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Suffering From Facial Pain And Fever. Had Lymph Node Swollen. Suggestions

Posted on Thu, 13 Jun 2013

Question: HELP!! Hi my wife has been suffering from daily facial pain in her jaws and ears with fevers that reach 101 degrees and has had a PET scan of her body showing no cancer . Dentists and dental bone surgeons cant find any problems with their xray machines but we think the molar teeth root canals have become infected. What exact type of device and test do we need to have done to show if there is infection in her teeth? We have been told a cat scan or a MRI but there is no consensus. Her blood tests show her white blood cell count has risen to 14.0 which is above the threshold of 10.9 and a week ago her lymph node were swollen under her neck and arm pits which was greatly alleviated by taking cipro but the pain remains and the source of the infection continues to remain unknown and WE know her root canal teeth probably need to come out (they hurt) as the surgeon said years ago that they only had a few years left before she would need to have them pulled. So what type of scan/MRI can help to show infection in her teeth. She also has received blood tests for cancer and her CEA was elevated to 6.6 (high) ( she smokes a lot due to being upset ,being in pain and nervousness) and her CA is only 5. So were going to make an appointment with an oncolgist but need to know what type of test we can get her that will show the infections growing ( we believe) in her root canaled teeth) but noone will pull them because they're afraid that they may not be the real problem and dont want to pull teeth unnecessarily. Your suggestions are much welcomed.

Thank you.

Answered by Dr. Anshumala Singh (2 hours later)

Dear friend.

First of all thanks for sharing your concern and giving me complete history.

After going through your history, I would first tell you following are the usual causes of facial pain.

1.Originating from decayed teeth and gums, due to infection, which accompanies lymph nodes swelling too.

2.Vertical or horizontal fracture of one or more teeth due to direct or indirect trauma.

3.Any cyst or tumor, benign or malignant, involving the jaw directly or indirectly.

4.Fracture of the jaw bone, due to infections like osteomyelitis or direct or indirect trauma.

5.And most importantly due to neurogenic origin, involving facial nerves.

Now since you have already visited dentists and got the x XXXXXXX done, so I assume that there is no infection seen in the teeth.

Please have faith and accept this fact that dental x-rays are designed in such a way that they can beautifully detect any pathology related to teeth if taken properly. I am sure they must have advised you Oral Pantograph (OPG) as well. Even this gives you complete picture of your dental hard tissues and jaw bones.
If required, go for a second opinion too for x rays.

Now, according to the given history I suspect your wife is suffering from neurogenic pain that has got nervous origin.

That particular nerve has to be detected, for example it could be trigeminal neuralgic pain, or trigeminal neuritis or trigeminal neuropathy.

Some times careful observation and questioning can establish correct diagnosis.
Therefore I would advise you to visit your neurosurgeon, once with complete history of pain only,that means when it starts, how long it persists, what medication you are taking to relieve it.
Upon neurosurgeon advise you can go for various tests advised by him/her in relation to pain.

So that only pain can be focused and as I suggested it can be well diagnosed.

Please let me know for further query I would be glad to help to the best of my ability.

Wish you good health .

Thanks.

Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshumala Singh (43 minutes later)

Thank you for your review of the information submitted. We have been to neurologist at the Tampa bay General hospital and university pavillion who said go see an infectious doctor since there was infection showing from th white cell count.
The infectious disease doctor referred us to an oncologist and about 10 years ago she has had a previous experience where they could not detect the infection resulting from what they call a " hot tooth" so my wife begged the dentist to remove the cap on a tooth and blood started spurting out like a fiery stream spraying the dentist in blood as he yelled " Hot Tooth" and they scrampled to stop the gushing torrent of blood - she got well quickly after that incident. Frankly, I have no confidence at all for the current xray medical technology used by dentists to determine anything but hard areas and they can not get an xray fo the soft tissue infections lurking below the roots of the teeth and that's why the question is what is the type of MRI or CAT scan that can detect infections in the jaws and roots of teeth as one of my doctors told me that a special MRI could do it and I read on the internet of a patient using a 64 slice scanner to detect areas of infection but they have high radiation and she has been xrays way to much over the past year to want to expose her to more high intensity xray--so the question I need answered is what type of test will find the infection and thereby allow them the teeth involveded to be pulled as we ahve already been down the trimenginal nerve road and it was ruled out as there were no electrical shocks just pain but it may have become infected by a hidden infection from teeth gone bad as her family has very soft teeth and prone to getting infections-- so, now hearing all this-- please tell me what an oral pantograph is because its the first time Ive heard of it and willmbe googling it as soon as I send this reply and hopefully we can figure the best test for her to get to get hewr out of the constant and unbearable pain..Thank you for your kind help.

Answered by Dr. Anshumala Singh (1 hour later)

Dear friend.

Thanks for your reply.

Oral pantograph is panoramic radiograph enables viewing of both upper and lower arches with their supporting structures.

A single image covers major part of facial region; also, radiation exposure is low here.

I would advise you to go for digital subs traction tomography.

Although there is hazard of radiation, but it is far better than MRI.

It will give separate images of bone, soft tissues including pulp and blood vessels separately and hence will be beneficial in pin pointing the site of infection.

Let me know for further query.

Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anshumala Singh (8 hours later)

Thank you Dr XXXXXXX :-)

Answered by Dr. Anshumala Singh (13 hours later)

Dear friend.

Thanks.

Wish you good health.
Take care.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anshumala Singh (16 hours later)

Hi,

My wife wants to know what type of blood or other cancers are caused by the Epstein Barr virus ?

Please, let me know as she is anxious.

Thank you.

XXXXXX

Answered by Dr. Anshumala Singh (3 hours later)

Hello,
Thanks for the follow up.

The following cancers can be caused by Nasopharyngeal carcinoma.

2. Infectious mononucleosis. (This is a premalignant condition, but can develop blood cancer)

3. Burkitts Lymphoma.

Let me know if you have any other doubts,

Thank you

Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Shanthi.E