On Thursday Jan 14th I had 3 wisdom teeth extracted. My upper right, and both lower were extracted. They were all impacted and under the gum, the bottom were both coming in at about a 45 degree angle and has partially erupted.

I was prescribed amoxicillin and vicodin. By Day 3 post Op my right side had swollen up to about it's peak, but by Day 4 there was no improvement. I scheduled an appointment with the surgeon on 1/18 and he just opened my mouth and told me "A little pain is very normal, it was a very badly impacted tooth". I felt stupid but was reassured. I hadn't been able to sleep in 3 days because of the pain and had a slight fever.

Day 5,6 and 7 the swelling remained the same and the pain got worse. Sometimes it would become so excruciatingly bad that I would just have to sit up in bed. I was sweating so much during my sleep that my bed would become somewhat soaked.

Finally on Day 8 my normal post op appointment arrived and I told the surgeon of my issues. He said it looks like a "baby infection" but the problem is I can barely open my jaw now. The range of motion has decreased tremendously. He asked me to force my jaw open (which was excruciatingly painful) and then he proceeded to squeeze the infected area like a pimple (worst pain of my life). He then took another panoramic X-ray which showed the wound completely unhealed (A good thing? infection is out int he open). Then he squeezed it out several more time and suctioned out the puss. I believe he irrigated with Chlorohexidine Gluconate (I've tasted perioguard many times).

My surgeon is extremely abrasive and unhelpful but I don't think he's negligent. My biggest complaint is that he made me feel like I was wasting his time and a baby for complaining about the pain on post op day 4, when I believe it should have been clear at that point that I had an infection. I have been prescribed Clindamycin 300mg for 7 days and began that yesterday taking 4 pills (3 per day, a double dose on the first time).

Immediately following the squeezing out of the pus, I felt better. THe pain was bad but it felt like good pain, the overall terrible feeling in my body had disappeared. I slept well last night and although I sweat a lot and had a fever it was much less than the night before.

Now I have two questions I'm praying you can help me with. One, I don't trust my surgeon, what should I do? There are 3 partners at his office and he is the youngest, should I attempt to switch? I would like as little hassle as possible but this surgeon just instills fear in me and is borderline innappropriate/negligent at times in my opinion. I think the nurses know he's very abrasive becuase the looks on their faces when he treats me the way he does, plus when he was squeezing out my pus the nurse asked if he should use clean instruments after the first manual drainage and he just ignored her. Should I just switch surgeons all together?

Second, I have an appointment with him in an hour and will update, but what can I do on my own? Simply salt water rinses? What should I be eating and how? It's very hard to open my mouth making brushing my teeth next to impossible, but I do so about 4-5X a day and i salt water rinse 4-5X a day also. The problem is the part I really can't reach with the tooth brush is the infected area so I don't know if it's doing any good. When I wake up I definitely have that disgusting bacteria mouth taste. Could this be a jaw bone infection? The swelling on my cheek is extremely rigid and begins 2 teeth before my first molar. (So it starts at the 4th tooth, then there's 3 teeth behind it and the 5th tooth woulda been the extracted wisdom tooth).


Any help is greatly appreciated!

Gee, I hope Bryanna sees this ASAP....this sounds brutal.

If it were me, I'd see another surgeon who is NOT in the same practice. I think there is the chance they would cover for each other.

You have to remember this guy is working for YOU ! You're paying him good money. Don't let him intimidate you. I know you're hurting and he's got you at a fragile time. Breath deeply and relax. Put your hand up when you want to ask him a question so he'll stop what he's doing and make him listen to you! Tell him to knock off the name calling. Get in his face and his type will usually back off. If he won't treat you like a customer, there are dozens other oral surgeons in town! Good luck!

Thanks, I should have done that earlier. At this point I dont' believe he is charging me for the care so that's my only incentive to stay at the same doctor's office. Him being an ******* is very offensive but my main concern is my health, then it's my money, and finally the emotional distress from dealing with him. As an update


I saw him today and took vicodin 30 minutes before. He did the same procedure and had a jar called "Dry Socket Paste". He irrigated the area with what I believe is Perioguard and then suctioned it off and squeezed it (it hurt badly, but wasn't as bad as yesterday) and said there was no puss coming from the area. I told him there is basically a huge lump on my jaw and I can't open my mouth, while I feel infinitely better today than I did yesterday, these main symptoms have not really got any better. He said it will take 1-2 weeks before I can open my mouth without pain again.

At this point I"m feeling a little better about it all but I am still not totally sold. I have another appointment on monday with him and I'm assuming he's just going to do the same thing and possibly treat for dry socket (he didn't use the paste this time). It sounded to me like the infection is supposed to heal within 3-4 days from yesterday and then I'll just be dealing with dry socket. So I'm still wondering

Do I need to be more concerned? I'm on clindamycin 500mg 3X a day for 7 days, is that strong enough to cure my infection? My jaw is pretty swollen and I fear it might need to be drained manually. The doctor did take a panoramic X-ray and he said it looked fine (doesn't mean much, but to me it means there's evidence of what he's examining so he would be afraid to not be somewhat conservative).

Is there a protocol I should follow? I have been rinsing with salt water and brushing after every meal but there is still plaque buildup behind my second molars and for the love of god I simply cannot get to it. It hurts pretty badly just to be able to brush the tops of those molars, I honestly feel like my jaw would snap or burst open if I were to open it wide enough to brush the back. (I'm not even sure I could if my life depended on it, I probably could).

dry socket hurtsss and whatever he called the infection.. sorry sounds awful.. he should have responded better the day 4...as I just had two wisdom teeth taken out thsi past week. They told me to let them know if hurting after few days... I am ok.. take care, sorry, sarah

My son had 4 wisdom teeth removed at once not too long ago.

One of them didn't do well..started to hurt. The surgeon was very considerate and offered him a numbing shot, before he irrigated it. Fortunately there was no further problem, and no infection really got in there. But all in all it was a very professional handling of the post operative pain.

This post sounds really brutal to me. I would NEVER go to a brutal dentist or oral surgeon...never. That guy appears to have little empathy for you, and that is a very bad sign...that he is not concerned about suffering.

Hi JWang,

First of all DO NOT go back to this dentist. Irrelevant of what or if he is charging you, he has not treated you properly from what you have written here.

A couple of things instantly come to my mind...

One, the intensity and duration of the swelling and pain that you stated is not normal for even an impacted wisdom tooth removal unless there is an unresolved and/or new infection. And yes, the infection can travel to your jawbone. If you have been reading earlier posts here about NICO or osteomyelitis...... this type of oral trauma is how many of those conditions occur in the first place and they become long term problems which are very difficult to erradicate. Your situation requires the proper care and this ******* dentist is not taking your situation seriously enough, IMO.

Secondly, what I'm about to tell you is not meant to frighten you but to let you know of the possible seriousness of an oral infection with severe swelling which is can occur with a lower tooth extraction it is a condition called Ludwig's angina. This is a rapidly spreading bacterial infection associated with cellulitis that can compromise the airway. This condition can be fatal if not properly diagnosed in a timely manner and treated accordingly. IF this is what you have, the oral antibiotics may hold it at bay temporarily, but they won't cure it.

Thirdly, your jaw is very tight because of the intense swelling. Opening your mouth wide enough to brush your teeth may be impossible and you should not force it open because you can injure the ligament, cause spasm in the muscle and end up with chronic TMJ problems. Use a q-tip dipped in diluted peroxide and try to maneuver that along the gumline behind the second molar. It will be difficult but do the best you can. Keep rinsing with warm salt water 4 times a day especially after you have eaten and before you go to sleep at night.

Fourth, it is imperative to eat a soft diet of nutritious food. Soft like the consistency of eggs, nothing chewier than that. Avoid sugar and empty carbs as these hold no nutritional value whatsoever. Fiber rich foods, even fiber supplements will help eliminate the toxins from the infection. Drink at minimum of 8-10 glasses of water a day to keep your renal collecting system functioning well... this also helps to eliminate the toxins. Seventy five percent of our immune system is within our digestive tract and any meds, trauma and infection will deplete our intestines of good healthy bacteria which we need to if we want to heal properly. If you're not doing so already, take a probiotic daily to replenish the good bacteria that the antibiotic and infection has destroyed. A probiotic is meant to be taken one hour prior to or 2 hours after any oral antibiotic pill to avoid any contraindications. A great probiotic for anyone taking antibiotics is called Culturelle. You can buy it online or in most large drugstores.

Also, avoid smoking as the nicotine and other carcinogens cause restriction in the formation of red blood cells depriving the surgical site of oxygen. Also avoid the comsumption of alcohol as it supresses the production of saliva causing the plaque to build up twice as fast and alcohol also disrupts the formation of the blood clot leaving the jawbone dry....exacerbating the dry socket.

You should also know...... a dry socket alone without exudation (pus) is cause for concern and needs intervention as early as possible because this condition alone can prevent the jawbone from regrowing which can lead to NICO (Neuraliga Inducing Osteonecrosis) and/or osteomyelitis.

Again, if this were me... I would not go back to this dentist. Not only is his abruptness and rudeness with you totally uncalled for but he should have treated you sooner than he did. As far as reusing instruments or not taking extreme precautions with using sterile instruments..... absolutely unacceptable!! Of course my suggestions here are based on what you have stated. Get all of your xrays, pre and post op, before you seek another dentist as they will tell the story in it's entirety.

I'm so sorry you are going through this nonsense....... please keep us informed on how you are doing!

Bryanna

Bryanna,

Thank you so much for your response. What you have told me is basically what I've been afraid of, but was uncertain what to do. Today is post op day
10 and clindamycin day 3 and I'm feeling much better. I can open my jaw another cm without pain but the inflammation is still there and it is very hard (i'm assuming this is as close to proof as possible of a bone infection as opposed to a gum infection?)

My gums have now completely healed, I don't know when this happened but it may have happened 2 days ago or so but I'm wondering if this is good or bad. Does this make it harder to access the infected area? I have another visit with the doctor from hell tomorrow @ 230pm and will decide what to do after then but I'm taking away 2 things from the relief of my symptoms and the responses on here. Please correct me if I'm mistaken but

1) Infections are a serious problem. Even if Clindamycin appears to work, that does not mean it will completely rid me of the infection.

2) I cannot trust this Doctor. He clearly doesn't care or have any empathy for me (and at times it seems like he might have done something wrong and knows it, so he takes out his rage on me because he needs to believe it's my fault).

With the two top statements being true, that means regardless of how much better I get, I need to have a second opinion correct? Sorry for being so wishy washy, my health is the most important but my financial situation is fairly dire and unfortunately has a big impact on my decision making. Essentially though I'm wondering, if the doctor says everything is fine tomorrow (barely trust him regardless) but then the hard swelling dissappears on its own as well, would I be reasonably in the clear?

Also I have been taking immense amounts of probiotics each day and I've had no negative side effects from the clindamycin digestion wise. This is in stark contrast to the past where I became violently ill or had bad diahrea from antibiotic use, so thank you for reminding me about that and cementing how important it is, it has really made a difference!

Hi Jwang,

The hard swelling is inflammation from the infection and the surgical trauma. Think of that area as a tight space with no where to expand except to go outward. The hardness is from the tight space around the muscular anatomy. If it were your arm the inflammation would have room to expand as it would find a soft place to travel to. In the lower jaw there is no such place, so that is why any large swelling on the lower jaw can compromise the airway. Does that make sense to you?

Answer to your questions:

1) Infections are a serious problem. Even if Clindamycin appears to work, that does not mean it will completely rid me of the infection.
>>Correct. This is a very serious infection. Sometimes the patient has to be put on IV antibiotics because the oral ones may not be enough. IV antibiotics bypass the digestive tract allowing the body to absorb a more concentrated amount of the meds. That's why they are more effective when dealing with serious bone infections. It is not uncommon for people who have had this experience to eventually revisit this situation if it is not cleared up at the onset.<<

2) I cannot trust this Doctor. He clearly doesn't care or have any empathy for me (and at times it seems like he might have done something wrong and knows it, so he takes out his rage on me because he needs to believe it's my fault).
>>Yup....... could very well be. I would not trust him for a few reasons. One, he may have contributed to the infection/dry socket in the first place during the removal of the wisdom tooth. Two, he did not address the seriousness of the situation sooner than he did.<<

You do not have a gum infection. It is in the jawbone. That's what a dry socket is..... dry infected bone. The gum tissue can heal closed while the bone is infected, not unusual. However, you wouldn't know that is happening unless it was seen on an xray and/or via a surgical exploration. The bone under healthy circumstances will take a year to completely fill in but in the meantime the gum heals closed.

If the swelling subsides you may or may not be left with a residual problem. The area should be monitored with xrays every 3 months for the next year to evaluate the progression of the healing.

Clindamycin can cause what is called Clostridium Difficile or C-diff for short. This is a serious bacterial infection of the intestines brought on by the use of antibiotics because they destroy all of the good, essential intestinal bacteria. Taking probiotics and eating nutritiously..... avoid sugars and empty carbs.... can help prevent this condition from occuring. However, once you have had this condition, you are prone to getting it again even after you stop the medication. That's why it is imperative to take probiotics every day of your life to maintain a good supply of healthy intestinal bacteria just in case you need to take meds for any reason.

It's good that you are being diligent with your meds and probiotics. I know you are going back to the same dentist....... please do the best that you can to have this area monitored at least once every 3 months with a small xray to keep tabs on the healing. Let us know what he says at your appt.

Bryanna

Bryanna,

Thank you so much for answering all my questions. You've clarified quite a bit. I went back on monday which was post op day 11 and he just irrigated the area. I was a little more firm with him this time (though not firm enough) and questioned him.

"What is this hard lump on my jaw, is it an abscess? Spasmed muscle?" and he said it was just residual "stuff" from the infection and that it would subside on its own. I then asked him what to look out for to know if I should be worried. He said "nothing, just keep taking the clindamycin" I pressed politely again and he said "Swelling and extreme pain, but that' won't happen".
'
On the inappropriate side, the Doctor had switched nurses (and all of the nurse staff at least for that day) and she chuckled at how anxious I was in the room. She obviously didn't know what I had been through in there. I told him I was healing but the worrysome symptoms were still around like the lump and being only able to open my mouth a bit and he stretched my mouth open and said "hurts less huh?" yea downgraded from excruciating to torturous, and finally to just inappropriate on his end in my opinion.

I have another appointment with him tomorrow (post op day 13) and at this point my fever is all gone. I only have 2 more days left of clindamycin and all swelling besides the lump in my jaw is gone. I can open my mouth enough to brush all my teeth and I irrigate the holes with a waterpik. The most passive option I am going to take to continue is certainly the checkup every 3 months which you have suggested but I'm still not sure if that's all. I'm worried because the Clindamycin is basically finished but the hard lump still remains, is that a cause for concern? It has been shrinking as far as I can tell, but it seems like it will take a month to go away on it's own, if it even does. Do lumps like these actually resolve themselves without some sort of physical drainage?

Also I thank you for all your help and input and I know how stubborn of a patient I've been. You guys here have made it clear that I'm being mistreated severely but due to financial reasons I keep going back to this doctor I obviously can't trust. I think of it as a poor free clinic at this point. One thing I was wondering, is there an apprpopriate avenue to complain about his behaviour? I would just like it on his record somewhere because I'm sure I'm not the first to complain and I won't be the last. My initial plan was to write a letter to his partners (who are both his senior), but now I'm thinking I should write a letter to the ADA and CC all 3 of the partners?