A Big Pain in the Jaw: Painful Lump on Jaw Following Wisdom Tooth Surgery Turned out to be Osteomyelitis

Wisdom Tooth Surgery

I remember sitting in the chair at my orthodontist’s office at the age of 18 as he adjusted my hot pink retainers. He told me that before I turned 20 I would need to have my wisdom teeth removed, as he had been telling me for a while (though he never really explained why). I probably should have listened to him—the roots of my teeth were smaller then and would have been easier and less risky to remove—but the teeth had never bothered me, never surfaced anyway, and I wasn’t about to have surgery just for the heck of it. (I had just gotten over a spontaneously collapsed lung and a chest tube—five painful days in the hospital.) So I never did.

Six years later, I’m 24. My dentist says that the panoramic x-ray of my mouth shows that my impacted wisdom teeth are growing in sideways, pushing on my second molars, and it would be best to have them removed. I knew the issue would come up sooner or later. So I scheduled an appointment with the same oral surgeon my whole family has been going to for years. He explained to me the procedure and all the risks involved, which he had told me were rare and likely wouldn’t happen—dry socket, infection, nerve damage… The biggest risk of all was being put to sleep, he had said. None of this sounded reassuring to me, but I reminded myself that this procedure was one that practically everyone must endure at some point, and I had been told by numerous people that it wasn’t a big deal. (Of course I was aware that the fact that I was “older,” and my roots were much longer and more deeply embedded in my jawbone than those of a younger patient would make things trickier for the surgeon and possibly leave me with permanent numbness in my lip and chin—my worst fear at the time, which thinking about now seems ridiculous. Numbness probably should have been the least of my worries.)

So, taking everything into consideration and enduring the anxiety that led up to it, I had my lower wisdom teeth extracted on Thursday, December 12, 2013. I woke up from the anesthesia with a fat, bloody lip, which I had accidentally bitten into while biting down on gauze, and I lost my voice almost completely for about three or four days as a result of the breathing tube that had been used during surgery, which had probably irritated my vocal cords. Otherwise though, I experienced little pain, didn’t use the pain medication prescribed, and did everything I was supposed to do, which basically involved irrigating the wounds with water using a syringe and rinsing my mouth with saltwater. I had been told there were no restrictions as to what I could eat, what activities I could partake in, etc. So I went back to work a little sore the following Monday and ate whatever I wanted, including crunchy, crispy, hard stuff—pistachios, BBQ-flavored potato chips, buffalo chicken egg rolls… (Though I remember chewing very carefully, my transition from eating soft to regular foods may have happened a little too quickly and was probably a bit risky.) Despite my impatience, I brushed, irrigated and rinsed religiously after almost every meal, reassuring myself that the surgeon had told me there were no restrictions on what I could do or eat. I wasn’t breaking any post-op rules…

A Painful “Little Infection”

Though keeping the wounds clean was a little annoying, it all seemed fairly easy, and everything was healing up just fine. Around a week after the surgery though, I noticed a hard, marble-like little lump on the left side of my lower jaw. It was painful, but only if I pressed on it, so I didn’t think it was such a huge deal. I met with my surgeon who told me it was likely just a “little infection” and prescribed me a course of Clindamycin. While on the medicine, I noticed that the lump continued to slowly increase in size and began to ache a little, even when I wasn’t touching it. I also had a weird, hard-to-explain sick feeling in my head.

Around the beginning of January, while still on the antibiotic, I started a new job. I noticed that I didn’t feel quite right throughout the workday. I was drained, and the unexplainable malaise I felt was more consuming. My face was a little swollen on the left side, but I figured that the wisdom tooth extractions had somehow altered my appearance, and I would just need to get used to looking a little different for a while until things returned to normal. I attributed most of my not feeling well to nerves.

By the weekend after my first week at work, the pain in my jaw began to worsen, especially when I chewed my food. I would, with each bite, get a little jolt or stab of pain that started in my jaw and shot up into the top of the left side of my head like electricity. I did research and feared that I had some kind of permanent nerve disorder called trigeminal neuralgia. I had also researched jaw fractures and bone infections and mentioned these to my surgeon in a conversation over the phone (I had been calling him a lot) and requested a script for an ultrasound. He said such complications occurred very rarely, dismissed the idea of diagnosing me with either, and said an ultrasound wouldn’t show anything. With no other plan of action, I would basically just keep taking the antibiotic as prescribed and over-the-counter pain medicine as needed until I felt better.

When I met with my surgeon again, he took a panoramic x-ray of my head, per my request. He had suspected that food might have gotten trapped under some tissue around the outside of my jawbone, but didn’t see anything in the panoramic. He told me the sharp pains I was experiencing were likely due to TMJ/TMD from having my mouth stretched open for a long period of time during surgery and/or from a shifting of my teeth, which were now hitting together awkwardly. This naturally occurred with the removal of wisdom teeth, he had said. (I highly doubted that TMJ or shifted teeth could have been the cause of the intense pain I had been feeling, but I did my best to trust the surgeon, who had to know more than I did.) He poked around in my almost-closed wound with a sharp instrument, causing it to bleed, but he didn’t seem to be able to draw out any pus. He cleaned the wound, recommended I have my dentist file my teeth down, and prescribed another course of Clindamycin, just to be on the safe side. (I almost knew for certain that getting my teeth filed would be useless, so I didn’t have it done until total desperation set in weeks later.) Overall, he wanted to remain as conservative as possible because he believed that reopening my wound could lead to many other complications.

Days after visiting with my surgeon, the left side of my face continued to swell, and the pain in my jaw and head continued to intensify. Chewing meant stabbing pain, so I began to avoid it, mashing food around with my tongue and then swallowing it. A few days without chewing or moving my jaw had seemed to help, but I was soon beginning to feel pain even when I wasn’t chewing, signaling to me that my problem went beyond TMJ or shifted teeth. After making numerous calls to my surgeon about my increased level of pain, he finally admitted that he didn’t understand why I was still in pain so long after surgery (around a month), and recommended I get a second opinion. I met with another oral surgeon who took a CT scan image without contrast, which did not show a jawbone fracture (I had at that point been suspecting that I had had a fractured jaw). This led him to believe that I had a dry socket, or inflamed jawbone, and likely TMJ. He brought in yet another oral surgeon from an office down the hall to give his opinion. He examined me and agreed that my jawbone was inflamed but there was no way of knowing if an infection was present without the evidence of a culture. No “culture” or biopsy was taken though, and I was prescribed Etodolac, a pain and anti-inflammatory medicine, sent home to wait things out and told to call if my pain became worse. (I was sure that pain medicine was simply going to mask a deeper problem the surgeons didn’t suspect I had.)

More Pain

I am not one to take pain medicine (I don’t even like taking Ibuprofen), but at that point, the pain in my jaw, head, and now ear, had gotten so bad, I didn’t have much choice. I wasn’t able to sleep through the night anymore (I would sleep for around three or four hours, if at all, only to be awoken again by excruciating pain) and my appetite was gone—I would push myself to eat for the sole purpose of prepping my stomach for pain medicine. All I could think of was pain, around the clock, two weeks straight. At times when the pain meds were taking effect (they lasted around four hours) I would sit at the computer and try to diagnose myself. When the pain would return (it would come on very quickly, and I always knew the hour I was going to start feeling it again), I would curl up in a fetal position, rock back and fourth, hold my face and moan for hours until I was able to take more pain medicine, which took an additional painful hour to take effect. It wasn’t long before the Etodolac began failing me and started wearing off after just two hours. More than that, I was only able to take it every twelve hours, which kept me pain-free for just a few hours during the day and a few hours at night (I was in severe pain for the majority of every day). That was when I saw a fourth oral surgeon who prescribed some kind of strong Acetaminophen with Codeine that I would be able to take throughout the day. He told me to hold on one more week, and had me set up an appointment to have a debridement for the following week (he planned to surgically reopen my wound and clean it out).

I did not do well with the new pain medicine prescribed at all. With only a half dose my vision went blurry, my heart began to race, and I began to sweat and shake, feeling as though I might faint. It was very scary. I drank lots of water to flush the stuff out of my system, waited for it to wear off, and did not take it again. I tried Naproxen Sodium, which did absolutely nothing for me, so I went back to regular Ibuprofin. I went another week in this insane state—barely eating, not sleeping, pacing the floors, crying, rocking, moaning in pain. It felt as though someone were stabbing me in the ear and jaw with a sharp object over and over again, and there was a persistent throbbing and aching in the entire left side of my head that made everything that much worse. It was a form of pain I cannot adequately describe with words, despite my efforts, and something no person should ever have to feel, especially for the amount of time that I did. My condition affected not only me but my parents and brother as well, who couldn’t rest at night due to my constant moaning and sobbing and did not know how to help me.

Into the second week of my pain I began calling pharmacists at a 24-hour CVS in the middle of the night for answers. I tried everything—dabbing my wound with clove oil, spraying my mouth with Chloraseptic, sucking on Chloraseptic cough drops, salt water rinses, eating ice, cold compresses, warm compresses, acupressure, sucking on warm tea bags… The one thing that seemed to work fairly well was packing gauze covered in dried clove in my wound. This remedy helped me make it out to see two more dentists (after already having seen four oral surgeons).

Worst Pain Ever

The first dentist I saw said that the ligaments in my jaw were inflamed due to awkwardly-hitting shifted teeth, and he filed a few of the teeth “cusps” down. As I had anticipated, this didn’t help my pain in the least bit. (I would need to wait to see if the swelling in my ligaments went down over time). I saw another dentist who filled my wound with clove paste, per my request. I think that this had actually made things worse, if that was even possible. My pain was at its all-time high after that. Accompanying the throbbing and stabbing, there was now an additional burning. I felt completely hopeless and as though I could not go on any longer. My behavior could have been compared to that of an animal or someone going through some kind of mental breakdown—moaning all day long, rocking, pacing the floors, not having anything else to live for but my pain, no end in sight. When spoken to, I found it difficult to respond. I was completely consumed in my own dark, painful little world and was overcome with frustration. This had gone on way too long—an absolute nightmare—and I questioned the existence of a just God. I had never done anything seriously wrong in my entire life to deserve this. If I had to go on another day this way, I just wanted to die. Somehow managing to push through every minute of the day, each feeling more like an hour, I would dreadfully look at the clock and wait for the hour I could take more pain medicine.

Root Canal

Cloves ceasing to be effective, I packed my wound with gauze soaked in Orajel (which eventually began eating away at the skin in my mouth and burning severely) to make it through the following day. The day after regretfully seeing the second dentist, my original surgeon called recommending I see an endodontist to discover if I had an abscessed tooth. But it was a Saturday, and no one was around. I remember my mom calling numerous offices, none of which responded, even after calling their emergency lines. She finally found an endodontist who agreed to see me that Saturday night, around six-o-clock. He did “hot and cold” tests and discovered that the nerve of the second molar, in front of the site at which my lower wisdom tooth had been extracted, was dead. He did a root canal, stuck a sharp tool down inside the wound behind the dead tooth, bringing up some pus and blood, and I was sent home. I remember Novocain being a wonderful, temporary relief from pain. I sat and rested, waiting for the pain to return, and it did, but some of the throbbing had ceased. I developed a 101 fever that night, however, and my face swelled up more than it ever had before, with puffiness and pinkness running down along my neck. My dad called the emergency room at a hospital in Bryn Mawr to be sure that, if we went, it would be worth the visit. Whoever he had spoken to was unable to say for certain what the hospital could do, but due to the fever, it would be a good idea to just go. So I got as much rest as I could that night—with the help of Motrin—and was taken to the hospital in the morning.

Hospital One

While in the hospital, I was given some kind of horrible narcotic (which I had initially refused, remembering my earlier experience, but the nurse insisted I try it), which made me feel like I would faint, in addition to 600mg of Motrin, IV fluids, Levaquin, Flagyl, more Levaquin and Flagyl later on, and I had a second CT scan taken without contrast. It was about eight o’clock at night when I was finally admitted to a room in the hospital. Barely an hour after I was admitted, I was told that there were no oral surgeons available to evaluate me and that I would need to be transferred to a hospital in Philadelphia. So an ambulance rushed me, along with my mom, to the second hospital in about fifteen minutes. We must have been going way past the speed limit, as the jerky ride itself was enough to make anyone panic (the breaks were rammed on numerous times, causing medical supplies to slam from side to side and topple out of compartments in the vehicle). I held on tight to the gurney I was strapped to, trying not to have a panic attack, while pressing a pack of ice to my forehead to stay cool. It was so hot in there that sweat was running down my neck. I attempted to remove my coat without busting my IV and finally worked up the nerve to interrupt the paramedic, who had been conversing with my mom, to please turn down the heat. (The fever was bad enough.)

Hospital Two

When I arrived at the hospital in Philadelphia, I had trouble getting a room. I was about to be placed in a shared room, which wasn’t ideal, being my whole family was planning to stay the night with me. While I stood staring at my hideous reflection in the shared-room mirror, wondering what was going to happen to me next, my mom somehow worked it out with the nurses and we finally got a private room. Once settled in the room and hooked back up to an IV, I got as much rest as possible (not much). I had blood work done and was given IV fluids, Flagyl, and more Motrin, 600mg. One resident (a group of about four or five residents came to see me every night) relayed that I would need surgery and possibly tubes to drain the infection in my face, which at that point had swelled up to look like I was storing golf balls in my cheek. I was going to be placed under the care of a fairly new doctor to perform the surgery, whom my mother refused. So we waited.

The next day, I had a CT scan taken with contrast. At the technician’s first attempt of injecting me with contrast, using with a power-injector, my IV must have been in wrong, and contrast spilled out all over me. I was given another IV in my right arm and everything worked out fine the second time around.

The fifth and final oral surgeon (out of the previous surgeons I had seen that month) that came to evaluate me on my first day in the second hospital said that I had osteomyelitis (a bone infection) of my jaw, and I would need to have surgery to clean out the infection and decaying bone the following day. (If I had waited any longer to be treated, the doctor said the infection would have eaten a hole right through my jawbone.) I continued receiving Flagyl through my IV and fasted from eating until it was time for my surgery. I watched TV and waited nervously. A therapy dog came to visit me. (I was wary of petting it and getting more germs, or something.) Things were a little off schedule, so I waited longer than I thought I’d have to, but finally, the transport guys came for me. I was taken down to be prepped for surgery, given anti-anxiety medicine, went into the operating room and remember having a hard time waking up when the surgery was over. (I had been left alone in some kind of pre/post-op room for a long period of time, which scared me—I cried.) Other than that though, the level of pain I experienced hours after the surgery was at that point very tolerable, even without pain medicine. My face still looked horrible, I had some numbness in my lip and chin, I was a little loopy (loaded up on all kinds of medicine), but I was happy. I was able to eat soft foods, I watched TV, I was given more IV antibiotics and a medicated rinse, and I waited for the infectious disease doctors to determine what medicine to put me on to fight off the remaining infection in my jaw. They finally agreed on a medicine called Ertapenem, which they had told me was similar to Penicillin, an antibiotic I am allergic to (I develop a rash, diarrhea, etc.). They also said that I would need to have a picc line (a thin catheter that runs through a vein in the arm and sits just above the heart, which serves as a semi-permanent IV) inserted the following day because IV antibiotics would be more effective than oral antibiotics in treating my deep infection. (Plus, Ertapenem must be injected or taken intravenously.)

Immediately after receiving my first dose of Ertapenem through my third regular IV, (which had to be done over yet again on my left arm, after my right hand and arm began swelling from a leak, or infiltration, by my second IV), I developed diarrhea, cramps and nausea, which lasted into the night. The nurses gave me Imodium and foods like oatmeal and mashed bananas. I felt like a nuisance constantly calling a nurse to help me disconnect the circulation pumps on my legs and unplug my IV so that I could get up and go to the bathroom. I eventually just started doing it myself. In addition, for fear of the possibility of my spreading an illness call “C. diff” to people around me, everyone who came near to me had to wear yellow gowns and purple latex gloves to avoid contamination. A nurse even made my brother and I watch a video about C. diff that basically repeated the importance of hand washing about twenty times. Turned out that I didn’t have C. diff.

The next day, I was scared to death but ready to have my picc line placed. A picc team of two women came in and talked to me about things unrelated to what they were doing (to comfort me, I guess). I shook my legs and looked away the entire time to distract myself. They covered everything with plastic sheets—me, themselves—measured the distance from my inner forearm to my heart, injected me with two shots of Lidocaine, a numbing agent, cut a line (36 cm) and placed it in about fifteen minutes. An x-ray was taken and sent to be studied to assure that the line sat in proper position. I was happy I had made it through all that, and a homecare nurse came in to show me how to administer meds to myself through the picc. Into her demonstration, however, I was told that my picc line had a “loop” in it, and I was sent back down into an operating room, crying, to have it fixed. I was laid down under some kind of “live” x-ray machine that displayed an onscreen x-ray of my chest. Two young girls (probably my age) forcefully flushed my line with saline water simultaneously, successfully un-looping the picc. But the supervising doctor determined that the line was too short and needed to be replaced. (Of course it did.) I was strapped down and covered in plastic yet again. A wire was fished through the existing line, the line was pulled out, I was injected twice with Lidocaine, a new longer line (39 cm) was inserted along the wire, and the wire was removed. I finally had a beautifully placed picc line… and heart palpitations. The nurses insisted that the palpitations were due to anxiety, but these were super-fast and definitely not due to anxiety. I was pretty sure I knew what anxiety felt like.

Home from the Hospital(s)—Life with a Picc Line

After being discharged from the hospital, my heart fluttering on and off, I experienced bad night sweats and intense palpitations. The next day I visited a heart doctor who put me on a heart monitor for 24 hours and determined that I had supraventricular tachychardia. It was possible that the picc line had “tickled” my heart while it was being inserted, and though the disorder sounds serious, it’s more of a nuisance than a serious problem. The palpitations subsided with time, but were very scary in the beginning. After my experience in the hospital(s), I continued eating soft foods, mashing everything up before swallowing it (my jaw was fragile and more prone to fracture after the surgery). I made sure to eat yogurt to counter the effect of the antibiotic on my stomach.

It’s been a week and a half since my picc line was removed (one of my nurses pulled it out in about ten seconds—painless). Nurses (I had seven) came to visit me twice a week for six weeks to take blood and vital signs and change my picc dressing. I visited my surgeon (the one who did my debridement) once a week so he could make sure I was progressing and everything was healing the way it was supposed to. I will continue to make monthly post-op visits for around the next six months. I also need to have the second part of my root canal completed and two cavities filled. Eventually, I'll need to have my upper wisdom teeth removed to prevent decay... Of course, I'm very hesitant.

While on the picc, I stayed home from work to avoid germs and prevent having the line bleed at inconvenient times. I administered antibiotics to myself each night by means of a process that became easier with time (involving saline ‘flushes,’ antibiotic ‘infusions’ and lots of alcohol swabs). I experienced chills, low body temp, low blood pressure, diarrhea and dizziness on and off after my time in the hospital. (I returned to a local hospital a few weeks ago for dizziness, which was likely caused by a combination of dehydration and low hemoglobin and iron. Gatorade and vitamins helped.) Sometimes the picc bled, sometimes it hurt if it was taped up in a weird position. It was annoying not to be able to get it wet in the shower (Glad Press N’ Seal under a plastic bag and tape kept it dry) or play the guitar without it bleeding, but I’ve come a long way, and it’s been worth it. My lip and chin are still numb on the left side from the surgery, but my face has almost completely returned to its normal state, and I’ve barely had any pain. I am even allowed to chew a little now, and I don’t feel horrible “stabs” when I do. Since completing six weeks of IV antibiotics (Ertapenem 1000 mg), and one additional week of oral antibiotics following the removal of my picc (Clindamycin 300mg, four times a day), I am very hopeful that my osteomyelitis is going to be wiped out completely, for good.

The Cause

I don’t know how I developed osteomyelitis exactly, but I really think that it had a lot to do with my lower left wisdom tooth extraction. The roots of the tooth were very deep, down in the bone (I’m “older,” remember), and bacteria could have easily gotten inside the wounds left behind after they were removed. It’s possible that the dead second molar that received root canal also contributed to the infection, but I don’t think it was a coincidence that the infection showed up within the weeks following my wisdom tooth surgery. The only other thing I can think of that could have led me to develop osteomyelitis was that I was never prescribed antibiotics or any kind of medicated rinse before or at the time of my wisdom tooth extractions, and there was therefore nothing preventing bacteria from multiplying at the site and doing damage. I don’t think that a rinse and antibiotics could have hurt me as much as osteomyelitis did, and if swallowing some pills was all it would have taken to prevent the infection, it would have been a much easier task to take on, compared to the full-blown ordeal I experienced.

Aftermath

If anything good did come of having my wisdom teeth removed, I suffer from fewer migraine headaches, which I used to have several times a week prior to the surgery, but have only experienced about twice since the surgery. I also have a newfound appreciation for my health and people like nurses and doctors who dedicate their lives to helping make people like me healthy. We all owe our lives to these people. I have also gained some knowledge of different medical issues through research (and firsthand experience, of course), and I have greater sense of awareness when it comes to my own oral health—I have learned that, concerning one’s health, it is always best to be safe and proactive (get second opinions, trust your gut when you feel something is wrong, become educated on your health issues). Having faith and keeping a positive attitude in general help to make everything easier. Overall, I believe that everything happens for a reason, and I do not regret my decision of having my lower wisdom teeth removed. (Even though it was a huge pain in the butt.) I will appreciate every day of my life more after having had this experience.

Osteomyelitis affects about two in every 10,000 people, according to Cleveland Clinic. It can occur in any bone of the body (Patient.co.uk). Here’s a link for more information: http://www.medicinenet.com/osteomyelitis/article.htm