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


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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.
 
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They can. I must warn you. Surgeons' job is to do surgery. It is like everything to a hammer is a nail. Hopefully the surgeon can give you an unbiased assessment. I still recommend going to TMJ specialist. Make sure you communicate all the traumas to the TMJ so the dentists won't go on a wild goose chase.
Thank you doctor.
I am still looking for some good TMJ specialist in Atlanta. I don't find any good dentist who specializes in TMJ. I got my cbct scan. I will post that images too.

Whether my upper wisdom tooth shows any infection in the xray? Whether they need to be removed asap? That's the reason for my swelling and jaw pain??
 
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honestdoc

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Some links: https://www.tmjtreatmentatlanta.com/














Goodness, Atlanta seems to have plentiful amenities and personnel! I bet they have good Southern BBQ! I don't have the means to research every one of the links for you. Try to find a convenient place that will take your insurance. Beware if any wants to extensively drill on your teeth or do extensive surgery right off the bat!
 

MattKW

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I'd definitely start with an endodontist to make sure the pulps have been assessed properly and that there are no hairline fractures.
If you have noticeable swelling, then a CT scan from an oral surgeon would also look for non-dental causes.
If still nothing, then maybe a TMJ specialist and have a proper splint made.
As honestdoc says, no interventionist treatment.
 
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Thank you doctor.
I'd definitely start with an endodontist to make sure the pulps have been assessed properly and that there are no hairline fractures.
If you have noticeable swelling, then a CT scan from an oral surgeon would also look for non-dental causes.
If still nothing, then maybe a TMJ specialist and have a proper splint made.
As honestdoc says, no interventionist treatment.
Thank you so much doctor @MattKW . How do we know if we have hairline fracture? There is nothing evident from the cbct scan and the x-ray. The dentist said he is guessing there might be a crack or fracture in that tooth. How do I know and confirm with Endo about it?

What should be my questions to ask for ? What test should I ask for the confirmation before proceeding the RCT?
 
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Some links: https://www.tmjtreatmentatlanta.com/














Goodness, Atlanta seems to have plentiful amenities and personnel! I bet they have good Southern BBQ! I don't have the means to research every one of the links for you. Try to find a convenient place that will take your insurance. Beware if any wants to extensively drill on your teeth or do extensive surgery right off the bat!
Thank you for the links doctor @honestdoc.

I will check with an Endo first as I have severe pain in the jaw. Then I will proceed with TMJ or oral surgeon. I see a practice in the above links which has TMJ specialist and oral surgeon(2 different doctors in the same practice). I will go there and check it out. Hope they can help me out.

Before that, will check with Endo to see if it's crack. I am not able to download the cbct scan images from the CD and I couldn't post it here.
What should I ask for in the Endo visit? How do they confirm if I have hairline fracture?
 

honestdoc

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When you go to endodontist (root canal specialist), ask about the pulpal health and any fractures. Fractures may be very difficult to detect. I hope the endo is honest because he/she can always fudge the tests to say you need a rootcanal. For TMJ and OS, discuss in detail your history of trauma to the TMJ and laying down, etc. The more detail the less wild goose chase.
 
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When you go to endodontist (root canal specialist), ask about the pulpal health and any fractures. Fractures may be very difficult to detect. I hope the endo is honest because he/she can always fudge the tests to say you need a rootcanal. For TMJ and OS, discuss in detail your history of trauma to the TMJ and laying down, etc. The more detail the less wild goose chase.
Thank you doctor @honestdoc. I will try to get an earliest Endo appointment. Hope they will do proper test and diagnose fracture without mere guess.
 
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I got an Endo appointment for tomorrow. That is the earliest available. I have to manage today with some ibprufen for pain.

They asked if they can schedule for RCT instead of consultation. That way, it will be lesser cost. But I don't want to do RCT appointment without confirmation.

So, I asked for only consultation for tomorrow. I am from another country and currently residing in the USA. The dental practice protocols is very strange and scary.

And do they perform RCT with pain and swelling? Do we need to wait till the swelling comes down or will they perform RCT with pain and swelling doctor? @honestdoc ,@MattKW.
 

honestdoc

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Health and dental care in the US is screwed up. Doctor here have tremendous pressures to produce (do procedures like surgery, RCTs, etc to make money). I hope the endo doesn't falsely tell you that you need RCT. If you have some swelling, the dentist can do RCT. It may require multiple visits if the swelling and exudate may be difficult to control.
 
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Health and dental care in the US is screwed up. Doctor here have tremendous pressures to produce (do procedures like surgery, RCTs, etc to make money). I hope the endo doesn't falsely tell you that you need RCT. If you have some swelling, the dentist can do RCT. It may require multiple visits if the swelling and exudate may be difficult to control.
Thank you doctor.
So if the endo say that I need immediate RCT, can I go ahead with the pain and swelling?

I have pain and swelling still and it's not reduced. Or should I get some prescription from her for pain and do RCT after pain /swelling subsides?
 
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Hopefully the endodontist will treat it appropriately.
An urgent query @honestdoc , @MattKW.

I contacted one of the dentist in my country through online. I sent the images. The dentist said , It looks like I horizontal fracture in the upper first molar and that need to be extracted. That might cause acute pain and swelling with infection. I was totally shocked to hear this. She is not my family dentist and recommended by a friend for online consultation since we are abroad.

So, I sent her the images. Do my upper first molar looks horizontal fracture??? Please confirm doctors. This is stressing me out. I thought it could be my lower first molar. Didn't think about the first upper molar. Did you see anythig on the images?

I do feel the bite is so hard and that molars hit hard and feel stiff while closing mouth. Please share your thoughts doctor.

Thank you.
 

honestdoc

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What country are you from? The UR first molar is not fractured. You have 3 roots (2 on cheek side, 1 on palate). The lines indicate the individual root anatomy. The xray is 2 dimensional and does not depict objects towards or away from the film. It's very hard to detect fractures on xrays unless there is separation of 2 fractured components. You should be fine for now. Invest about $25 to get a night guard at the drugstore.
 
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What country are you from? The UR first molar is not fractured. You have 3 roots (2 on cheek side, 1 on palate). The lines indicate the individual root anatomy. The xray is 2 dimensional and does not depict objects towards or away from the film. It's very hard to detect fractures on xrays unless there is separation of 2 fractured components. You should be fine for now. Invest about $25 to get a night guard at the drugstore.
Thank you doctor.
I got the night guard a week back when you said. Am using it.

I don't see much difference. May be it takes time. Will wait and see.

I am having an Endo appointment today. This Endo doesn't allow/see images from another dentist office. She said she has to take another CBCT scan in their office. I had CBCT scan and panaromic last Friday. Can I take another one today? Is it very harmful Radiation of having more than one CT scan in a week?
This might sound silly . But I am anxious about dental treatments. So would like to know if getting more than x-ray and CT scan not harmful?
Any thoughts anyone?
 
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What country are you from? The UR first molar is not fractured. You have 3 roots (2 on cheek side, 1 on palate). The lines indicate the individual root anatomy. The xray is 2 dimensional and does not depict objects towards or away from the film. It's very hard to detect fractures on xrays unless there is separation of 2 fractured components. You should be fine for now. Invest about $25 to get a night guard at the drugstore.
Hello @honestdoc doctor,
I am just back from the Endo appointment. They took an x-ray on my lower teeth. They said they want to cbct scan. I told them that I have to talk to Dr for the confirmation before taking the scan.

She looked into my tooth with the microscope kind of thing. She said she couldn't see any fracture. She did cold test. Something very cold. She pour it on my each tooth and asked if I could feel soreness and for how long. I never experienced this before. It was very very throbbing for 2 seconds and stopped. But for #30 , I felt soreness and tender for about 5 to 10 seconds. She said there might be small crack in that spot. You don't need a RCT for they. You can get a crown from the dentist.

And I asked why I am getting the throbbing pain while lying down and I have swelling which is not reducing at all for about a month.

She said she will check the tooth with cold test again. And test me one more time. She has put more cold spray this time by mistake and she apologized for that. I was throbbing for more this time since she put more ice thing spray. Then I felt sore for sometime for about 10seocnds.

I have throbbing pain in the night when I lie down for about 20 to 30 minutes on and off. So she said if it's throbbing more and paining for you, you can go for RCT and put on a crown. This is what happened today. She initially don't want to do rct and since I said I have throbbing pain, she said I can go for RCT.

I asked her why I have the swelling. She said she is not sure about it and the crack or the sensitivity doesn't cause swelling and might cause only the jaw pain. She also said your Swelling doesn't look big inside the mouth. Inside mouth is fine. Only the cheeks are swollen and she is not concerned about it at all. She told me to come back for RCT if I decided to.

But my main concern is the jaw pain and the swelling. I still feel throbbing pain sometimes in the upper and lower molars. Is putting more cold spray causes more throbbing?

What should be my next step to get some relief from this pain and Swelling? Any thoughts doctor?

Thanks for reading.

Tagging @MattKW , @Dr M
 
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honestdoc

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Do you think I should do the crown or RCT with crown immediately?

No, I've encountered numerous people like you who most likely are grinding/clenching. Have you picked up the OTC nightguard? I think most of your problems may be relieved with a custom appliance made by a TMJ specialist.
 
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No, I've encountered numerous people like you who most likely are grinding/clenching. Have you picked up the OTC nightguard? I think most of your problems may be relieved with a custom appliance made by a TMJ specialist.
I got one from the store doctor. It's like a straight thing with fluid pads in between. That was not very comfortable for me.

I see some mould types night guard from Amazon. So planning to order those.
 
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Hopefully they will relieve your pain. Curious when your TMJ consult will be.
Next week doctor.

Just curious to know.
I never been to an Endo before. I don't have any big crack or fracture or I am not a candidate who is worth testing for RCT. I mean after the consultation I felt so.

She did that very cold spray thing for so many times on my tooth. I felt so throbbing and i felt so sore afterwards for a long time. Is that cold spray thing will hurt our nerves or pulp ? Is it harmful to check tooth even when it's no damage inside.
Because the second time , she did more spray and she apologized that she did more. I felt throbbing and jumped up. Does it harm the nerves?

I am so sorry for this question. Me and my family never had any root canal before. My parents, my siblings. All had good teeth so far. Touch wood.

Does the cold thing will harm? I still feel sore in that area even after hours of spraying.
 

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