Hi JWang,

First let me say that you should not be taking any blame for any of this. You are trying to communicate with the dentist but he sounds like he's not interested in communicating much of anything. He legally has to give you a full explanation of what is going on as well as what to expect in the near future. This is not rocket science and he sees this all of the time. But he is once again dismissing your situation as unimportant. His attitude is lackadaisical to say the least.

The opening of the jaw is limited because of the swelling. Remember how I described the area as being small and with no place to go but ouward? As the swelling subsides, so will the tightness on the ligaments that hold the jaw joint tight. Did he suggest anything to help loosen the jaw or reduce the swelling?

The hard swelling can be an accumulation of infection......and/or alot of inflammation. He would know that better than I would because he's seeing it clinically. If it's from the inflammation, yes it will subside on it's own eventually. Could take several weeks or more. If it is infection, then you will develop symptoms of an infection..... fever, malaise, pain. This is a wait and see situation at this point. The main key here is to be aware of any change in how you are feeling in the next few months and to monitor the area radiographically.

Dry sockets and/or surgical abcesses are a serious matter. They can be difficult to treat and require frequent evaluation until the area is healed completely. Sometimes residual infection resurfaces months or years down the road which would require some type of intervention. This is why the area gets monitored......

I'm not sure what type of dental facility you are going to but if it is a free clinic or some sort of that, your complaints may be fruitless. However, that would not stop me from writing to the owners of the establishment expressing my concerns over the way I have been personally mishandled and the fact that my questions have not been answered to my satisfaction. You are right, if he is treating you this way, he is doing the same to others. So chances are someone else has complained also.....

Please keep us posted on how things are going!

Bryanna

Thanks so much Bryanna. You make me feel a lot better about my situation and make me feel justified, in well, the way I feel since this doctor clearly wants me to think I'm crazy.

It is not a free clinic, in fact it is a upper class Oral Surgery practice where my surgeon is the 3rd partner (or maybe not even, his name is on the title though). Right now I'm feeling good, it's post op day 14 and I can open my jaw about 75% of the way I could before surgery and the pain is all but gone. I just finished my last dose of clindamycin but I have also been taking colloidal silver, olive leaf extract, and Vit C religiously. I also have a waterpik and have been putting periogard in it and irrigating the wound area.

The hard swelling is still about a minimum of 60% of it's maximum, honestly it might even be 90% which is the most scary to me. I had an appointment with the surgeon on post op day 13 (yesterday) and it went pretty well, he said "I really turned the corner" and he answered most of my questions. Seems like the better condition I'm in the better treatment I get, but as soon as anyhting goes wrong he refuses to acknowledge it. In any case I asked him exactly what the hard swelling is and he said "it's just stuff left over from the infection", so I think he basically has no idea. I questioned him because I said if it is from the infection, how is it going to go away on its own and won't it just reinfect me once I'm off antibiotics? He said it would just go away and it won't. I have an appointment for post op day 21.


I also read another one of your posts where you recommended The dental organization IAOMT.org. I did some research and found a practitioner in my area and I will likely pursue a CAT scan of the lump area and make an appointment with a participating provider. Thanks so much for the help, I will keep posting updates on my situation for follow up purposes!

Dear JWang, I have just been reading your story and I am so sorry for all that you have been through. I have had a similar experience and over 5 months on I still have pain - with no explanation. I do hope that this is not the case for you and that your infection completely clears and your muscle tension soon eases off.

As soon as I started reading your first post I knew it was dry socket, as you eventually disccovered. It is the most horrendous pain I have experienced in my life - at least comparable with labour and childbirth, if not worse! So, your denstist was completely out of order to treat you the way he did, although again, unfortunately, I had a similar experience where you end up feeling like you're making a fuss about nothing and just being a pest. It is, however, very difficult to stand up to and argue with/challenge these kind of people. It's just a horrible situation to be in.

Good luck with it all and I hope you make a speedy and full recovery.
Jasmine.

Thanks Jasmine! Wow to compare it to labour and childbirth...I feel special now! As a male, my mom and older women always trump me in conversation when they talk about the pain they went through during childbirth, now I have proof of a similar situation!

I'm sorry to hear about your situation, what did you try for it? I got a waterpik and have been rinsing out the area everyday plus I've been taking colloidal silver and acidophillus everyday. My jaw is still seeing slow improvement so I'm hopeful it'll recover now (It's post op day 17). So maybe those things would help you? I started trying to open my mouth a little wider each day and thus far my range of motion is still increasing. Was that your experience?

Bryanna,

I noticed something interesting. Today is post op day 22 and while cleaning out my holes, the previously infected socket shows bone. It doesn't hurt when I touch it though so it looks to me like a tooth. Does this make any sense? The post op X-rays don't show any remaining fragments of the tooth, they were taken post op day 7. Could this be my jawbone? If so wouldn't it hurt when I touch it? And if it's not, could a tooth have possibly grown back in 2 weeks time?

I have an appt with the terrifying doctor in 3 days so I will certainly ask him too.

Hi JWang,

Day 22 post op and you still have openings at the extraction sites?? Those areas should be closed over with gum tissue by now. You should not be seeing anything that resembles bone in those "holes". No, it would not necessarily hurt to touch it but please do not touch those areas because they are prone to infection since they are open.

You may be irrigating too aggressively which could be one reason why the areas haven't healed over with gum tissue. The best thing to heal an oral surgical wound from an extraction is simple warm salt water rinsing. Rinsing or irrigating with anything else disrupts the healing process especially if there is an interruption with the healing to begin with... such as a dry socket.

By any chance do you smoke, chew tobacco or drink alcohol? Any of those things could cause the sites to remain open.

I really wish you could see a different dentist. Your descriptions indicate that your surgery has not healed properly.

Please keep us informed on what's going on....... I really hope you are able to get the proper treatment soon.

Bryanna

Ok, I understand. I have been irrigating 3-4X a day with water and colloidal silver(to keep it clean) and I will reduce that amount. I've basically been doing it after every meal to clean out the sockets. I've been feeling much better and the range of motion in my jaw is about 85-90% now.

I read it is normal for it to take 3-6 months for the holes to completely heal so I didn't think anything was wrong but I understand what you are saying. The socket no longer hurts at all and the pain and inflammation in the infected site is essentially 90-95% gone so I assumed I did not have dry socket. I do not smoke, chew tobacco, or drink alcohol, but I have been eating hard foods regularly and have no been avoiding drinking through a straw (I've been doing this ever since about day 14 post op). Could this be a problem?

Thanks for all the advice Bryanna, I really appreciate it and I'm going to get a second opinion this week just to be safe.

Hi JWang,

Ok, let's backtrack a bit. I think on about post op day 9 you stated the dentist treated you for a dry socket. Your description of the events that took place after the extraction are clearly that of a dry socket and again from what you have stated here, it sounds like it may not have been properly treated. Dry sockets need to be treated either daily or every other day for about 4 to 10 days depending on the severity of the infection. It is initially treated by the dentist debriding the socket of debris and fibrous tissue. This procedure will do two things..... one, clean out the debris....... and two stimulate the vessels to bleed so a new clot will form. A medicated paste or an impregnated material is placed in the cleaned out socket (tastes like cloves). This material is removed and changed daily (or every other day) by the dentist for several days until the inflammation subsides and the symptoms diminish. There should be no aggressive rinsing or irrigating by the patient during this time period because the medication is what will encourage the area to heal and it can't be disturbed. From what you described, your dentist did not follow that protocol and you have been treating it yourself at home.

On post op day 10 you stated the gum had healed over. Now you state there are holes that you are irrigating. Did the gum heal over and reopen?

I am a huge believer in colloidal silver. But only in the form of tiny nanoparticles as in the products made by Purest Colloids. Does your brand use nanoparticles? The smaller the particle the purer the product which means less concern for toxicity and less concern about a permanent skin discoloration called Argyria from the silver. With that said, rinsing with colloidal silver or anything other than salt water after a tooth extraction can interrupt the healing process. I know there are some dentists who irrigate with chlorhexidine or peroxide..... both can be more irritating than helpful. Straight up saline is the best irrigation both during surgery and post operatively. However, irrigating with saline too aggressively will impede the healing also.

So, you have a situation in which an infection developed in the gum and jawbone after the extraction. The usual dental protocol for this was not followed according to what you have written here. Then you have been aggressively irrigating the surgical sites. All of which will impede the healing process.

The surgical sites can remain open from oral surgery for several months to years ....... ONLY if there are compromising issues that disrupt the healing process. These issues could be from a dry socket, aggressive irrigating, periodontal disease, medical issues (diabetes/cardiovascular/autoimmune/lymes/HIV, etc) certain medications (bisphosphonates/chemo/radiation/chronic use of an inhaler or decongestant) or a persons lifestyle ie: smoking, etc. Otherwise, under healthy conditions, the sockets will close over within 2 to 6 weeks depending on the individual. The jawbone takes up to one full year to heal completely and longer in anyone with any of the above issues.

It is great that you are no longer in pain and that you are able to open your mouth more normally!!! At this point it doesn't matter that you are drinking through a straw. Initially, using a straw could pull the clot out but that's not an issue now.

I whole heartedly think an unbiased opinion from another dentist would be a good idea. It is hard for me to be sure 100% about what is going on without seeing it. So I am going by what you are telling me. However, I am 100% certain about what I have written here about the irrigation and rinsing issues.

Please keep us posted.............!

Bryanna




QUOTE=JWangSDC;618511]Ok, I understand. I have been irrigating 3-4X a day with water and colloidal silver(to keep it clean) and I will reduce that amount. I've basically been doing it after every meal to clean out the sockets. I've been feeling much better and the range of motion in my jaw is about 85-90% now.

I read it is normal for it to take 3-6 months for the holes to completely heal so I didn't think anything was wrong but I understand what you are saying. The socket no longer hurts at all and the pain and inflammation in the infected site is essentially 90-95% gone so I assumed I did not have dry socket. I do not smoke, chew tobacco, or drink alcohol, but I have been eating hard foods regularly and have no been avoiding drinking through a straw (I've been doing this ever since about day 14 post op). Could this be a problem?

Thanks for all the advice Bryanna, I really appreciate it and I'm going to get a second opinion this week just to be safe.[/QUOTE]

I understand, I was never treated for dry socket. He only irrigated the area with chlorohexidine to clean out food debris, that's all. He never added any dry socket paste whatsoever even though the paste was on his treatment pan each time (the nurse brought it in). "and two stimulate the vessels to bleed so a new clot will form." After reading that, clearly i have been neglecting my health.

On post op day 10, I was completely mistaken. By then I accidentally placed my tongue over the back area and I found no hole so I assumed the gum had healed over. This baffled me as to how to dentist could irrigate out food. The reason for this was simply because I could not open my mouth wide enough to see back there, and the hole is near my cheek, not directly over the gum as I assumed. So I mis-spoke completely on that part.

I took the cue from the doctor that all I needed to do was continue to irrigate to remove food and all would be well. This has been a huge error on my part as I can clearly see now. What should I do about food getting caught in the holes for the next few days? I rinse with salt water but that rarely gets all the food out. At that point should I irrigate or not? I could also sterilize a pair of tweezers to manually remove the food.

Also should I purchase clove oil myself and begin treating the area just for the short term (few days before i see a new dentist)?

Again thanks so much for your help. I am embarassed about how often I go into denial about my situation as soon as any symptoms subside and I thank you from keeping me from swaying from panic and denial and instead reminding me to focus on the problem so I can fix it.

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Hi J,

Thank you for not getting upset with me for being so blunt! I see your situation so frequently in patients who come in from other offices.... and it always upsets me how neglectful dentists can be with their lack of following a basic protocol in serious situations along with their lack of detailed post op instructions to their patients. In every dental office that I have worked in, along with my other responsibilites, I have been given the role of the patient advocate. I am the one who goes over all of the details with the patients and follows up with them post operatively when necessary. Unfortunately, there are only a handful of assistants in my capacity because it requires alot of clinical experience and a constant willingness to take on this role even when the dr has left no time in the schedule to do it. At my age, I am not shy to express my philosophy which is .... I am here for the patient, period. I will take the time no matter what and even call a patient later on to go over the instructions again if I think they may have missed something. Do I think I'm special, nope. I think this should be done in every dental office!

Back to the subject, sorry I digressed a bit.......
The description that you originally gave of pain, swelling, pus, inability to open your mouth a few days post op extraction .... all indicates dry socket. The reason the dentist did not use the paste is because the area where the lower wisdom tooth was located was only partially in the bone. After the extraction there was little to no bony socket to put the paste because that area was mostly gingival tissue. However, in those cases, the surgical site is debrided, a good blood flow is established and an impregnated piece of gauze (with a clove tasting medicament) is packed in that area at least a few times within the next several days. The gauze acts as a barrier to debris and the clove oil is actually therapeutic at that stage of healing. Why he chose not to use this, I really am not sure about that.

Ok, I understand that you were mistaken about the gum tissue being closed over on day 10. I know exactly what that area looks like as you have described the hole being more near the cheek than the bum. This is how the wisdom tooth was laying in your mouth... partially in the bone but partially only in gum tissue.

When a patient is instructed to irrigate an open oral wound, it means to gently flush out debris. It does not mean to get in there and sweep it clean. But you wouldn't know that because it was not explained to you properly. I didn't tell you to stop irrigating because I didn't know for certain the exact post op instructions you were given and I didn't realize you were being so thorough.

Do not use a pair of tweezers or put clove oil in the surgical hole. Ether rinse with warm salt water 3-4 times a day vigorously with a drawing motion as to naturally pull debris from that area or fill the syringe with warm salt water and gently irrigate the area. This is the post op instruction that is generally given to patients on post op day 7 until the gum tissue heals closed.

Please do not feel embarassed about anything! You have not done anything wrong. You did what you thought was best and now you know to back off a bit

I am glad that you are seeing a new dentist. I am crossing my fingers and toes that he gives you good news!!!!

Keep me posted ok....

Bryanna








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