New here. How to diagnose if I have eagle syndrome. Whom to see? ENT or TMJ specialist or neurologist?

General
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I understand reluctance to take rounds of antibiotics. It definately can wreak havoc on stomach in the long run and it is suggested to take probiotics to help balance the gut during and after antibiotics. I have a touchy stomach myself to any kind of meds. I take a look at a different antibiotic that might be easier on the stomach.

I can only to suggest you cry and beg your PCP to do CT scan of neck. That you are desperate for answers and tired of going in a circle. That you don’t want to have a tooth extracted and then an implant or crown unnecessarily. Unfortunately most ENTs that specialize in Eagles want to see a CT scan done prior to seeing you in their practice.

As for TMJ specialist - was this a dentist who does some tmj work on the side? Ive been to several and have seen several that their whole practices are dedicated to TMJ only. The ones that also do standard dentistry and a little tmj, I would be suspicious of their expertise. Im not sure why TMJ specialist who said it was all muscular why it was not suggested to get some injections such as botox to relax the muscles. Also could do steroids and or nerve blocks. If this tmj doc’s practice is not dedicated to TMJ, I suggest searching one out for a 2nd opinion. We all have gone to multiple doctors and sometimes for years trying to get a diagnosis so hang in there and keep pushing and advocating for yourself.

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Thank you @Snapple2020.

I will ask my Endodontist today if I need more antibiotics. To be honest, I don’t think this root canal and crown on this tooth is necessary now. I was scared that I might have infection underneath and have to address that…I saw another endo In September and she told me my tooth is healthy and don’t do anything to it. I went with first endo and dentist opinion and did rct thinking it will help with my symptoms.
This is unnecessary now. Now if I extract this tooth, that will be another thing to deal with implant or bridges. I don’t know much about those things either. Have to read more if I go for extraction.

I went to a tmj specialist office who see only tmj and sleep apnea patients. He is dds though. He see only tmj. He said muscular issue and his guards will help me. It’s 4k$ out of pocket. So I am dragging. He also told me to address all tooth issue before I coming there for guards treatment.

For now, I am focusing on this tooth issue and ruling it out. Don’t want to keep that in the loop. I have to request my PCP. She won’t agree mostly. I think I have to beg her. She always say no unnecessary imaging.

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I have an appointment with Endo this afternoon to check this tooth. I hope he can help me with his definite answer. He always blame tmj for my pain whereas my dentist say it’s tooth fracture. So it’s so hard to believe or understand their opinion. I made my dentist talk to Endo yesterday and they spoke. I am not sure what they spoke. I hope endo can help me today.

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Good luck with endo. I understand about not wanting to pay out of pocket for TMJ specialist as I am there right now myself and suspect the guards will be the next step. I did have doc suggest in the interim, a disposable night guard made by Plackers. They are called “Grind No More” dental guards. they are sometimes hard to find at stores so I ended up ordering them on Amazon for a pretty good price.Can get a pack of 20 for about $20.

I’m not sure where you live in US but I did go to a local university dental school and oral health center. I was about to go in and revisit getting an appliance but then COVID came along. The costs are significantly lower there. If a dental school is close, you may want to consider that? Sometimes they have some of the more cutting edge technologies there. My friend in medicine just told me one of the best TMJ centers is at TUFTS on east coast. It takes months to get in. Unfortunately I am on west coast.

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Thank you @Snapple2020.

I am in Atlanta. I will check if any dental school nearby.
I got an estimate of mouth guard for 4k from tmj specialist. The dentist sent me to tmj specialist to check jaw pain. Now my dentist say , he won’t rely or trust mouth guards. He said that, he don’t want me to spend money on guards. He told me to wait for tmj treatment. His statement is so confusing. He said don’t spend money on guards. Your issue might be from tooth, so don’t spend on guards.

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I suggest you try those Plackers guards first to see if they help at all before spending money on the guards. There is alot of mixed opinions about guards and why I have hesitated as well. Sounds like dentist is giving mixed messages. TMJ doc suggests guards?

Check this out for dental and oral health care:

Emory Oral & Maxillofacial Services

The Division of Oral and Maxillofacial Surgery at Emory is a regional center for the treatment of oral and maxillofacial disorders for adult and pediatric patients, from basic wisdom teeth removal to facial and jaw reconstruction. Division surgeons perform a wide variety of diagnostic, inpatient and outpatient services through Emory Healthcare at The Emory Clinic, Emory University Hospital and Emory University Hospital Midtown; the Emory Children’s Center at Children’s Healthcare of Atlanta; and the Atlanta VA Medical Center and Grady Memorial Hospital.

Contact: 404-778-4500

Division of Oral and Maxillofacial Surgery
The Emory Clinic, Building B
1365 Clifton NE
Suite 2300
Atlanta, GA 30322

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Thank you @Snapple2020.
I will check this out. I don’t know if emory is a dental school.

I got an otc mouth guard from Amazon which molds in hot water. Tried one night in June and it gives so much discomfort . So stopped using it. I will get another one and see if it helps.

Yes, tmj specialist suggested guards. My dentist is giving mixed opinion and statement. In August, he told me, to be honest your issue is not from the tooth and it’s from the tmj , go get a guard from them and try.
Now his statement is, don’t spend money on guards. I don’t think that will help you. He want me to try extraction as he suspect that fracture tooth could be the culprit and want me to take it out. This was his statement last week. He also referred me to see a micro neuro dentist to see if any nerve injury or neural issues. I am yet to see them . I saw a neurologist in November. I don’t know if neurologist visit and neuro dentist will make any difference. I have been going around to different dentists.

I did tell my dentist that I consulted neurologist and asked me to do an mri. He said not to do any medical tests before trying extracting this tooth. So it’s confusing what should be my next step.

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Ive tried those hot water ones too and found them useless and uncomfortable. These are comfortable and easy to use and cheap alternative to test if they help at all.

Well extraction to me is a method of last resort. Dentist cant really or wont order a CT scan. I suggest seeing this neuro dentist and/or working on PCP for CT scan. If you can get into Emory for a consult above and a 2nd opinion, it might stop this circular pattern. Emory has an excellent reputation as a center of excellence.Id go to them before letting your dentist extract a tooth. That’s if it was me.

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Hi Newuserhere,

I think I’d skip taking further antibiotics. It sounds like you’ve taken enough over the last few months. If they were going to help, they would have, but it seems like they didn’t do much to stop your symptoms.

In the future, when you take antibiotics, it’s important to take a probiotic, too. That helps keep your intestinal flora in balance i.e. as the antibiotic kills off infection, it also kills off some of the good bacteria in your gut. Taking a probiotic or eating yogurt each day about 2 hrs after taking your antibiotic will help your stomach stay well by helping your gut flora to restore itself & will also help prevent diarrhea.

I am sorry for your frustrating situation. I’m praying your PCP will give you the referral you need for a CT scan so you can figure this out once & for all. To remind you, ES can be caused by calcified stylohyoid ligaments which arise from the hyoid bone & calcify toward the styloid processes. Elongated styloids are more common but normal length styloids w/ calcified stylohyoid ligaments is also ES.

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@Isaiah_40_31, @Snapple2020
Went to Endo visit today. He spoke with my dentist yesterday. Looks like my dentist have convinced the Endo for tooth extraction. Last time when I saw the Endo, he was very confident saying not to extract. If it was me, I won’t extract. So don’t do it. Do only crown.
Today when he see me, the first statement is, sorry to say ,you have to think about extraction. I told them I didn’t finish the whole round of antibiotics last time and they are not happy with it. They said I would have called them for alternative. It would have helped me if I finish the course. So they prescribed me again the same antibiotics today . Penicillin 4 times a day for 7 days. I feel 4 tablets a day will be very high on stomach but they want me to take it.

He did check the bite using bite paper, tapping on tooth and both hurts and sensitive on that tooth. He said, it should not pain while tapping. There might be fracture or inflammation present. The fracture will not be visible on the cbct scan. I took my personal laptop with disc images loaded as he couldn’t open in his system. He couldn’t view properly on that too. He said he don’t know how to view those images as my dentist used another software. He told me that tapping on tooth shouldn’t cause any pain or sensitivity. I told him more than this tooth pain, my main area of pain concern is the lower jaw under ear and neck. He asked if it’s very unbearable tooth pain, you can try extraction.

I asked him if he can see anything in my cbct. He didnt view those properly. He told cbct won’t show anything. I asked again and again and pushed him that I wanted a cbct scan to be seen by him as I am going round in circles for this issue. I also told him that I need to see the neuro dentist to check if it’s nerve pain.
He don’t want me to spend money on cbct. But I didn’t have any choice. I asked him to take one today and he saw that in his own system. He then said no signs of fracture. I couldn’t see anything. I can do one thing for you. I see the fillings very narrow in the root canal. I can reopen the re do the RCT and make it everything wider. We can try that and see if it helps. If not, you can go for extraction. I asked if redo will help and he is not sure though. He told me to take antibiotics for a week and see. And asked me to come back after 3 weeks for redo. He said he will do it for free. But I am not sure if I go back to dentist after that for filling in top of it. I don’t have any idea how this works. The dentist will not do core and crown again for free I believe. Or no need of dentist work. I am not sure about this. I didn’t ask endo about it. He told me to talk to my dentist. I also don’t want to traumatize the tooth again by re rct. Dont know where I am leading to.

I just took a dose of penicillin in the evening along with yogurt. The nurse told me to take with a cup of yogurt. So took it with plain greek yogurt. It still hurts my stomach. But this time I am planning to finish this course and see if it helps. The Endo is not sure why I have tapping pain on that tooth. It hurts and sensitive for tapping and biting.
Sorry for long post.

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Thank you @Snapple2020.
I will check about this emory. I haven’t been to any dental school. i am from another country , currently living in the usa.been in usa for last 4+years. Getting used to the medical protocol s here.

Thanks for your suggestion. Yeah. I feel the same about extraction. Dont want to do it without knowing the cause. Today saw the Endo and he said no fracture. But he recommended extraction. I don’t know what does it mean if i have pain on tapping on that rct tooth.

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Thank you @Isaiah_40_31.
I have been prescribed antibiotics today from my Endo office. It’s 4 tablets a day for 7 days. They asked me to finish this complete course. I just took one and it still hurts my stomach. I take it with yougurt. The nurse told me to take it with yougurt. Didn’t know that I have to take yogurt after 2 hours. I will try that. It hurts and I don’t know if I should withdraw or continue. Moreover, not sure if it helps with my tooth sensitivity and tenderness for tapping and biting. The Endo said it might or might not help. Just give it a try. I have taken a lot of antibiotics since May.
Which probiotics do you recommend? I am taking greek yogurt.don’t know any other probiotics.
How to know the calcified stylohoid ligaments from hyoid bone? Through neck or head ct ? Should I ask for both?

@Isaiah_40_31, @Snapple2020, do you know anyone who did re root canal. Will that help? Have you heard of it? I don’t know if I should proceed with re root canal. The Endo doesn’t have that plan at all. He was telling me to do extraction. When I asked him to see my cbct and he couldn’t view properly. I asked him to take one at his office. He is good and didn’t want me to waste money on it. (this is expensive though, and I really wanted him to take a look for diagnosis) . By looking at cbct, he said no bone loss, so no fracture. We can’t see fracture in cbct. Then he said , he will do re rct before taking that tooth out. He said he filled it conservatively now. So redoing it by making wider filling in all canals. That’s what he said. I don’t understand much about it. But I am wondering if I should spend money again for core and crown work. I have to check with my dentist. Don’t want to start this process again to be honest. Did this for last 3 months only for rct and crown. Took a long time to finish it off. So frustrating to think about second round of it.

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Hi Newuserhere,

If yogurt doesn’t help, go to a pharmacy like CVS, Rite Aid or Walgreens, & ask the pharmacist to recommend a probiotic to help your gut flora while you take your antibiotic. That’s the best way to get something very good. There are many brands of probiotic supplements so getting a professional’s recommendation would be best.

I know we sound like a broken record here, but before you do anything else w/ that tooth, keep pushing for the CT scan. As we have said, you will need a scan of your neck from your hyoid bone to your skull base. That will show your styloids, & if there is calcification on your stylohyoid ligaments it will show up on the scan as well. You can specifically ask for the scan to be diagnostic for Eagle Syndrome & for the radiologist to evaluate your styloids & stylohyoid ligaments & stylo mandibular ligaments for calcification. That will cover all bases for ES.

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Thank you @Isaiah_40_31.
I will check with pharmacy. Stomach hurts since last night and I passed loose stools twice. I will surely request my PCP to give me an ct order. I think I have to take mri also before doing anything with that tooth to check TN.

And I am not sure if this mild tapping pain and sensitivity to tap ,bite root canal related to Eagles? Or root canal not done properly? Endo was keep telling me to either wait or do extraction if pain is worse. But when I told him to take cbct, he saw those and said he can redo the root canal. But only problem is, i got the permanent crown placed. So I don’t know how it will work with permanent crown.
If dentist ask money for redo core and crown work, i really can’t afford. I don’t know if he agree to it. I would like to know if anyone did re rct.

So do you suggest me to get CT,mri done before trying this re root canal??

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OMG. Same antibiotic? I’m not sure why they would prescribe same one instead of alternative one since you have so many stomach issues with that one. I can only suggest to call and ask for another antibiotic that has a better stomach side effect profile. There are many options to chose from.

Well at least the endo will redo rct for free. Ive had about 8 root canals myself and and familiar with all this. If you can take antibiotics and wait 3 weeks like he suggested, Id follow his advice. I suspect the dentist would want to recharge for new crown? He may give a discount given all you have been thru. Id ask. I would not worry about re-traumatizing the tooth by doing a new root canal. If you do a redo rct, you could wait before even proceeding with a new crown. If its not better, then extract?

You are in a tough place. Clearly something is going on but the source of it could be multiple things. If you read the link I gave you about tooth pain, it can be complex teasing it out. At some point, you will just have to go with your gut.

If tapping and biting on the tooth (which has been root canaled) causes pain, (aside from neck/jaw issues) something is going on in there (1. possible infection, 2. narrow filling of roots, 3. fracture in root - requiring extraction) and I think your providers have suggested options.You just need to chose which option and in what order to do them.

I encourage you to call that number at Emory and see if you could get a quick consult appointment. That number is not the dental school but an excellent oral health and mouth center (they can refer to dental school) where you will have access to advanced diagnostics and highly trained experts in oral health. They could help you decide how best to approach this? Just a suggestion.
In closing, if your pain so severe you cannot handle, you may just have to extract. I dont know if that helps.

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Thank you @Snapple2020.

Yeah. Got the same antibiotics. They were like , why didn’t you finish the course last time. It obviously gives you stomach upset. Take it with yougurt. That was the reply. I don’t think that antibiotics will surely help with this tapping and biting paint/sensitivity. I remember I have this same pain to tapping before the crown(after doing rct), before the root canal during my first visit too. I still have the same. The Endo is not sure why I have that tapping pain. But he asked me how severe it is. If it’s less, i can just leave it. I told him more than this tooth, my main pain area is lower jaw under ear and neck. That’s constant burning pain. He said the tooth is related to all nerves there. So tooth might be the reason. If redo RCT doesn’t help, extraction is the next step. He decided about redo RCT after seeing my CbcT scan yesterday. Before that he told me to get it extracted. I asked him to take a CbcT scan. He saw it and said all canals filled narrow. May be I make it wider.

I just emailed my dentist to inform that endo doing re-RCT for free. I asked his thoughts on how to do core and crown again. I don’t know much about this as this is my first ever rct and first ever crown. I am sure he won’t do it for free. But I can’t spend another 1600$ for crown and core. Already spent 3000$ for this RCT and crown now.

As you mentioned, something is going on that tooth since the beginning. Same tapping pain and biting pain/tenderness since June visit. I experience that tenderness only during the bite paper test. I won’t use that side to chew food at all. Using only opposite side. Sometimes I use this side to chew soft foods and I don’t experience anything but I feel tender and sore in the doctor office for bite paper. So don’t know if that makes any difference or way of biting there. So, even If I complete antibiotics course, I can’t say the difference until I go to the dentist or endo for them to make tap and give bite paper to see how it responds to.

Endo did say that he filled it narrow which is conservative. He will reopen the tooth and fill it wider and make everything big. I don’t understand though. He said , I will make every thing bigger inside. I asked about infection and he said no since nothing showed up in x-ray. He is not sure about fracture.

I don’t want to directly jump in to tooth extraction without knowing this is the reason for jaw and neck pain. That’s my main concern. But something is going on this tooth too. It’s the same symptoms in all my visit. Pain for tapping and biting on paper/tooth sloth. Don’t know if I had this earlier too before jaw /neck issue. I remember I was eating more on this side only. So didn’t feel anything. It was good. Since this jaw pain started, I am not using this right side at all.

If this tooth extraction helps , I will do it for sure. But no one is certain about it. That tooth pain , soreness is bearable now.
I doubt my dentist will agree to redo rct. I didn’t get any response from him yet. He want me to pull that tooth out soon. So he will not agree to it. It would be better if atleast he gives a discount for the crown. Can’t spend the total amount again as he is out of network for my insurance and it’s covered only 50%. Don’t know if insurance will cover again.

Do anyone know what should be done for this tapping pain? Does it require extraction?
Anyone had implants before? I am worried about it too. I need to try implant if i go for extraction route.

What would you do if you are in my situation? I am not able to think wiser and decide accordingly now. Feel like mind is completely occupied with different opinions and thoughts. Don’t know how to proceed further.
@Isaiah_40_31, @Snapple2020.

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Well tapping pain usually indicates need for RCT. I personally don’t know enough about root canals to understand the value in widening root canals and how that might help or not.I’m not sure any of us could answer that one since we are not dentists or endos.

The only pro about going directly to extraction is that in the end it may be the most cost effective. IE; Wont waste money on another crown and those moneys would go towards implant.

As I suggested, call Emory and see if you can get a quick consult and an expert opinion.If you cant get in quickly, you will have to make decision on your own.

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If it was me, I would wait to do anything else to the tooth until after the CT scan & MRI. I think you need to rule out the other possible causes of your neck & under-jaw/ear pain & pressure. It may have nothing to do w/ your tooth. Since you said you can live w/ your tooth pain, set the tooth issue aside for awhile & pursue an appt at Emory as well as the scans.

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Thank you @Snapple2020. I did call this number today and no one picked up. No website available for this address. I will check emory website and call their central location number.

You are right. Extraction is the cheapest option considering the cost. I have spent 1500$ for root canal and 1600$ for crown and core. Crown is covered only 50% under my insurance as my dentist went out of network this year. I don’t want to change to other dentist at this current situation. So I continue going to his office.

I did ask my dentist about the retreatment. Dentist is ok with endo decision as well about retreatment and he don’t want me to go for extraction without trying retreatment. But cost involved is the only thing. It would have been better if I did this with temporary crown.

He said, no need of core work again. Sometimes crown will fracture or break during the root canal work. So he said , if it breaks he will charge me 500$ for new crown. If it doesn’t break, he said he will do refilling for no charge. But he said he can’t guarantee if the crown will break or fracture during that tooth re- root canal procedure. I am holding on to this as of now. Taking antibiotics 4 times a day. Took 3 so far and gives me diarrhea and stomach cramp. If diarrhea gets increased or worse, I will stop and call their office. Passed loose stools 4 times since morning. Hope this is ok. Taking yogurt as well.

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Thank you @Isaiah_40_31.

I will try to get the imaging done sooner. I am also planning to schedule and appointment with neuro dentist. This tooth pain and symptoms might not be related to my pain area at all. I am not using that side to chew food. Just babying it.
I have severe burning pain , tenderness under the ear in lower jaw. It hurts to touch and I have small lump like spots under the ear and side of the neck like small pea size.
It’s been there since May. It hurts to touch. Feel very sore and tender to touch. That’s my main concern since may and none of the doctors or dentist concerned about it. Dentist and Endo say that might be because of tmj or tooth issue. I have pain in the entire lower jaw line now. It hurts like sore pain in the jaw line from under the mouth to under the ear.
I am taking antibiotics to see if it makes any difference. But it’s hard on my stomach though. Hurts and diarrhea.

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