Its me with yet another question I hope I can articulate half-decently .

For a little over a year while I was sick (before I was being treated for lyme) I started having really horrible problems with popping, creaking, cracking & grinding noises in my jaw area. The noises were not constant but sometimes were really loud and even embarrassing. I also know I clenched my teeth at night due to a sleep study.

After about a year I was prescribed Klonopin & it really helped me with these problems... my jaw stopped making all of those noises, or greatly diminished and I slept better so I assume the teeth clenching improved also.

Recently I was taking flagyl/metronidazole and some of the jaw symptoms returned and also tinnitus (ear ringing) which I didn't have before. Also the tinnitus gets alot worse with large jaw movements, like yawning, so that makes me think they are connected....

At first when I took klonopin (2003) I thought the jaw pain and other stuff I mentioned was due to a neurological imbalance towards excitation

[http://www.immunesupport.com/library/showarticle.cfm/ID/3154/T/CFIDS_FM/searchtext/cheney%20klonopin ].

I am pretty sure that I did and do have something like this since I have a lot of other symptoms which correspond to it, muscle spasms, exaggerated reflexs, sometimes a lot of cognitive "noise". I think these can all be lyme symptoms?

Anyhow, considering my reaction to flagyl now I'm wondering if what really is most relevant to all of the jaw issues is an infection of the joint fluid or of the bone, and in this case the klonopin was just covering up a part of a stimulatory/excitatory response to this infection?

So my questions are:

*Has it been shown that lyme can infect bone? And specifically the jaw bone if anyone has any information about that?

*If so, is that especially common in chronic lyme? Somewhat common?

*Is there a list of antibiotics or antibiotic classes that penetrate deep into the bone (specifically jaw) or will just about "any old" antibiotic be able to do this?

*Do you guys think it is possible that all my problems with ear and jaw pain and tinnitus, (despite having previously responded to klonopin) are more indicative of a local infection than just another manefestation of a system-wide neurological imbalance?

*Is it possible, or likely that flagyl could stir up an infection (by causing cyst conversion into the spirochete) if inadequete concentrations were reached? Or that it could cause too much of a massive dieoff leading to an exacerabation of inflammation?

*If you think the flagyl could have caused an excerbation of my jaw symptoms by a way like that mentioned above, how is it that I still have this exacerbated symptoms nearly 6 weeks later? ... Does that make sense or suggest something else is happening?

*Due you think the exacerbation of jaw pain & popping and tinnitus from flagyl is just due to its neuropathic effects and I'm taking a totally wrong approach to thinking about this. ?

Also I'd love to hear anyone's experiences that they think correspond, or are relevant or would just like to mention.

Thanks! I'm also glad things look promising for the future of Lymenet at the moment, this board is so generous and helpful.

Sincerely,

john

------------------
"All visible objects, man, are but as pasteboard masks. But in each event -- in the living act, the undoubted deed -- there, some unknown but still reasoning thing puts forth the mouldings of its features from behind the unreasoning mask. If man will strike, strike through the mask! How can the prisoner reach outside except by thrusting through the wall?"

--Captain Ahab from Moby Dick
 

There is no antibiotic that will undo this. Reasons explained in the article below. It takes the work of the best oral surgeon you can find.

I am sorry - but that's said without beating around the bush. That's why so many have dental problems and tooth loss, on and on. You may not necessarily have pain also. I had absolutely no pain brought on by this infection. That's why so many are not aware of the damage and why they are unable to get well and cure their Lyme.

Here is an article by the doctor who did my oral surgeries to correct the problem. The title of the article may not exactly resemble what you have - but I am sure it comes close. Read it thoroughly. The man that wrote it is the best in the country and knows what he is talking about. No regular amalgam dentist will agree - that's for sure; and neither will the dentist on this board that now is appearing again under a different alias. I wish here were in touch with reality.

You of course are entitled to follow any advice you deem right. I myself avoid these dentists like the plague.

Here is the article that I have posted before.

W I S D O M T E E T H or Teeth of Misfortune (Third Molars)

Facial Pain Linked To Infections
by Christopher J. Hussar, D.D.S., D.O.

For almost a century controversy has waged regarding the existence of a disease process with infectious origins within the dental alveolus. These localized infectious processes have been strongly implicated in generating facial pain including trigeminal neuralgia along with other cranial facial pain disorders including, remote pain disorders in distant regions of the body.
The Father of modem dentistry, G. V. Black, recognized and gave notice in one of his textbooks to the actuality of a hollow jaw bone, housing an infectious process within the dental alveolus.

review of the literature reveals numerous papers from the early 20th century written by both M.D. and D.D.S. alike, describing the surgical debridement of jaw infections including devital teeth, and localized osteomyelitis lesions that successfully treated, not only localized facial pain, but remote pain disorders such as arthritis as well.

Sir Wilfred Harris, a British neurosurgeon, proposed the reality of a chronic intra osseous infection within the alveolus causing neural degenerative changes and demyelination to trigeminal nerve branches. This was in 1926 and was widely accepted by dental surgeons in America nearly a century prior.

In the early part of this century the theory of "focal disease" arose in which a chronically infected area of the body was responsible for causing pathology elsewhere. Many tonsils as well as teeth were removed with miraculous, as well as not so miraculous, results. The clinician would script an article expounding the cure of arthritis after the patient had several diseased teeth removed. Anecdotal cases of blindness reversal was documented (your author has witnessed such an event)...

Much credit must be attributed to the brilliant research of Dr. Weston Price in the early part of our century. With incredibly reproducible results, this research dentist demonstrated the existence of multiple bacterial strains in dental teeth including root canals. In addition, he addressed the chronically infected periodontal membrane and periodicular bone resulting from infected teeth and the cavitation of such chronically infected bone if thorough socket curettabe was not performed properly.

With the ``disproving'' of the focal theory by our progressively autocratic medical/dental complex, the concept of chronic dental/alveolar infections has gone practically unrecognized for the past sixty years.
One of the reasons may be poor visuatlization of these chronically ``cavitated'' lesions on intra-oral radiographs. Usually housed within the cancellous bone, the cortical plates and their different x-ray absorption qualities obscure and alter the true picture lying deep within the jaw bone.

In reality, this is not the case as certain radiographic landmarks are quiate visible and will readily confirm the presence of these lesions. With continued x-ray evaluation along with curettage of a suspected lesion, they will become obvious.
The above mentioned as been well documented by Jerry Bouquot, D.D.S., M.S.D., in his numerous articles on NICO (Neuralgia Industing Cavitational Osteonecrosis) lesions describing ``laminar rain,'' the x-ray visible, boney changes resemblung the rungs of a ladder.

This results when the bone of the extraction site refuses to heal properly, literally leaving the root outlined. Micro calcification within the confines of the original extraction site, further confirms the presence of an inflammatory bone lesion, often referred to as a cavitation.''.
In surgerizing mandibular lesions, involvement of the inferior alveolar nerve (IAN) by the obstructive process creates a characteristic appearance on the x-ray. The superior aspect of the mandibular canal, the ``roof,'' is usually eliminated and the fine, dense superior white line is seen to disappear as the IAN courses through the lesion site. Absolute certainty of course only occurs with biopsy confirmation of curettaged tissue from these lesions. With little practice and suspicion, near one hundred percent accuracy is possible when performing the surgical debridements.
Perhaps our subject matter has been ignored for decades because of a failure to biopsy on the part of dentistry as a whole.

Do endodontists rely on the biopsy for verification of tissue? Hardly, for my dental training down-played the role. Do oral surgeons send their extracted teeth in for biopsy along with any abnormal bone that may be removed along with those teeth? It is my policy to biopsy every tissue fragment I remove from the mouth. My judgement in determining pathology has been incorrect less than .5% of the time. Once you begin to recognize the disease, the diagnosis becomes much easier.

When curetted, the contents of these intraosseous lesions may present varying types of diseased tissue. Commonly, when surgically opened, the lesion site is void of caancellous bone; thus the derivation of the term ``cavitation,'' a hollow cavity exists. Other presentations include hemorrhagic bone with easily curettaged spicules of both viable and non-viable bone. Multiple globules of adipose tissue representing degenerated bone can commonly be curettaged; in fact, **************opening up one of these lesions with a fissure burr causes an exudate not unlike bloody chicken soup with countless micelles of fat floating on the surface of the serium***************.
If an area of condensing osteomyelitis/osteitis is evident on an x-ray associated with a suspected cavitational area, surgically speaking the alveolar bone will usually possess a consistency of pearl-like hardness implying condensed bone that has been made devital by ischemia. This is extremely difficult bone to surgically eliminate especially in the presence of the inferior alveolar nerve. These patients will often develop facial pain syndrome and can be difficult to treat.

Microscopically most biopsy reports will demonstrate marrow fibrosis as the body attempts to regenerate itself, fibrotic material heals easier than bone. Multiple fragments of bone shard appear as the impaired blood supply cannot provide adequate flow to new bone attempting to replace diseased bone. When your patients come to you months after a difficult extraction, showing a small bone fragment that has worked its way through the gingiva, you didn't forget to irrigate it out; the body refused to nourish it and it sloughed. Lymphocytes may or may not be encountered depending on the chronicity of the infection, the immunity of the patient, nutritional status, and other factors. Neurophils, most commonly seen with acute inflammatory processes, are seen infrequently with cavitations. What is seen primarily is necrotic bone flake often intermingled with viable bone. Remarkably, very few osteoblasts or osteoclasts are observed in specimens.

Most articles covering facial pain are written dealing with trigeminal neuralgia, atypical facial pain (AFP) and TMJ, with the latter two being the most common. Most of these reading this article are well-versed in the treatment of TMJ disorders. However, what treatments do you prescribe to the patient who has had 5 or 6 bite splints from other practitioners and his facial pain persists without alleviation? You must always be suspicious of a ``NICO'' process smoldering in the patient's alveolus when consulted by such a patient.

********************Their orruccurrence is of epidemic proportions; if the patient has had any third molars removed, it's a safe bet to conclude that cavitations are present. Why do they cause pain in some and not others Multiple theories have been proposed as to what mechanisms exist allowing NICO's to generate pain
A general consensus agrees upon the initial development of an intra-alveolar infection from a devital tooth, root-canaled tooth, ir extraction site. This infection persists within the alveolus and can ``tunnel'' or remain localized. In the mandible, the bascula system is an end-organ type or terminal vessel allowing basically one-way flow of blood. Chronic infectious agents harboed in these cavities, namely bacteria and their endotoxins along with what appear to be viral agents causes a vasculitis in the arterial side eventually compromising the flow of blood.

With the onset of ischemia other changes occur. Antibiotics are not as effectivce for they rely on a blood supply to reach their target zone. Infectious agents often will die off or become rapidly attentuated and be rarely seen in biopsy. Bone necrosis develops, the affected alveolus cannot heal properly, and a pathologice entity arises called ``NICO.'' What caused the pain?

The physiology of the trigeminal nerval is extremely complex. Peripherally, the dentin contains 30,000 to 70,000 microtubules per square millimeter! Free sensory nerve endings and dentinoblasts course through these tubules and communicate with each other and pulped nerve fibers, The pulp itself contains at best 600 t 700 nerve fibers with a majority consisting of the myelinated type. This concentration of fibers is higher than the corney making human pulp an extremely pain sensitive structure. Sensory distribution of the trigeminal nerve is extensive as it supplies the ``central computer'' with information on pain, temperature and touch impulses from most of the head, skin, face, oral and nasal mucosa and dura mater.

*******************The axonal transport mechanism is capable of antegrade and retrograde flow, nourishing the periupheral branches with antegrade flow. Retrograde flow brings bacteria, viruses, endotoxins, and other degenerated compounds that are generated by devital teeth, N's, etc., to the central nervous system (CNS) and ultimately the main sensory trigeminal nucleus and spinal trigeminal nucleus. At some point, the CNS perceives a threat based on this feedback mechanism and goes on alert.

The multiplicy and overlapping peripheral innervation (dentinoblasts, pulpal fibers, periodevital ligament fibers) further complicates the picutre by converging as it approaches the CNS. An inflamed pulp from a hot tooth could be causing impulses that are below the threshold of pain perception of the patient. Add to this, a root canal and two NICO leasions from old third molar sites and the CNS, via cranbial nerve #5, is aroused it lets the patient know there is something wrong causing pain. The pain can be intermittend and excruciating like that of trigeminal neuralgia or vague and heavy, disguised as a headache, ear pain, sinus pain or non-specific jaw pain, troublesome enough to cause suicide.**********************

Localization of these pathological ``foci'' of pain-causing disease is best accomplished by anesthetic confirmation of ``neural therapy''. This technique utilizes local anesthetic, both vasoconstrictor and preservative free, that is injected into and about the periapical mucosal area of suspect N leasions or teeth in order to ascertain their effect on the patient's perception of pain. Approximately 1/2 cc of anesthetic solution is delivered to the suspected site via 30 gauge needle. If the pain is abolished, it is with high certainty that you have found the primary lesion. If only some of the pain has been attenuated, then continued testing in other regions both ipsilaterally and contralaterally in the arches is necessary. Be suspicious of any edentulous regions.

******************* You will discover every third molar area is usually associated with a NICO lesion prior to extraction. W I S D O M T E E T H are misnamed; they are teeth of misfortune.**********************

References/I think I typed enough for now/gg

Take care.
 

Have you done anything else to address the bruxism? I have it again recently from the antidepressant buproprion, which I like so far. I also had it earlier, may have been due to st johns wort or perhaps I was accomplishing it all on my own, cant quite recall. At any rate I would suspect it reflects not only the drugs but also a predisposition inherent in my central neuropathy.

Anyways, I use a device called an NTI-tss which you can read about in various places. I wouldnt be the expert on what risks it might present, but the ones I read about, in a rushed sort of way (I'd had a headache for a month overtop of nasty anxiety), were not very concerning from my perspective. It seems to work fairly well for me. However, I never got a chance to test it out much when I first got it, as my bruxing stopped soon afterward. Now it appears to be remissing my bruxism headaches, but I've only been using it less than a week. The only time I've had a bruxing headache despite using it, I had eaten very little at the time of going to sleep and was feeling hypoglycemic and weak (I often have a poor appetite). I dont know if that could have intensified bruxism tendencies. In contrast, I think I'd had 3 or 4 days of crappy NSAID-refractory headaches the prior week, before noticing a diagnostic touch of pain in the jaw, and realizing that I was bruxing and ought to dust off the NTI-tss.

I'm not always here but you can email me later if you want to find out if its still working. It cost me 350 USD which seems to be median. It needs to be custom made, however this takes 20 minutes and then they hand it to you on the spot, so charging more than 350 USD for it is a damn crime (I called all around town and one place I called said 850 bucks! I pretty nearly told em just what I thought of that).
 

I took all the lyme symptoms - one by one - and linked them to a primary Mg deficiency (but several other nutrients drop too).

The nutrients missing and causing TMJ are in those posts as well as the other symptoms you are mentioning. This is a common problem since many persons are Mg - B vits. deficient...not just from lyme...often simply from stressful lives and lousy diets too.

Did you get a mouth guard? Very important. A good one runs about $250 (made in the dentist office by taking a mold of both the upper and lower teeth and sending the mold to California. They really, really help.

John, to help explain what is happening as fast as possible ( a lot to comprehend), please read my Updated Nutshell post. Print it out and read the 24 "points".

You will catch on...instinctfully you recognized the neurological imbalance...it's acetylcholine...actually what is needed to make it...acetyl CoA.

How long do you think you have had lyme? If several years then yes, bone deterioration could be happening...the joints take a hit.

And if your essential minerals are low (need testing) then the bad guys (Hg and Al) might show up - be elevated on a heavy metals test.

Normally...bile salts are supposed to take care of the bad metals...get them out of your system.

Are "silver" fillings bad...not in this country, but they have been banned in several other countries/discouraged for pregnant women and children in Austria, Germany, Canada...the list goes on...

Should they be banned here? IMO, yes.

[This message has been edited by Marnie (edited 17 August 2005).]
 

GiGi: The article you posted and your comments that you didn't have any tooth pain despite having this problem are really interesting, though also disconcerting as you say.

One thing I'm not understanding is whether he is saying having the process of third molars (wisdom teeth) removed increases the risk of an infection of the jaw, or rather simply that having them removed is a risk factor to look for.

I think for us, it might work backwards, as I can't think of any reason why the sequence would be the tooth infected and then the jaw instead of random (since you would expect both to *potentially happen as the disease became disemminated*). T

Therefore its hard to know if jaw involvement or any bone involvement for that matter would be confined to a focal region as the article suggests or whether if would be diffused to many places, I think would probably complicate what if anything should be removed besides the extracted tooth. Regarding infection of the dental pulp it sure would be interesting to see how often borrelia can be found in the pulp of extracted teeth from lyme patients... does anyone know if there are any studies on this or similar?

Also could you tell me if the original website for this article, if it came from a website, has pictures or diagrams, -that might make it a little easier to follow what he is talking about for me. Much Thanks!

Hodologica: Thanks for posting your good experience with the NTI-tss. I researched it a little bit and it seems like it is similar to a dental-splint/mouth-guard (or whatever they call it) but better since it can prevent the kind of jaw clenching that can still occur with the splint or even may be made worse (according to where I looked).

Presently I'm not sure if I should do this if the problem gets worse or whether would be a good thing regardless it sounds like an interesting option for symptom-abalation & possibly slowing/halting tissue damage that may be occurring, however if what GiGi posted is the case with most of us, then it would seem to me it probably wouldn't be the most direct way to get to the root problem,... however if it is an overstimulated nervous system like I used to think one would think it would come near enough...

Marnie: Thanks, for all the points you've mentioned. I am taking a good amount of B vitamins & magnesium so hopefully am covered there, though I've heard IM magnesium is supposed to work better.

I've had lyme disease for at least five years, and have only one or two fillings which I don't think are mercury or silver ... though I have never heard of silver causing a problem before? My heavy metals tests were in the normal range for a really liberal lab (i.e. top 25percentile is considered abnormal) but my coenzyme Q was low. I think bartonella might effect the co Q levels as it is supposed to be an aerobic bacteria.

Thanks for you're links. Since borrelia only thrives on a complex media (lots of extra nutrients and cofacters) and in infection obviously we are the "complex media" it does seem to me to be a bit of a dilemma what things and how much to supplement (e.g. help yourself & immune system as much as you can and the bacteria as little as you can).

The posts you refer me to seem to deal with this kind of subject so i'm wondering is that the research angle you've taken to bb infection? If that's so, that would be great to stand on the shoulders of someone whose gone before.

There are so many references in your previous posts its hard for me to tackle even in multiple sittings, but of course all the references is a good thing! I haven't investigated this area in detail but hopefully I will be able in the future. I will definately come back to the posts you mentioned.

Lyme ED: Thanks for the extraordinarily thorough lymeinfo.net reference. That is a very good symptom list and I'm always suprised to see how much commonality there is between my experiences and the symptoms described (probably enough for me to print it out to show a few people who are skeptical that I have lyme disease).

I've lately wondered if lyme disease could be occurring in a person (member of my family) with only a few narrow symptom manifestations such as hearing loss, tinnitus, paresis of gastrointestinal tract & some joint pain. It seems from reading the different quotes that sort of thing is very possible, but I'd still like to get anyone's opinion/experience on whether they had close relative diagnosed whom exhibited very few "classic" symptoms?

P.S. It seems like the some of the cephalosporins, the quinolines, rifampin, minocycline, ketek, and the aminoglycosides can all generally penetrate bone fairly well (though usually 2-3x worse than peak serum concentrations) though in certain cases it appears the infected portion of bone does need to be removed when it is in large part dead.

It seems impossible to know how many people with chronic borreliosis would have this not knowing a baseline of what % of people have infected bone(s).

Ketek Penetration Into Bone

Antibiotic Treatment of Bone & Joint Infections

[This message has been edited by sunnyslumber (edited 24 August 2005).]

[This message has been edited by sunnyslumber (edited 24 August 2005).]
 

Since yeast can exist in the oral cavity and having a weakened immune system and/or taking antibiotics could possibly make a yeast infection worse, I agree there's a very strong possibility which I forgot about, that yeast could be at least a contributer to these tmj & related problems. Especially for me, since I have some thrush. Thanks.

john
 

Parenteral Mg is indeed superior in my experience - an IV used to immediately abolish my muscle twitching for 6 weeks (the only unequivocal effect for me), whereas regular oral Mg did nothing. Now that my illness is much reduced, oral Mg does suffice to suppress the twitches.

Chroniclymie,
There are those out there who think the alignment theory of bruxism pretty dubious. I dont know how one would judge; I am not familiar with any relevant experiments. However the limited amount of WWW/USENET patient/practitioner testimony I read (18 months ago) was generally down on the full-teeth guards. It seemed fewer were down on the NTI, tho a small number reported it messing up their incisor alignment or something.

Anyways bruxism is a bizarre phenomenon. From what I've read, the forces involved are immense (larger than those one can produce voluntarily while awake), which leads me to greatly doubt that bruxism is an attempt to correct malposition of the teeth/jaw. I am more inclined on a theoretic level to believe bruxism to be a malfunction of the nervous system. In that connection its worth noting that many people, including me, brux severely during sleep only when under the influence of various antidepressants, and also that many non-medical psychoactive drugs cause jaw clenching while awake.

 

I can't believe you brought this up because the other morning I woke up very early and felt fatigued.

I usually never fall asleep. Went to lay down, and I did not put the night guard on, fell asleep, and now my gum is throbbing and tmj is painful.

I have a dual bite. Years ago the orthodontist wanted to move my jaw, but I refused.

He said, your going to have problems later on. Maybe I should've listened! Just couldn't imagine eating baby food, and eating through a straw!

I do believe going without the night guard is definately what aggravated it!

And don't ya know, since I had to take early retirement, I was told it would be better to drop the dental ins. because it wasn't worth it!

This back tooth has a gold crown.That's where the gum is sore, and red.

Don't know much about metals, but did ask dentist and p.c.p. and they told me not to worry!

Do you wear a night guard? I don't know how the ones you buy in the pharmacies are, but you might be irritating it because of the grinding!

Shouldn't the antibiotic take care of this?
That's what I'm wondering!
If it has to be pulled, I want my gold back!! haha