nukuspot,
I just happen to be on here when you were!
I'm pretty good at analyzing a dental situation given the number cases and years I've been involved. There is also a lot of stuff that is routinely seen which for me has made them obvious.... for others perhaps not so much.
You did remove the source of the original problem which was rct tooth #19. However, prior to the removal other things were happening and #20 was one of them. This is one area where patients are often ill informed about in that infected or root canaled teeth have the likelihood of causing problems with the adjacent teeth. Sometimes those problems do not surface clearly until the source of the problem (the infected rct tooth) is removed.
That triangle of gum tissue may have some granulated or thick fibrous tissue between it and the tooth. Remember, that side of #20 was in close proximity to bacteria and inflammation from rct #19. That would account for the gum feeling irritated by a cleaning but then feeling better once it healed. Even if there is a slight bit of residual granulated tissue left in that area after the cleaning, it will grow a bit once the site heals. Each time you floss in there that tissue gets irritated. I know you are trying to keep your mouth very clean but you do not need to brush 3 times a day or floss more than once. Twice a day brushing, morning and just before bed is adequate for most people. Floss and scrape your tongue after brushing at night is also adequate for most people.
If it is not thick fibrous tissue then it could be just the opposite. You mentioned that #20 is at an odd angle. There are different thicknesses of gum tissue in different areas of the mouth. When recession of the gum occurs it is common to lose some thickness of the gum tissue. Depending on the individual, the tissue can become granulated and thick or thin and fragile. Either way, if you over do the oral hygiene you will irritate that tissue.
Gentle, thorough oral hygiene means........
Twice a day, use a soft head tooth brush and angle it at a 90 degree angle along the gum line. Gently and with light pressure, maneuver the brush head in circular motions to remove the plaque. Only direct the tooth brush back and forth over the biting surfaces, not the gum line.
If you use an electric tooth brush, follow the same directions but let the brush do the work. Do not press the brush into the gums. Just lay it snug against the gums.
Once before bed time, floss in between each tooth. Gently place the floss straight down in between, do not see saw it back and forth. Gently hug the side of the tooth with the floss and gently go down as far as comfortable. Gently elevate the floss while hugging the side of the tooth 2 or 3 times. The switch the floss to the other side of the tooth and do the same thing. Bring the floss straight up and out from between the teeth. If the contacts are too tight to bring the floss straight up, then pull the floss straight through along the gum line. Use a floss thickness that is comfortable for your particular teeth.
Water pik.... only use on a mild setting. This is meant to be therapeutic, not like a fire hose. The idea is to gently cleanse away any residual bacteria that the floss may have missed.... not cause the pocket to open up of be irritated.
Clean your tongue... either with your tooth brush or a tongue scraper. I perfer OOLIT tongue scrapers. But there are lots of different ones out there. The tongue holds TONS of bacteria and debris. Cleaning it reduces bad breath and can help prevent oral cancer. So it should be a part of daily oral hygiene.
Regarding the tissue growing in the extraction site... aside from you hesitancy about being too inquisitive because you have every right to be that way and it just does not matter what anyone else thinks about it ...... it's not wise to assume it is normal. It may be, but if it looks weird to you or continues to grow above the gum line, then it should not be over looked. FYI.... dentists and most dental staff are the most annoying patients.... because sometimes a little knowledge opens up a can of unwelcome worms. Never worry about what others think of you when you are trying to take care of yourself and need proper help to do that ... it is irrelevant what they think, just be yourself
Bryanna
Quote:
Originally Posted by nukuspot
Hi Bryanna,
That was so fast! Wow! Thank you heaps for that quick reply.
I really like your breakdown of what you think is going on. Even though you have never seen me, it seems like you really gave an amazing summary and explanation of what might have happened/be happening. I wish my dentist was so verbal and explanatory.
As far as the theory you had about 19 infecting or irritating 20, that makes sense to me and it was what I had always kind of assumed in the back of my mind. However I really thought that getting the "source" of the issue away which was 19, then 20 would calm down. To be clear it's not like the tooth itself is constantly painful, its that triangle of gum that was between them both (is is called a papillae?) And only the side that faces towards my lip, nothing on the tongue side. The triangle of gum between 20 and 21 is fine. It's such a small area but SO painful! If I press on it or manually do anything to it, it gets worse. But it's been that way since last year. I just thought that the extraction would help it!
Am I right in getting that your theory is that it's not the actual gum itself that has an issue, but it's part of an exposed root that is UNDER the gum in that area which is painfully activated?
I have visible recession on 20 and also the same premolar on the other side of my bottom arch (I don't know the number of that one.) I have had that for years. You can see the darker bottoms of both of the root areas on those teeth. I have been told it was from agressive orthodonia at a young age which caused my teeth to be straight but did not take into account occlusion or jaw placement. As a result my teeth do not line up correctly. It is probably the root cause of my TMJ on the left side as well. I had braces from age 8-12. Very early and very agressive. I had an impacted canine tooth and a "class 3 occlusion" which they treated with braces and oral surgery to attach a bracket to both my canine teeth. Anyway that is kind of off the subject....Sorry to ramble. But yes, I do have exposed root on 20 is what I am trying to say. However my recession/exposed root areas on those two bottom premolars usually only is an issue when I eat anything sweet. As a result I rarely eat sweets, even sweet apples will cause pain in those areas. But it's a fleeting pain until I rinse my mouth. This current pain in the gum at 20 is constant, has been there for a year now. I notice it gets better after a dental cleaning or after I use my waterpik in the area, though both of those do initially exacerbate it for the first few hours. I always imagined I was flushing some irritant away...? Can an exposed root give constant pain and not just fleeting pain too? Maybe I have a different exposed surface on 20 than what is visible.
You mentioned being gentle to clean the area. Can you advise me more about that? I brush three times a day, using a natural toothpaste from my dentist called Coral White. I used to use an electric toothbrush but it was too much for that gum area at 19/20. So I use a normal extra soft bristled brush. I floss once a day (sometimes twice) and use a waterpik with the pik pocket head and baking soda in the tank. I have tried oil pulling but it irritated the gum worse, though I don't know why. I wanted to try a desensitizing toothpaste to see if it would help the issue of that painful gum but I cannot find a natural one. The Toms of Maine one is the closest but it still contains SLS so I don't want to use it. If you could advise me further about this cleaning aspect of the area I would appreciate it, because it does feel worse after brushing/flossing. But I want to keep it clean as I can. I am also still doing the salt water rinses since the extraction, even though I probably don't need to do them anymore. They keep food out of the hole and can't hurt, right?
Finally, in regards to that weird tissue in the extraction site---I am very reluctant to call the dentist. I have an anxiety issue around health care providers. It stems from years ago when I went through a long misdiagnosis period for my interstitial cystitis. I saw many doctors and was in a lot of pain. Some "fired" me because I was too needy and they didn't know what to do (because they had misdiagnosed my issue as repeated UTI.) When I finally got diagnosed after a year, it left me with a real fear of being a "problem" patient. I literally break into a sweat when I have to call a dentist or doctor. I have called both the dentist who did the extraction and my general dentist SO many times in the last few weeks, I am very reluctant to call again. Especially since the dentist who did the extraction was pretty clear that he wanted my follow ups to be with my general dentist. So I will hope and assume that he saw that tissue yesterday and it was normal, that is why he didn't mention it. It's really almost impossible to miss! You see the hole where the tooth was and half of it is filled with this pinky colored tissue with red flecks that looks totally different to the rest of my gum. I totally understand that you can't dx it because you can't see it and I am not your patient. No worries on that and no expectations you could do that. I just thought I would mention it, because it looks so weird. I am hoping it's just what new tissue looks like in an extraction site! I never looked this closely when I had my wisdoms out.
I am giving that appliance a chance and hope so much I can get used to it! As far as the other stress reduction, it's hard because I don't feel stressed so I don't know how to judge if it's working or not! But I am trying lots of things. I wish I could find a way to know if I was clenching less at night to see how it was working....
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