Looking for Help - Excruciating Tooth Pain, a Dentist’s Check, and Diet Change

[RayBee]

Sorry for the length of this in advance…
And for the weirdness…
I guess I’m just weird…

I put my ResMed F30 on, go to bed and within 30 minutes, I have excruciating pain in my lower right wisdom tooth area. It spreads and radiates eventually to the whole side of my face, within an hour. It’s a throbbing pain just like a bad tooth abscess would be. (Had them, know what they feel like.) I take my mask off and sit upright or stay laying down, and the pain recedes within an hour to completely gone.

I can lie down on my right or left side and the same thing happens - right side pain starts around my lower right wisdom tooth, and expands as above. This seems to discount the headgear or cushion/mask pressing on the right side of my face.

I saw the dentist yesterday as I thought I had an abscess brewing. Dentist said my wisdom tooth was sensitive to cold and they could pull it, if I wanted. The next tooth over was my suspect tooth initially. It had a root canal done and metal crown about 30+ years ago. I thought the old dead roots might have a fracture and starting an abscess, like another one did several years ago. The dentist said it looks perfectly fine, as does all the bone and soft tissues in that whole area. The teeth forward of the wisdom tooth are not sensitive to cold and don’t seem to be problematic. All the fillings in those surrounding teeth look fine.

Tylenol and Ibuprofen doesn’t provide any relief. Even a little relief.

I’m guessing there is some sort of nerve pain getting triggered. But how? The nerve feeding those teeth exits the lower jaw bone at the top of the hinge area. So I can’t imagine the headgear pressure would be doing this. I’ve been using this F30 cushion system for a couple years and been on my ASV for several years before that without any problems.

This problem has been getting worse for only the last 4 or 5 days - from completely normal to excruciating pain. Crazy.

Last night I masked-up and went to bed. After 30 minutes, the pain was getting too intense to fall asleep. So I took the mask off, and as a test, I just laid there and noted the pain had eventually subsided completely. Interestingly, I think I had one of the best nights sleep for the last month - without using my ASV.

Interestingly, this does coincide with the last month of being in the Kaiser Medical Weight Management program. It is a calorie-restricted, mostly liquid diet for the first 17 weeks. So I haven’t eaten anything more solid than their meal replacement protein bars (one a day). So I didn’t crunch down on anything potentially damaging a tooth. I have since lost 17 pounds over the last 30 days.

Any ideas to this craziness?

[Jeff8356]

An infected root canal can be a real tough one!  I had one for several years.  The pain would go from my jaw to my middle ear.  It was constant.  Doctors didn't have a clue s to what was causing it.
As luck would have it I was eating a piece of hard candy and went to bite down on the candy.  That broke the tooth in 3 places.  Made an emergency appt with my dentist that day.  Had the tooth pulled right away.  The dentist said there had been a bad infection there for a long time.  right after she pulled the tooth, the pain I had going from my jaw to my inner ear, which was there for years,  just disappeared.  

If you can have the dentist get some good shots of those two teeth and see if anything might be hiding in the roots.
My mask straps do go over where that tooth used to be.  If it were still there it would be driving me crazy!  I had all my wisdom teeth taken out in the 90's after going through that.  Might be worth it for you to have them yanked out.

[StevesSp]

You have my sympathies. I vividly remember the excruciating pain I suffered from a root canal that went wrong. After the excavation, I was sent home with the temporary filling. When the numbness faded it was replaced with some of the worst pain I had ever experienced - even worse than the two kidney stones I have suffered. My wife drove me back to the dentist and the relief I felt when he gave me another local anaesthetic was overwhelming. After removing the temporary filling along with some remnant nerve he'd missed, all was well.

Truly, I hope you get this sorted out soon. Oh and as has already been suggested, make sure you get some good x-rays of the adjacent teeth and jawbone. Long-standing infections can spread and kill bone.

[Crimson Nape]

RayBee  -  I'm taking another route for consideration.  Could your pain be a differed pain caused by nerve inflammation?   If you have another mask brand or type, like a true FFM, try switching and see if the pain continues or subsides.  The test mask should not be of the same style as the F30, so you won't be touching the same facial pressure points, particularly under the nose.
- Red

[mesenteria]

I wonder if a blood panel might show elevated leukocytes.  If so, you might have a chronic infection, possibly inflammation, perhaps associated with a sinus...or two.  However, this isn't a problem for you generally, as in during the day.  It only appears when you recline to sleep, perhaps when the mask is applied, maybe when pressed by the pillow? 

How about simple neuralgia?

[OpalRose]

I have suffered over the years with various tooth, jaw and nerve pain, often pain that would last for weeks. The nerve pain is the worst and often hard to pinpoint.

RayBee,
I wonder, even though you're using a full face mask, if you may be mouth breathing to some extent and the air is hitting nerves around the affected tooth.

Just a thought, but it does seem like this pain is coming from pressure of your mask or air hitting your teeth and gum area.

Hope it resolves for you soon.

[RayBee]

Thanks for all the great ideas and kind words my AB friends.

I believe I have finally figured this out. Last night / this morning at 3:00 AM, I woke up with mild pain in my lower right jaw. I looked at this as an opportunity to check further. I pressed down, pushed right (outward), and pushed left (inward), on my back three teeth one at a time. The only one with any kind of sensation of pain was the wisdom tooth in the downward and outward directions.

I was thinking about how I press my tongue forward, displacing the air in my mouth, to keep from blowing air out of my mouth and breaking the mask cushion seal. This is now a subconscious act (I think). I believe this to be at least part of the problem. One that I cannot fix.

I believe that over the past few years, my wisdom tooth has become ever-so-slightly loosened in its socket. “Micro-loose” if you will. If the tooth’s root-tip area is moving slightly with respect to the socket in my jaw, there are the tiny and delicate nerves going through that transitional juncture. Neither one should move with respect to the other. So I’m thinking the nerve area there is inflamed, tiny as it may be, and any undue force or movement is going to continue to make things worse and painful. If this wasn’t the entire cause, perhaps some time over the past few years, I inadvertently bit down on something and traumatized that root-tip area. Quite possible. Then the on-again, off-again pressure from my tongue just exacerbated the aggravated area until this finally developed.

As far as x-rays goes, my dentist took a full set of x-rays Tuesday and all looks good. She even reviewed them with me, and they appeared to be fine. So, no raging abscess anywhere. No cavities or failed fillings. She blew a tiny bit of air on those three teeth and when she got to the wisdom tooth it felt like she hit me with an ice pick.

Tooth be gone. I have scheduled a tooth extraction date for next Wednesday. I don’t think I will be able to use my ASV machine before then, but will try, as I am feeling the effects of no PAP for two nights.

Any idea of how long I should wait for my gums to heal up before going back on ASV?

I suppose this weird problem just reaffirms that I really am weird.

[SideSleeper]

Ask the dental professional about the CPAP use. I had a wisdom tooth pulled and didn't have to skip my APAP, but things can certainly differ.

[RayBee]

Good idea SideSleeper. I'll ask before I'm all drugged-up and loopy.
I'm guessing I'll probably be like you and dive back into PAP. I know I'll be ready to start back up again.

Surprisingly though, I haven't really felt that bad off my ASV machine. But it usually takes several days before I revert back to the foggy-minded lost puppy.

[RayBee]

Well, the old cantankerous wisdom tooth got yanked last Wednesday. And of course while I was down from that, my body decided it wanted to mess with me all the more and the old kidney stone decided it was time head on down south around midnight the next morning.

Ok, I started using my ResMed ASV last night again. Everything went fine. No pain, yes gain. I'm still on this side of the grass and livin' the dream.