My wife had been experiencing swelling and pain in the right jaw bone area since late June 2010. We saw her dentist initially who took and X-ray which showed nothing abnormal. He prescribed 500 mg daily dose of Penicillin.

We have seen our ENT several times since than. When the pain and swelling did not go away after the penicillin, he said that it was a salivary gland infection and prescribed 4000 mg daily dose of Augmentin. The pain and swelling got initially better than the right face swelled up really bad.

The ENT scheduled surgery to remove the salivary gland. On surgery day, September 8, the ENT changes is mind and sent us for a CT scan that same day because there was swelling and pain in the area of the right jawbone.


The next day the ENT calls my wife and says that the CT showed "Diffuse Cellulitis" and for her to keep taking the Augmentin which she did. There was no improvement so he prescribed a new antibiotic, Avelox, 400 mg daily dose.

There was a mild improvement but then the right face swelled up again plus there was continuous pain. She no longer has any feeling in the area below her bottom lip.

On October 4th, we saw and infection disease doctor who requested an MRI and felt that there was an infection inside the right jaw bone.

Yesterday we saw the infection disease doctor who read the MRI result: "OSTEOMYELITIS of the right side of the mandible without evidence of cortical destruction or adjacent abscess. There is abnormal enhancement in the adjacent mucosa."

His recommendation was to treat with IV antibiotics and surgery.

We immediately went to go see the ENT who is in the same building. He read the MRI report and his conclusion was that the infection is on the outside of the jaw bone and not inside because the CT scan would have shown an infection within the bone. The ENT seemed OK with the IV antibiotics and referred us back to the original dentist we saw in June.

After seeing the ENT, my wife had a PICC line placed. After the PICC line we were able to see the dentist who took additional x-rays which because of the radiation treatments are not very clear and "cotton" like. The dentist feels that the pain and swelling may be caused by a tooth which has a large filling near the area where the pain is.

This morning a nurse came to our house and gave the first IV antibiotic infusion. The antibiotic is UNASYN (AMP/SUL) with a treatment regimen of one 133 ml dose every six hours for 6 weeks.

Any help or assistance would be appreciate it. Has anyone had OSTEOMYELITIS and what was the treatment given and the outcome? Thank you.
_________________________

Sorry to hear your wife is going thru such a rough time. Im not familiar with this, sorry. I am familiar with the picc line and IV antibiotics. So if you ever need info about that, I can help you.

Does your wife see a prostiodontist? If not is her dentist familiar with oral cancer patients? Before any major dental work she should have hyperbaric oxygen treatments to prevent ostiradionecrosis. This is very important. Do not let any dentist pull teeth before having HBO.

Best of luck with everything.

Christine,

Thank you for your reply. We are new at the picc line. The nurse has shown me how to clean, flush and change the IV bag and I am to do it for the next 40 days.

Yesterday was my wife's the first infusion. All day she felt very nauseated and she had a splitting headache. Today she felt much better.

The dentist we see specializes with cancer patients and was recommended to us by USC Kenneth Norris Cancer Center an we have been seeing him for the last five years. We liked him and he is a very good. He was skeptical of the osteomyelitis diagnosis of the MRI report.

We have never seen a prostiodontist. What is their specialty? We would be interested in seeing one at this point in the hope of finding out what really is causing the pain. Can anyone recommend one in the Southern California area?

Our ENT has recommended hyperbaric oxygen treatments after my wife finishes the IV antibiotic regimen. Our dentist also has strongly recommended the HBO treatments and he has advised that he will not do any tooth extractions without HBO treatments.

Would root canal work require HBO treatments first? My wife has a tooth with large filling near the area where the jaw pain is. The root has never been removed.

Thank you for your help.

It is my understanding that HBO is not needed for a root canal.

I hope the antibiotics help your wife.

Take care,
Eileen

A prosthodontist is a dentist who after graduating from dental school takes an additional three years or more of graduate education to become a specialist in dentures, missing teeth, etc. A prosthodontist who takes an additional year in a special fellowship training can become a Maxillofacial Prosthodontist. Maxillofacial prosthodontists treat patients with defects of the head and neck (maxillofacial) region due to cancer, surgery, trauma, and/or birth defects. Maxillary obturators, Speech-aid prosthesis (formerly called as Pharyngeal/Soft Palate Obturators) and Mandibular-Resection prostheses are the most common prostheses planned and fabricated by Maxillofacial Prosthodontists.
My CCC insisted I go to Maxillofacial prosthodontist and I have been extremely happy with his dental care. He has made two soft palate obturators for me which have really improved my speech. In talking with patients in his waiting room, I discovered they have flown in from Chicago,IL or driven from Philadelphia, PA or Richmond VA to keep seeing him
I had two rootcanals after my radiation TX and did not need any HBO just like Eileen said but my understanding is that extractions are a different story just like Christine said. I don't know any West Coast specialists, just this Washington DC suburban one.
Hope this helps
Charm

Charm,

Thank you for your reply and information on prosthodontists. After some inquiry, I found out that our dentist is indeed a Maxillofacial prosthodontist. He was also recommended to us by our CCC and we have been seeing since June May 2005 before the start of my wife's radiation therapy. We are very happy with him.

I am happy to hear that your speech has improved with the palate obturators. I am also happy to hear that HBO treatments are not required for root canal work.

Vin

Glad to help. I want to caveat my advice to say that if my prosthodontist had told me to get HBO, I would have but he didn't. So please double check with yours as each individual's situation is different and he certainly sounds qualified.
Charm

We got news from our ENT that my wife has indeed OSTEOMYELTIS. When we saw our ENT a week ago we had left with him a DVD of the MRI images.

The ENT had the MRI images reviewed by a radiologist at our CCC and the conclusion was that it is OSTEOMYELITIS. The MRI was done at Huntington Memorial Hospital since Huntington has an open MRI machine. The radiologist at Huntington had also concluded that it was OSTEOMYELITIS.

We are confused because the radiology report of CT scan done at our CCC in mid September did not say anything about OSTEOMYELITIS.

My wife so far has had eight infusions of the antibiotic including the one today. I change the IV antibiotic bag in the morning before heading for work.

For the fist 5 days there was a slight improvement with less pain and face swelling. But then the pain came back strong. She has also a times severe headaches and nausea.

We have discussed doing HBO treatments in conjunction with the antibiotic treatments with the infectious disease doctor and he feels that this may help. His staff is making arrangements for us for HBO treatments.

The infectious disease doctor also recommended surgery in conjunction with IV antibiotics. Our ENT however is strongly opposed to doing any surgery.

I would like to thank all who responded and your help. I would like to hear about your experiences with OSTEOMYELITIS. We are worried about this condition.