Pain in Jaw- 8 years after radiation treatment

Mavish

Hi everyone,

I had SCC in my left tonsil. I had surgery of tonsil and lymphnodes from righ side of my neck 2 camepositive for SCC and than had 70 Gy radiation treatment in 2016.

I had severe osteoradionecrosis in my maxilla (uper jaw) started in 2018, two teeths came out on their own as the bone was not able to support them. Then left me with a big exposed bone, which became loose and drop, soft tissue closed well so I did not need the survery. A year agoI lost my bottom wisdom tooth. I did not have any symptoms since the exposed bone came out.

Recently, I started waking up with terrible pain in my jaw. There is no lession or broken bones seen in my panoramic x rays of mouth. No infection, just seen the dentist. I have severe trismus and fibrosis on left site of my neck.

Does any one had similar experience? Any thought would be appreciated?

M

wbcgaruss

Hi, Mavish, sorry you are having latent issues after H&N treatment.

So if I am correct you had surgery and radiation in 2016 involving the right side tonsil and lymph nodes.

Two years later you had severe osteoradionecrosis, lost some teeth, and had exposed bone which became loose and dropped some pieces of bone but eventually healed and closed well.

You then say...

"A year ago I lost my bottom wisdom tooth. I did not have any symptoms since the exposed bone came out."

My question is has this healed over or is there still exposed bone there? If you have exposed bone that is something that needs remediated. It is probably causing the pain.

Something like a broken bone shows in the x-rays but you may have an infection and I am not sure if that would show. I think they can tell if you have an infection by x-rays. I looked it up and came up with this...

"An x-ray of the teeth is often the only way to determine if a tooth infection is present. However, if a tooth infection has spread beyond the tooth, it may not be visible on a regular x-ray. Sometimes an illness is located inside a tooth root, and a dental x-ray can show if an abscess has formed. A dark area may be seen on a dental x-ray, and it can be painful to touch it. If the tooth has lost its vitality, it may not respond to a cold or hot test."

Here is a link to the article...Can tooth infection be seen on X-ray?

https://northpointdentalclinic.com/can-tooth-infection-be-seen-on-xray/

You may have a small infection and need a round of antibiotics.

I would say go back to your dentist, there is a reason for this pain no matter what the x-rays show. This is always an issue for we H&N people to take seriously. This radiation around the H&N area affects so many things, especially things like saliva which has a huge impact on our dental health. We have to be meticulous about our dental care at home and have regular appointments at the dentist.

I would seriously recommend you see an oral surgeon, either get one on your own or better yet get back to your dentist and make him aware of your pain situation and the fact it has not gone away and have him refer you to an oral surgeon, I am sure he has one he refers patients to. I have an oral surgeon recommended by my dentist and they work hand in had to give me the best possible outcome.

Also, my dentist and oral surgeon worked with my radiation oncologist and got my radiation records as to the strength and field of coverage and strength of the areas covered. Check with your dentist and oral surgeon if you get one to see if your radiation records would help them care for you.

You are not alone when facing your problems there are others on here with similar circumstances. For now, I am stable with no issues but with radiation in my past like most on here, it is always a possible issue.

Mavish, I hope you can very soon get this taken care of, don't wait get it looked at, and get back to your new normal as we call it.

Wishing You The Best

Take Care, God Bless

Russ

Mavish

Hi Russ,

Many thanks for all the reccomendations.

Where my tooth coming out of jaw bone, there is no exposed bone, but in the x ray, it looks like a black area The shape of black area matches the root of the tooth that I lost. Dentist I saw, thought it migth be ORN, while an oral pathologist though that it is a bone trying to heal as she saw a trabeculas, ( which she show me) but does not a calcificated yet. Obviously, if the second opinion is correct, it is taking too long too heal. (Consodering 70Gy radiation, slow healing is not a suprise).

She also thouth that tooth coming out in the lower jaw likely because there is no teeth above it for a long time ( the ones came out from upper jaw), not due to ORN in the lower jaw.

I will make an appointmet in the cancer center dental clinic, that I am treated to see what the oral surgeon will think about it.

Pain is not vonstant, it hits me two days in row than go away a week or so then come back out of no where. It is very sharp.

Many thanks again

God bless

wbcgaruss

Mavish, one last thing I would say about your pain that comes and goes.

I had surgery on my neck and lymph nodes due to an unencapsulated lymph node which the cancer had spread outside of the node. My cheek on that side where my molars come together when I chew can be sore while chewing. My ENT checked me out and said everything looks and feels normal and I have had scans afterward and there is no cancer. So my ENT is saying due to the surgery nerves are affected and they are telling me there is a sore area when there is not. This area is like your soreness it may be noticed for days and sometimes weeks and then it is gone, not feeling it at all. My dentist also verified that everything in the area is normal.

I say all that to say this, your situation may have some nerve involvement in it that causes the similar symptoms we have. Your nerves may be affecting this issue.

I hope eventually it just goes away and stops or the can find an answer for you.

Thankfully there is no exposed bone and maybe it is just an extended healing period.

Wishing You the Best

Take care, God Bless

Russ