc.

I went to my dentist office and saw the new dentist. I told them the history. I also told them I did chew some meat and fish hard before all this happened. I also hear a big snap or click from the jaw. Like a knuckle the next day. After that, swelling started with pain.followed by ear pain, jaw clicks while opening.

They did check my bite with blue color stick(I think bite stick) and asked if I have any discomfort. I feel tender when I bite on tooth#30. He checked for few more times and that feels so tender. So he said I might have a fracture in that root. And he told me to get a CT scan for that tooth to check a clear picture.

I asked if it could be a TMJ problem or jaw bone issue or jaw fracture problem. He said that doesn't look like jaw issue. And they said if it's jaw issue or TMJ, I won't get swelling under the ear and the jaw line. I insist them to take panaromic x-ray just to check the jaw. Then he said ok. I had both pan and CT scan for that tooth.

I am yet to receive the xray pictures from their office. I will share it here once I receive my email.
After the CT scan, he said that it's predictable or not predictable. He couldn't see much of a crack or root fracture in the tooth. And guessing there might be a fracture and told me that either I have to extract the tooth or root canal with crown.
But he insist me that it's a trial and error. Even after root canal, it might give you the same pain. Then we have to extract it. So, it's better to extract in the first place and do implant immediately. I was so shocked to hear these and completely blanked out. I don't have any idea how root canal or extraction will be.

I would be happy if he said the answers conclusive. Not by a guess. Do the tooth crack or root fracture doesn't show up in x-ray or CT scan???
I asked if it works for wait and watch approach. He said I have to do it within a week. I have already delayed this because of assumption of ear, sinus infection and he is surprised that it doesn't hurt me more all these days. He said it will hurt more if untreated.

So, I have to decide if I have to do root canal or extraction on tooth 30. But I don't have any throbbing pain or gum redness or swelling inside on that tooth before I go in for a visit. I totally didn't think about that could be an issue.

And about my upper wisdom tooth, in the xray the root color was black. So the dental assistant told me that root is getting there. Since I had already taken antibiotics in the past weeks, the dentist said he couldn't see any infection in any of the tooth in the x-ray.

So, he also told me to take out the wisdom tooth #1. I am ok to take that. But I am thinking if I should take off #30. Whether the lower jaw pain, ear pain and swelling could be of wisdom tooth pain or infection. Since I taken antibiotics, that might be resolved. Is that possible??

Will the upper wisdom tooth cause swelling on the lower jaw?? Any inputs?

The dentist whom I saw today is new to the dental practice and he has been
practising for an year. He asked one of his colleagues for an opinion and she also said the same after reviewing the CT scan. Whether fracture of tooth or root not shown in the images??

Sorry for long post. Thanks for reading. I just want to be as detailed as possible.

 

[honestdoc]

Attach the x-rays like pano and periapical. The CT image may not accurately depict any fractures. It is very difficult to detect fractures. Using the tooth sleuth, you bite down, ease firm and let go. When it hurts when you let go indicates possible fracture. Another test is the gum probings. The probings will have normal readings until a sharp drop in deep probing indicating attachment damage. Did the dentist do a cold test on #30? I would not do RCT and or extraction unless it is absolute which I think they were more or less guessing.

Extracting #1 is fairly minimal trauma so that shouldn't be a big deal. TMJ may have some swelling depending on the amount of damage. If the swelling is away from the ears under the jaw line, it may be coming from the tooth.

 

[Du_deleted]

Thank you @honestdoc.
I had the following x-rays today. I will send the images once I receive from their office.
1. intraoral - periapical first radiographic image
2.intraoral - periapical each additional radiographic
3. panoramic radiographic image (no charge)
4. 3D Cone Beam capture lim FOV #30

they did bite test. I don't know if he did gum probing. He did scratch my gums with some metal thing and that was painful. He go over the gum lines and checked. It was very painful for me. Like scratching the gum edges. He didn't do cold water test.is that necessary to find the cracks or fractures?

I do have swelling under the ear. And also under this tooth too. The whole lower jaw area. In this tooth #30, I have some tenderness and shoot pain from this afternoon. Don't know if it's because of that gum probing which he did in the office. I also have shooting pain from upper wisdom tooth. Feel shooting and sharp pain in tooth#1 and 30. If I touch the bottom or gum area on tooth 30, it's so tender and painful. I have to press it hard with my finger to feel tenderness.it gives a shooting pain on the bottom of that tooth in the jaw outside( the cheek.)

He is not very absolute in his answer. He is very sure to say trial and error.

I want to know if it's from TMJ issue. He said it's not. I am not sure why I have pain under the ear with swelling. I do have swelling on #30 tooth cheek side. So, don't know what's the issue. Whether crack and fracture will give swelling all over the jaw? He did say that my jaw looks fine from the pan
x-ray. It's so painful and I am continuing the antibiotics and anti inflammatory for pain. I think I have to go for a second opinion or to an endodontist to get consult. Will share the x-rays as soon as I receive. Their office is already closed and I can catch them up only on Monday. Meanwhile, how do I control the pain and swelling? What is the normal treatment for the fracture? I asked the dentist if I can wait and watch? He said I should do extraction or RCT in one week. I am so confused and worried. I never done RCT before. There is not even a big cavity in that tooth. I don't know how this crack or fracture happened.

Thanks.

 

[honestdoc]

Without images, its like driving to a new location without a map. The x-ray will not indicate anything but a baseline. It will not diagnose or pinpoint any details unless obvious in which your dentist will see it. Your dentist would have detected any bone disease or defects. In order to diagnose a fracture, there are illuminating tests where the dentist use a high powered lighting unit used to cure white fillings. Sometimes an internal crack will show up sometimes not especially if it's down in the roots. Tooth sleuth (bite test) is used on each tooth cusp and after you bite down and upon release, the crack will flex painfully. Gum probing will detect attachment damage but usually after a few weeks after the crack forms. So sometimes the probe will not detect anything yet. To cold test if the tooth needs a root canal, a cotton pellet will be saturated with liquid nitrogen and placed on the tooth. If the tooth feels no cold, then the nerve inside the root canal died. Many dentists use Q-tip which does not get cold enough and will yield false results. If the cotton feels extremely painful and lingering over 30 seconds, the nerve is irreversibly damaged and needs a root canal. If the tooth feels cold and minimal pain, then it is normal.

 

[Du_deleted]

I am so sorry @honestdoc for asking questions without images. I will try to get the images and post it here. He didn't talk about any bone disease or defects after seeing the images. He couldn't find anything and guessed about the fracture.
Thank you so much for other test information. I have never heard about it and done that before. I think an endodontist can test that for my issue. I will get the referral on Monday.

Just another question here.
I bite down on tooth 30 and when I close the mouth, that side upper and lower tooth feels hard while biting.

And when I bite down on 30, it hurts while biting and relieved while releasing the bite. Does it mean cracked it fracture root?

Thanks.

 

[honestdoc]

This is just a guess. From my experience, the best case and most likely scenario is that you are clenching and grinding. Fracture is when it hurts upon releasing the bite because the fracture flexes. Try going to the store and pick up an Over the Counter Night Guard and try it. Seeing a TMJ specialist will make custom bite appliances to manage and treat the condition.

 

[Du_deleted]

This is just a guess. From my experience, the best case and most likely scenario is that you are clenching and grinding. Fracture is when it hurts upon releasing the bite because the fracture flexes. Try going to the store and pick up an Over the Counter Night Guard and try it. Seeing a TMJ specialist will make custom bite appliances to manage and treat the condition.

Thank you so much @honestdoc .

Are you in USA or uk? If you are in US, do you have any recommendations for good dentist, endodontist, TMJ specialists in Atlanta. I really not trust the dentist opinion and I don't want to jump into extraction without concrete answer. My regular dentist also always give a guess answer. He did fillings on my left side tooth which was very very small and I had a lots of trouble from that for an year. I don't know if I will get a genuine and concrete diagnosis from him on Monday if I go in. I am also planning to check with some endo to ask if I need RCT . I never been to any Endo in the US.

Thank you!!