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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Headache in the temporal region after fish bone removal, no remnants, hypertensive, diabetic. Reason for headache?

sir, i am a dental student, recently a case of fish bone stuck on a palatal exostosis in relation to 27 which was removed by the patient 2 weeks ago. the patient complaints of headache on the left temporal region. traumatic ulcer on palatal exostosis was diagnosed. IOPA 25, 27 was taken(26 missing) and also a maxillary occlusal radiograph. no obvious remnant of fish bone seen. the patient is diabetic as well as hypertensive. is it necessary to do a periodontal surgical exploration? or prescribing antibiotics to prevent secondary infection of the ulcer and put the patient under observation is sufficient? and what is the reason for headache to occur in such case? is it referred pain or is it genuinely a headache due to severe pain? your help is highly appreciated.
Mon, 15 Apr 2013
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Dentist 's  Response
hello and welcome to HCM forum,
i appreciate you wrote to us, first of all i would like you to know that due to biting on a hard substance like bone, temporary headache might occur as a referred pain.
For headache analgesics will be helpful, whereas for the ulcer ,if present on the palate prescribe broad spectrum antibiotics, NSAID's and an antibacterial mouth wash(betadine) to avoid secondary infection.
keep the patient under observation for a week,
also, oral multivitamins/antioxidants(once/day) will promote healing.
i hope i answered your query,
if you any further queries ,kindly post them.
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Dentist Dr. Farah Hussain's  Response
hello and welcome to HCM,

Nothing to worry about , no surgical intervention is required in this case .

For ulceration on the palatal mucosa you can suggest the patient to follow symptomatic treatment at home like gargling with lukewarm saline water or antiseptic mouthwash like chlorhexidine or betadine.

Application of oral antiseptic ,analgesic ointments like dentogel or mucogel topically over the affected area will help in faster healing.

Headache in such patients can be relieved by prescribing analgesics as it can be referred pain or even psychological.

You can suggest an OPG RADIOGRAPH to the patient to confirm damage to the underlying structures.

i hope this helps ,

take care.
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Dentist Dr. Anshumala Singh's  Response
Dear friend.

Thanks for sharing your concern.

first of all its nice to know that you are a dental student.

The history that you have given, suggests that it is, traumatic ulcer on palatal exostosis.

In this case everything whatever you have done till now is very correct,and in my view no surgical exploration is required.

you have missed a very important point that is taking complete history of patients general health,i mean what medication he is taking now?what does his blood report say about his sugar?is it under control?

please focus on these points,i think the cause of his headache is his blood pressure.

so i would suggest, to send your patient first to his physician and then after his consent only do the needful.

take care.
thanks.
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