Hi toothless,
You can expect to have some pain, swelling, drainage and a large open wound with this type of infection and oral surgery for a few days. If you develop a fever over 100, swollen glands, extreme swelling of the face, swelling of the tongue, or other exaggerated symptoms, call the oral surgeon as soon as possible. A rapid heartbeat is typical of an oral infection such as yours. But it can also occur from medications, anxiety and exercise. You should refrain from all forms of cardiovascular exercise until this surgical site heals more because with exercise the heart pumps blood more forcibly to the arteries and any surgical wound will become susceptible to over stimulation of that volume of blood.
Do you smoke? If so, stop. The mechanical act of smoking draws suction from the open wound and can disturb the formation of the clot resulting in a painful condition called dry socket. The multitude of toxic chemicals in tobacco can infect the wound, contaminate the jaw bone and prevent the bone from closing completely. This can lead to ischemia and a necrotizing condition of the jaw bone called Osteonecrosis and Osteomyelitits which can be difficult to eradicate.
Do not rinse with any type of mouthwash. The alcohol and chemicals in mouthwash cause irritation, secondary infection and slow down the healing process. Gently rinse 3 times a day with warm salt water, no mouthwash. It is important to brush 2 times a day, floss once a day and scrape your tongue once a day to reduce the amount of plaque in your mouth and on your teeth. A clean mouth will heal faster.
Let me offer some clarification which will help clear up some of your uncertainties about what occurred prior to the extraction and why the extraction was warranted.
The pimple on the gum that exuded pus was called a Fistula. This is NOT an infection of the gum. It is the result of a severely infected tooth. A Fistula is the opening of a tract of infection that is draining from the inside of an infected tooth. Meaning, the infection overwhelms the tooth and proliferates beyond the tooth. The infection burrows a hole through the bone from the tooth, and will often come through an opening of the gum which is called a Fistula. There is no palliative care or topical treatment that can cure the fistula because the source of the fistula is the infected tooth.
Endodontic (root canal) therapy, is not a cure for an infected tooth. It is a temporary measure, at best, to try and retain an infected tooth. Every tooth has many hundreds of microscopic canals that contain nerve tissue. These canals are not accessible, therefore, irrelevant of what is done to the tooth, the nerve tissue inside of these canals remains infected. Eventually, the infection overwhelms the tooth and proliferates beyond the tooth.
Not all tooth fractures can cause pain. Not all tooth fractures can be seen on dental xrays. Here are a few ways a tooth can fracture:
1) Direct injury to the tooth but also frequently occurrs during a root canal treatment.
2) Infection, certain medications, poor diet, and nutrient deficiencies can lead to a deterioration of the integrity of a tooth making it weak and prone to fracture upon chewing.
3) A bruxism habit can cause various types of tooth fractures.
I will copy your specific questions and then answer them in LARGE type.
Now the questions:
<<1. Was the tooth extraction truly neccesary?>>
YES, WITHOUT QUESTION.
<<2. Werediagnostics of vertical fracture done correctly?>>
YES. A VERTICAL FRACTURE TYPICALLY CAUSES NO SYMPTOMS AT THE ONSET OF THE FRACTURE BUT EVENTUALLY CAUSES THE EXACT SYMPTOMS YOU BEGAN HAVING 6+ MONTHS AGO. VERTICAL FRACTURES THAT ARE NOT DISPLACED CAN BE TOUGH TO DIAGNOSE VIA A DENTAL XRAY BECAUSE THE XRAYS ARE ONLY 2 DIMENSIONAL. EVEN A MULTI SLICED CT SCAN MIGHT NOT PICK UP A NON DISPLACED VERTICAL FRACTURE IN A TOOTH.
<<3. Why surgeon didn't know or didn't want to tell whether tooth was broken or not?>>
GIVEN THE EXPLANATION THAT I DID ABOVE PERTAINING TO ROOT CANAL THERAPY, TOOTH #46 WAS ACTUALLY INFECTED FOR 15+ YEARS FROM THE TIME IT WAS ROOT CANALED. IT IS NOT UNUSUAL FOR AN INFECTED TOOTH TO HAVE LITTLE TO NO SYMPTOMS UNTIL THE INFECTION OVERWHELMS THE TOOTH AND BONE. THE EXTRACTION OF AN INFECTED TOOTH CAN BE COMPLICATED BECAUSE THE TOOTH IS WEAK AND PIECES OF IT FRACTURE OFF DURING THE PROCEDURE. THERE IS OFTEN A LOT OF INFECTED BONE AND INFECTED TISSUE ENCASING THE TOOTH WHICH MAKES IT DIFFICULT TO GRAB HOLD OF THE FRAGILE TOOTH. SO WHEN PIECES OF THE TOOTH BREAK OFF, SOMETIMES THEY ARE SLIVERS OR FRAGMENTS OF TOOTH AND JAW BONE WHICH CAN MAKE IT DIFFICULT TO SEE OR DIAGNOSE WHERE THE ORIGINAL FRACTURE(S) WERE.
<<4. Have surgeon used too agressive approach to get the tooth out?Honestly, I expected only a simple extraction, while (complex) surgical removal would be undertaken only in a case, if some piece of tooth would stay below gums.>>
NO, IT SOUNDS LIKE HE DID WHAT NEEDED TO BE DONE. YOUR TOOTH WAS IN BAD SHAPE AND WOULD NOT BE CONSIDERED, IN DENTAL TERMS, A SIMPLE EXTRACTION. MOST EXTRACTIONS INVOLVING A BADLY INFECTED TOOTH ARE COMPLEX IN THAT THE TOOTH AND BONE ARE BOTH FRAGILE. THE COMPLEXITY OF THE PROCEDURE DEPENDS ON THE CONDITION OF THE TOOTH, THE BONE, THE SEVERITY OF THE INFECTION, IF IT IS FRACTURED AND THE ANATOMY OF THE PATIENT.
<<5. What should I do with my gap in the teeth? What functional and aesthethic consequences can develop, if I leave the gap as it is?>>
YOU SAID THIS WAS TOOTH #46. IN THE FDI TOOTH NUMBERING SYSTEM THAT IS YOUR LOWER RIGHT FIRST MOLAR. YOU ALSO MENTIONED THAT YOU HAD TOOTH #36 REMOVED WHICH IS YOUR LOWER LEFT FIRST MOLAR. DID YOU REPLACE #36?
REPLACEMENT OPTIONS DEPEND ON THE REST OF YOUR PERMANENT DENTITION AS TO WHAT OTHER TEETH ARE PRESENT AND WHAT OTHER TEETH ARE MISSING. IF YOU HAVE YOUR 2ND AND 3RD MOLARS ON THE BOTTOM AND YOU LEAVE THE FIRST MOLAR SPACES OPEN, THEN THE SECOND MOLAR WILL EVENTUALLY TILT TOWARDS THE OPEN SPACE. THE 3RD MOLAR MAY MOVE OR MAY NOT MOVE. IF YOU HAVE UPPER FIRST MOLARS, THEY MAY TEND TO DRIFT DOWNWARD INTO THE OPEN SPACE BELOW. USUALLY THE UPPER TEETH WILL EVENTUALLY STOP DRIFTING DOWN IF THEY ARE IN DIRECT CONTACT WITH THE THE OTHER LOWER MOLARS.
<<Please tolerate my english, because i'm not a native english speaker.>>
YOUR ENGLISH IS FINE.... NO WORRIES ABOUT THAT!
<<xrays can be found here:>>
YOU HAVE TO ATTACH YOUR XRAYS OR PHOTOS AS AN ATTACHMENT. SO THAT WOULD MEAN DOWNLOADING THEM FIRST TO YOUR COMPUTER AND THEN ATTACHING THEM AS SUCH.