Swelling under ears near the lower right jaw. Is it any tooth issue?

[Du_deleted]

Hi all,
I have jaw pain and swelling under the right ear near the lower end jaw. Exactly under the ear. It's very tender to touch. It's been there for more than 2 weeks. I had facial pain and pressure. I have nose and ear congestion. Went to the urgent care and they diagnosed sinus infection and Otitis media. Prescribed antibiotics and NSAIDs.

Finished the medicine for a week. I still have the swelling and jaw pain. I also have sinus pain. I feel the pain in the face, upper jaw, ears when I bend down. I know sinus infection will take time to clear up. But this is the first time I have swelling under the ears near the jaw along with my sinus and ear pain.

Whether it could be any tooth issue? I don't have any dental fillings that side. Upper wisdom tooth with cavity. No lower wisdom tooth. I chewed fish for a long time before this happened. i.e before 2 weeks. I chewed on the same side only. Whether that cause any swelling? I don't see any gum redness and tooth doesn't hurt when chew and swallow.

I don't want to go to a dental visit at this current situation. I am not really sure if it's dental issue or swollen lymph nodes because of sinus infection. Any input is really appreciated. I still have the stretchy sore pain in the jaw under the ear and it hurts down the jaw line. I feel very sensitive in those teeth from this morning. It feels sensitive without chewing or anything inside the mouth. It's not sensitive to cold and hot foods. I feel very sore inside the ear and under the ear(jaw area). The swelling is still the same from day 1. I am keeping up with ice. Anyone have any experience like this?

 

[Dr M]

Do you perhaps have any radiographs of your teeth to better help us with an idea of what the cause can be?

 

[Du_deleted]

Just an update here.

I have the same ear pain, lower jaw pain, swelling under the ear and top of the neck area along with nose and ear congestion. Finished the amoxicillin antibiotics 2 weeks back. I have severe ear and jaw pain with swelling.

So, I went to an ENT today to check if it's ear or sinus issue.

I thought of checking with ENT before going to a dentist. I told them the history. I am prone to cold , sinus infection and strep throat throughout the year. I get almost one infection in 2 or 3 months. So I told them about that too. I have not tested any allergies before.

ENT checked my ears with an otoscope and did nasopharyngoscopy with Endo to check my sinus. He said my ears are completely fine and no sign of any infection. He said my sinus also looks clear and no pus.

He said may be the swelling a secondary infection from sinusitis or TMJ. He was not sure. He told me to get an x-ray and CT scan after 2 weeks just to check if any infection present. He prescribed cefdinir for 2 weeks.

The doctor was not sure why I have the jaw pain and the swelling. My sinus and ear is clear now as per the scope examination. He prescribed the antibiotics for 2 weeks and imaging after that.

It could be TMJ or any tooth issue? I don't have any gum redness.
I have called my dentist today to check this out. He is booked up today and till July 2nd. So they put me with another dentist tomorrow. I am planning to go in and check this out. I don't know if I am assumed this swelling as ear and sinus pain so far(more than 3 weeks). I am going to the dentist tomorrow. This is going to be a new dentist and I am not sure how he is going to check.
What should I ask for? Just posting here to get some information on hand. Do I need to ask for full mouth panaromic x-ray? Or normal x-ray? What else do we need to check since this involves my jaw area under he ear.

Please help if you have any inputs. Thank you.

 

[Dr M]

Good day,
A full mouth panoramic radiograph would be best, since we can then assess your wisdom teeth and sometimes your TMJ as well. If it is a TMJ related issue, further investigations might be required.

 

[Du_deleted]

Good day,
A full mouth panoramic radiograph would be best, since we can then assess your wisdom teeth and sometimes your TMJ as well. If it is a TMJ related issue, further investigations might be required.

I went to my dentist office and saw the new dentist. I told them the history. I also told them I did chew some meat and fish hard before all this happened. I also hear a big snap or click from the jaw. Like a knuckle the next day. After that, swelling started with pain.followed by ear pain, jaw clicks while opening.

They did check my bite with blue color stick(I think bite stick) and asked if I have any discomfort. I feel tender when I bite on tooth#30. He checked for few more times and that feels so tender. So he said I might have a fracture in that root. And he told me to get a CT scan for that tooth to check a clear picture.

I asked if it could be a TMJ problem or jaw bone issue or jaw fracture problem. He said that doesn't look like jaw issue. And they said if it's jaw issue or TMJ, I won't get swelling under the ear and the jaw line. I insist them to take panaromic x-ray just to check the jaw. Then he said ok. I had both pan and CT scan for that tooth.

I am yet to receive the xray pictures from their office. I will share it here once I receive my email.
After the CT scan, he said that it's predictable or not predictable. He couldn't see much of a crack or root fracture in the tooth. And guessing there might be a fracture and told me that either I have to extract the tooth or root canal with crown.
But he insist me that it's a trial and error. Even after root canal, it might give you the same pain. Then we have to extract it. So, it's better to extract in the first place and do implant immediately. I was so shocked to hear these and completely blanked out. I don't have any idea how root canal or extraction will be.

I would be happy if he said the answers conclusive. Not by a guess. Do the tooth crack or root fracture doesn't show up in x-ray or CT scan???
I asked if it works for wait and watch approach. He said I have to do it within a week. I have already delayed this because of assumption of ear, sinus infection and he is surprised that it doesn't hurt me more all these days. He said it will hurt more if untreated.

So, I have to decide if I have to do root canal or extraction on tooth 30. But I don't have any throbbing pain or gum redness or swelling inside on that tooth before I go in for a visit. I totally didn't think about that could be an issue.

And about my upper wisdom tooth, in the xray the root color was black. So the dental assistant told me that root is getting there. Since I had already taken antibiotics in the past weeks, the dentist said he couldn't see any infection in any of the tooth in the x-ray.

So, he also told me to take out the wisdom tooth #1. I am ok to take that. But I am thinking if I should take off #30. Whether the lower jaw pain, ear pain and swelling could be of wisdom tooth pain or infection. Since I taken antibiotics, that might be resolved. Is that possible??

Will the upper wisdom tooth cause swelling on the lower jaw?? Any inputs?

The dentist whom I saw today is new to the dental practice and he has been
practising for an year. He asked one of his colleagues for an opinion and she also said the same after reviewing the CT scan. Whether fracture of tooth or root not shown in the images??

Sorry for long post. Thanks for reading. I just want to be as detailed as possible.

 

[Du_deleted]

Good day,
A full mouth panoramic radiograph would be best, since we can then assess your wisdom teeth and sometimes your TMJ as well. If it is a TMJ related issue, further investigations might be required.

I have been dealing with upper and lower jaw pain with swelling under the ear. It's been more than 4 weeks. I did have some sinus infection and ear infection. I got some antibiotics from urgent care. After 2 weeks of antibiotics, the jaw pain, ear pain with swelling doesn't reduce. I went to an ENT this week to check my ear. He did Endo to check my sinus and also checked my ear. He said there is no infection in sinus and ear.

I was so confused and did go to the dentist. He checked for infection in the x-ray and it's not. He said since I was on antibiotics, if at all there was an infection present in the upper wisdom tooth or any other, it would have been cleared. He checked all my tooth in that side with a blue color stick and asked me to bite. I felt some discomfort and tenderness on one tooth bite. It's tooth #30. He said I might have a fracture in that tooth root and asked me to get CT scan. I took CT scan for that tooth(#30) and pan xray.

He didn't see any jaw bone issue in the pan xray. He said he couldn't find any crack in the CT scan. But he see something little and he is guessing that it might have a fracture. So he told me to go for extraction asap. He said RCT with crown might not work. If I feel pain after RCT, it's a waste of time and money. So he told me to go for extraction and implant immediately.

I was totally confused and worried. He is not my regular dentist . My regular dentist is not available today and he is a new dentist and he has been practicing for an year.

I don't know if I can proceed with extraction with this guess. I do have some pain in the upper wisdom tooth and i have to extract that. I feel sore and stabbing/throbbing pain in the upper wisdom tooth area and the lower jaw (exactly under ear and under tooth #30). It's swollen on the whole lower jaw. I don't know how to proceed with.
I was assumed that this swelling and jaw pain was because of ear pain and that was cleared by ENT. Then I thought it's TMJ. But that is not as per the dentist. He said TMJ issue will not give this swelling. I feel continuous pain in the lower jaw area. If i bite down, I feel sharp pain on tooth 30 and relief while releasing.

I don't know if its because of tooth# 30 crack or upper wisdom tooth or TMJ inflammation. How to identify?
I do have throbbing pain in the upper jaw and the lower jaw throughout the day. I have some sharp pain in the upper wisdom tooth area and the lower tooth area(#30).


I don't want to proceed with tooth #30 for rct or extraction without knowing the concrete answer for this issue. I don't want to exaggerate tmj pain if that's the cause.

 

[Dr M]

Good day

I had a look at your x-rays. It is difficult to determine if a tooth has a crack from a normal panoramic radio-graph alone. I would have to have a look at the CBCT as well.
On your radio-graphs it does look like you have some infection on the top right wisdom tooth. And you mentioned that it is painful?
In my opinion I would approach this through a process of elimination. The top wisdom tooth needs to be extracted anyways, due to infection and due to no opposing lower wisdom, which means that over time this tooth will continue to grow in a downwards fashion, leading to problems later on. It is also completely possible that a top wisdom tooth, could cause pain on the lower jaw, especially if it is on the same side-this is called referred pain. So I would start there.
If the pain does not go away, I would consider getting a second opinion from a dentist that you trust-maybe have him look at your CBCT-this is your records after all.
If a crack is suspected, I would start with the first step of a root canal, rather than extracting the tooth.
By opening up the tooth, and removing the nerve tissue, you can sometimes better evaluate the crack, if there is any. If the pain and swelling disappears and no crack can be seen, the tooth can still be saved with a root canal obturation ( which is the second step of a root canal treatment ).
If there is a crack and the crack does not extend to the pulpal floor, or roots, root canal therapy can still be done with a crown to protect the top part of the tooth.
If however there is a crack that extends down, this might lead you to extract the tooth.
Either way, the first step of a root canal treatment or emergency root canal treatment, can be used as a diagnostic tool in this case, and at least you don't pay for the full root canal treatment if it goes either way. ( Usually the second phase is more expensive ).

It might also be worth your while to consider getting a referral or opinion from an endodontic specialist. This is a type of dentist that specializes in root canal therapy as well as the management of cracks. He could give you better advice on whether a tooth is worth saving or not, since he makes use of microscopes etc.

Hope this helps.