I find it interesting how often these dentists want to do grafts on the same day of an extraction and how often they refuse to give advice or answer good questions related to their own profession or treatments.

Again, think positive, but don't hesitate to get a second opinion from an oral surgeon and even your gp.

Sometimes, our bodies just need extra time to heal. But if your instincts tell you something could be wrong, double check.

Be very careful. I was careful, but still ended up with severe medical problems that should never have happened.

this is a classic example of dentristry profitering he knows exacly what hes doing and wants to make as much money as he can.his work might well be good but he wants as much out of it that he can

Especially since you have MS you need to be ultra careful when it comes to nerve damage. If you even suspect your dentist isn't being ultra careful or is doing any procedures that are unnecessary or risky, get another dentist or at least a second opinion.

I just had my molar #14 extracted yesterday and the surgeon didn't do a bone graft. I had planned to talk with him about getting one done at the time of the extraction and mentioned it to his staff when I called to set up an appointment but I forgot. Then the procedure began and I only focussed on the crunching and grinding sounds of bone and hoping to god that I would get out of the procedure safely.

I was going to call his office on monday and find out what my options are. Is it more risky to do now because it wasn't done during the extraction? What things should I be concerned about?

My initial reason to do this is in case I want to get an implant or bridge in that spot later. Or I think even with a flipper it won't sit right because of the bone loss because I didn't get it done with the extraction. Now I bet that spot will be all squishy and if I put a flipper or a bridge on it I won't even be able to chew food on it.

How soon should I go back to get the bone graft if it's even possible at this point? And now I'm freaking because I'm going to have to go through more grinding and crunching...I think. If someone could give me some advice it would be really appreciated. I feel like an idiot for not bringing this up right away. I think even if I had wanted a bone graft he couldnt have done it because he had someone on deck after me and was kind of backed up. Plus, I'm not sure how much more work it would have been to put the graft in. maybe only a few more minutes. I have no idea. Sorry for rambling.

Hi asquirrel,

Bone grafting is generally recommended at the time of the extraction providing there is no infection in the bone. However, not every extraction requires a bone graft. It all depends on the size and quality of the bone after the extraction. I am surprised that he didn't discuss this with you himself??
Was it a root canaled tooth that was removed?

It is not too late to do a bone graft. Some surgeons wait 2 weeks post op the extraction some a bit longer. It depends on the health of the bone at the time of the extraction.

To place a bone graft using synthetic bone material is not a big surgery. It only takes a few minutes. Just so you know....

Call the surgeons office and ask to speak to the surgeon (preferable) or have someone there speak to them about doing the graft. Better to do that than wonder about it.....

Bryanna

Hi Bryanna

Thank you so much for responding!

I think I was too worried about the extraction and I totally forgot to ask him about the bone graft. But in retrospect I guess he probably should have brought it up given that I was scheduled for an extraction.

Here’s a breakdown of my journey to an extracted tooth. This thing cracked back as early as 2004 from I guess a filling that gave out from my family dentist. Another old school 70’s style office. Been using this guy since I was a little kid. Silver amalgam fillings (whatever that old school stuff was).

I chose this new dentist because he was referred to me by my sister and brother in law. He had a nice office with lots of new equipment. Yeah. I should have looked for a personal reference or just went back to my family dentist. Expensive lesson learned.

So I went to the new dentist. The tooth (#14) that was extracted just had a temporary crown on it. The tooth was cracked laterally and I was in constant pain from the moment the dentist prepped it to the time the molar was extracted by the oral surgeon. The temp crown was put on 1/9/13. We had an appointment to put the permanent crown in for 2/11/13. Total price was $1731 for the crown. He also had to redo a filling that the crown was going to be next to for $315 because the crown wouldn’t fit right if he didn’t do it. I paid half down ($1024.50) with the balance due on the final appointment.

Afterward the procedure I was having shooting pain through the left upper and lower jaw plus a constant dull pain on number 14 (the one that was prepped with the temp crown put on). On 1/14 I went back to the dentist for a solution and he ground the crown down on #14 some more. He thought it was due to an uneven bite and said give it about 3 days for the tendons to relax. On 1/19 I was in severe pain. I was eventually able to speak with him on the phone and he thought the tooth was infected. He prescribed penicillin and hydrocodone (6 pills). On Sunday I called him back and told him my tooth was still hurting. He prescribed another 6 hydrocodone pills. He cancelled my emergency appointment that we set up for Monday because I was in so much pain and recommended that I contact a local endodontist for a root canal.

On Monday I was able to get an appointment set up with an oral surgeon for an extraction with whom my mom had gone to with good results. My sister had just had her #14 extracted from a holistic dentist place who advised her against a root canal. I had done my research and came to the same conclusion. That’s why I decided to get the tooth pulled.

Unfortunately, the appointment wasn’t until the following Thursday (1/31). I was put on a standby list and would be called if there was a cancellation. At that time I spoke with the surgeon’s nurse about getting a bone graft. She told me the range would be between $550 and $975 depending on whether there was …barriers? (something like that). She said to speak with the surgeon when I came in for the extraction. I mentioned the penicillin I was taking and she said the bone graft may not be able to get done in one visit because of the infection but to speak with the surgeon when I came in for the extraction.

I called my dentist for a refill for the pain meds and he said no. He suggested I try to get in with another dental professional. He said he’d call the lab to cancel the crown and charge me a reasonable hourly rate for the work he did thus far.

On Tuesday (1/22) I called the dentist and spoke with his wife. I asked if he could send me something as far as what he’s proposing for a credit. She told me she’d ask him and then said that he called the lab and that the permanent crown had been completed.

On Wednesday I was able to get in touch with my dad’s endodontist. I was in so much pain I was seriously considering anything that might relieve it. The endodontist was a nice guy who’s been doing endodontics since the 70’s. Probably spent about 10 minutes on the phone with me. I described my symptoms and there was no question in his mind the tooth was infected and that the nerves were inflamed and dying. I told him my concerns with a root canal and he said that although there’s risk involved he’s had a lot of success. Wednesday night I was up reading horror stories from people who had failed root canals even after initial success. Really bad infections going into the sinus cavities.

On Thursday I cancelled with the endodontist and spoke with his wife who was very understanding about my concerns. I called the oral surgeon to see if he had any cancellations. The nurse said they just had one and I was able to get in yesterday (1/25) for 9:45 a .m.

The surgeon was also a nice guy. The digital xrays sent over by the dentist of #14 via email were 35kb (kilobytes) and were too low resolution and blurry to be of any use. The surgeon said that if the tooth was cracked laterally there was fair chance the tooth couldn’t be saved to begin with. He did take new xrays but honestly I didn’t even remember what the results were. He’s office isn’t state of the art (old school xrays with the shield and stuff like that). He’s been doing this a long time. He’s also been in practice since at least since the early 70’s. I was just looking at him and his tool kit. It looked like an auto mechanic shop kit and my brain shut off. The procedure went as well as expected. I got some pain meds and was told to keep taking the penicillin I got from the dentist until it ran out. Total price for the extraction was $315 + 28 for the xrays. Pretty fair considering I called around and the next oral surgeon wanted about $130 more even looking at worse case scenario from the surgeon I went to and was about $400 less than the next oral surgeon if the bone graft was only $550.

So that’s the rest of the story.

I’ll give the surgeon a call on Monday. What’s the longest I can put this off before I get bone loss? How do they get back in there to put the bone material in? I suspect Novocain, then cut hole open with scalpel and then stick the bone stuff in and then stitch it up?

What’s the best material to use? I heard there’s like harvested bone from cadavers and also from bovines. Plus there’s your own bone scraped off and ground up (I think I want to pass on that). Is there something else? What would you suggest? I also heard that the bone powder stuff doesn’t stick around and solidify. It gets absorbed into your body and then your body makes it’s own bone to fill in the hole?

The reason I wanted to get the bone graft is that I MIGHT get an implant. Still worried about getting anything else drilled or screwed into my mouth after this ordeal. Most likely I was thinking of getting a Nesbit dental bridge. I think I read about it on the site here from a google search. My concern is if I don’t get the bone graft the area will either be too uneven or squishy for the Nesbit.

Thanks again for your help. I was really lucky to find this forum!!

I'm not a dental professional, squirrel. I'm someone who ended up with lots of pain, likely permanent, as the result of questionable dental care. I'm also someone who has been, lets just say, profoundly disappointed in this field.

Some dental professionals are now saying that root canals are not good for you. Others vehemently disagree.

I think, most, if not all surgeries, should be done by an oral surgeon. And almost all procedures should be double checked with a second opinion. Easier said than done, since sometimes it is very hard to get an appointment.

Especially if a person has any autoimmune issues....issues like diabetes, lupus or MS, extra care needs to be taken.

Please post when you are able and send an update. I hope you are getting excellent and safe dental care and are feeling well.

Hi Vowel Lady!

I went to see the oral surgeon today and got an appointment to get the bone graft done. It will be done in about 30 days. The surgeon said he'd like some time for the site to heal and 30 days isn't too long to lose bone.

The site where my tooth pulled feels horrible. I feel like there's two spines in the gums that didn't come out which are sore when I touch them. There's a huge gouge in my gum line. Feels like he used wire cutters to cut a big "V" into the gum to get the tooth out. The extraction hole feels fine though which is a relief.

I feel your pain. Literally. Getting any surgical or dental procedure can result in permanent damage. And it seems like professionals are reluctant to say that one of their colleagues made a mistake (unless they're an expert witness). Maybe they're thinking, "there but for the grace of god go I."

I totally agree with you that all procedures should be checked with a second opinion. Only problem is I have pretty limited means (and probably most people do). High deductible health insurance and no dental insurance. So second opinions are an expensive proposition unless someone went really bad and you HAVE to go see someone (yeah, kind of like my dentist tossing me out in the rain when I was in pain). I'm still sore about the hole thing...literally (again). Alright, no more puns.

Anyway, I'm somewhat apprehensive about my bone graft but I'm hopeful things will go well. The surgeon has been doing this stuff since the 70's and I should be confident he knows what he's doing. I'll keep you posted. Thanks for your response!!!

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Asquirrel,

How did I miss your other post????? So sorry about that :/

Anyway... the two spines you talk about are probably bone spurs or bone splinters. This can sometimes occur if a tooth is badly fractured or breaks apart during the removal. It can also occur if the instrumentation was not angled properly or too much force was put on the bone when removing it. FYI.... older dentists who have never altered their original methods, those practicing for 25+ yrs or so tend to extract with more force than necessary. That is how they were taught. The technique has changed over the years to be more what is called A traumatic which is gentle, persistent and less aggressive.

Sometimes the gum gets torn during an extraction. The huge gauge in your gum is a great description of what can happen when an east/west elevator is used.... which are typically used by "older" dentists. Those elevators are generally used less often now since there are others that are a bit gentler on the gum tissue. Hopefully the tissue will heal without a huge indentation in it.

Did this surgeon offer you options of bone graft material? Honestly, was this surgeons office clean and somewhat up to date...?? I ask that because there still are dentists, young and old, who skimp on certain aspects of sterilization and disposable items because they think that stuff is over rated. I know scary..... but true. I'm just a little leery based on your description of things so far.

Bryanna

I'm pretty "sore" about dentists as well. I don't know whether to laugh or cry, but I get it. Sometimes it is best to find a little humor in things that are difficult or in my case profoundly disturbing.

A friend of mine went to a dental school to have her work done due to expenses. It was less expensive, etc.

She had a cracked tooth. Interesting thing, they never fully explained why they did what they did....although I'm sure after what happened to me, my friend would ask a million questions.

Anyway, they told her no root canal. They recommended pulling the tooth and waiting three months for the area to heal, and then do the implant. They did not do or even mention a graft. She was very happy with their work and had little pain and no problems. She has an autoimmune disorder, fairly well controlled. They took everything slowly.

Wishing you a positive, safe experience with quick and steady healing.