Greetings all,

First, let me say how grateful I am to have stumbled on this site. I searched on wisdom tooth pain and landed here. I can see that there's a real atmosphere of helping and caring here, and that's just what I could use. Bryanna, especially, seems to be some sort of saint in terms of her patience and understanding with the many who have posted their problems here.

I'm 51 (male) and had never had dental problems. 6 weeks ago, I developed an abscess (a fistula) beneath the molar just in front of my lower left wisdom tooth. I saw a dentist, who referred me to an oral surgeon here in Palm Springs where I live. I was told I needed all 4 wisdom teeth out. Iwas placed on antibiotics, first clindamycin (to which I had a reaction and severe headaches/diarrhea) after which I was changed to 7 days of Azithromycin (Z-Pack). I was about to have the procedure on that Monday, but because I had bronchitis, I wanted to wait a few days because I couldn't imagine adding post-op recovery pain to my already weakened and highly congested state. Fast forward a week to the next Monday; I show up, and have the surgery under IV sedation. I was told after the surgery that there was a tiny piece of the lower left wisdom tooth that the surgeon thought it better NOT to remove, for fear of damaging the nerve. He said what he did remove was difficult to get out, and that it had taken him quite a while. He said that recent studies had proven that it was less damaging to allow the piece to either heal over or slowly migrate up to the surface where it could easily be removed if that occurred. (Note that this oral surgeon is reputed to be the best in the area.)

So, I go home, groggy, and begin the recovery. 3 or 4 days later I return with pain and am told I have a dry socket. He packed it and I got some relief. At this point, I was off the oxycodone and managing the pain with Advil. The pain wasn't excruciating, but was enough to warrant a couple of Advil at night. Another 10 days went by, and I was now 2 weeks post-op. Pain persisting, with some pain radiating up into my left temple area. Not terrible, just enough to be annoying. The surgeon (who is a nice fellow, but is a bit hurried in his manner) told me that there was no sign of infection. I continued to use the syringe to clean out food which got stuck in the lower holes. (also note that, despite having a small knot in my left cheek near the difficult extraction, I was always able to open my mouth fully. There was a bit of swelling in my left cheek, but that has now gone.)

I'm writing now, because tomorrow will be 4 weeks to the day, and I just had to pop another two Advil for the pain that always seems to show up around 7:30 in the evening. The Advil controls the pain, but I'm concerned that it's still there. There is no visible sign of infection at the extraction site - just the rather large hole, and I would not say is it extremely tender. I have been eating mostly normal food for the past 2-3 weeks, but still avoiding things like nuts and tortilla chips with sharp edges. I also have no fever according to my thermometer. On a scale of 1-10, I'd say the pain will max out at about a 4 or 5 if I don't take the Advil. I CAN see the oral surgeon again, but I feel that he's just going to tell me to keep doing the saltwater rinses. I'm fine with that, and I can keep dealing with the pain at this level (Assuming that, at some point in the not too distant future it will go away) but I don't know how to assess whether or not this pain could indicate some sort of deep (bone?) infection, or whether it is just nerves that have been disrupted, muscles stretched, or something more or less benign. Learning about terms like "Ludwig's angina" and NICO has me concerned that the dry socket may not be healing properly and that this pain is just the first warning sign of something worse to come. But... if there's no swelling or fever or discharge... or other sign of infection, no numbness... could the pain just be post-op pain from the difficult extraction? Would that last 4 weeks or more??

Sorry for the long, rambling post, and thanks in advance for anyone who might have the patience to read through this and offer their perspective or advice. I realize as a 51 year old that I do not heal as quickly as a younger person, but I do not smoke and am healthy overall. My only symptom (no fever, no swelling) is just this evening pain and my anxiety that it could be some sort of warning sign.

Thanks

Hi Berus,

Please clarify for me....

Was the dry socket the same site as where the fistula was.... and is that the same place that the piece of root was left in?

Regarding leaving a piece of root in the bone after the extraction ..... generally that is not an ideal thing to do especially if the area had an infection to begin with. However, it is a judgement call at the time of the surgery. The piece of tooth may or may not work it's way up towards the gum. If it does, then it's possible to have it removed at a later date. If it doesn't then that site needs to be monitored with x-rays at least once a year to make sure an infection is not brewing.

Not all dental infections cause fever or significant pain. Sometimes people can be diagnosed with NICO and only complain of intermittent pain or vague symptoms. Others are in excruciating pain.

It is common for a patient to have lingering pain several weeks post op of wisdom teeth removal due to the stretching of the jaw during the procedure. When you have IV sedation, your mouth gets propped open fairly wide which puts a strain on the ligaments, muscles and TMJ joint. Any time there is a difficult extraction, especially a lower molar, the jaw is over worked in trying to remove the tooth. So your symptoms could be the result any any of those things.

If you are feeling anxious about this area and you feel that pain is just lingering too intensely, then either see the same oral surgeon or another one to evaluate it with an x-ray. The bone takes a year to fill in completely, but at 4 weeks post op an x-ray could be taken to compare with the original x-ray to see if a possible infection is brewing.

If your oral surgeon is impatient and you are concerned he will think your concerns are bothering him ... then see someone else. It's funny when people say ..... "he is the best in town or the most reputable" ... because that statement does not always indicate a dentist or doctor. It does however indicate a popular one who has in some way made his mark on the community via any number of ways. This is not to say he is not good at what he does.... he may be very good! But sometimes popularity rates dentists (or whomever) higher than their level of skill.

Thanks for the kind words... by the way
Bryanna

Hi Bryanna,

Thanks for getting back to me. OK, to answer your question, the fistula appeared on the gumline beneath the molar located right next to the lower left wisdom tooth. That wisdom tooth was sideways under the gumline and invisible below the surface of the gum, impacted onto the molar which developed the fistula. The fistula burst, and drained over the course of the week I waited (with bronchitis) to get the 4 wisdom teeth taken out. I should also mention that there is an INTENSE cold-sensitivity in the fairly large pocket left by the removal of that tooth. The pain is largely non-existent at this point aside from that, UNTIL about 7:30 pm each evening, at which time it kicks in at that same spot, and radiates upward and beneath the other lower teeth on my left side. It is well controlled by 2 Advil, and I have no trouble sleeping after I take those.

Thanks again for your attention and advice on this!

Berus,

Ok, so the fistula formed near teeth #17 (impacted wisdom tooth) and 18 (second molar).
Is #18 a root canaled tooth? What is the health of this tooth? Does it have a large filling or crown?

What site did the surgeon leave the piece of tooth in?
What site did the dry socket occur?

Bryanna

Update - saw the oral surgeon again this morning, and discussed my concern about the nightly pain, and the intense cold sensitivity. Looking in, he said that there was still some bone exposed, although healing was occurring. He then showed me the panagraph X-ray taken just before surgery, and explained that the molar (I think he called it 18 or 19) had suffered some bone loss from the wisdom tooth next to it being sideways under the gum, and growing toward its roots. He said that there was still some exposed nerve from that, and that this could account for the cold sensitivity. I asked about NICO, which he, at first didn't seem familiar with, but then said "OH, we call that Osteo Necrotizing (something or other)." He then said that he saw no signs of infection at all, and that I should give it another month because healing was slow due to my being 51. He gave me two syringes of some sort of yellowish gel and told me to use that to control pain and promote healing.

So... I'm not sure if I feel good about that or not. I sort've wanted another X-ray, but he assured me there was no sign of infection. Any suggestions, Bryanna? Should I seek a second opinion now, or give this another week or two? Also... and this is a bit embarrassing... having been on antibiotics for the first 3 weeks of this ordeal (two weeks before, and 1 week after surgery), I came down with loose stools. I was tested for C-diff by my primary care physician about 3 weeks ago, and it was negative. However, it's continuing, despite my having used some Florastor pro-biotic intermittently. (I have been lax in making sure I get 2 doses per day. When things improve, I tend to slack off, and the problem returns.) Could this be C-diff, or is this normal after so many antibiotics? (I have been off antibiotics for 3 weeks now.)

Thanks again!

Berus,

The OS is correct about the sensitivity issue. Sounds like a portion of the root surface of the second molar is exposed due to bone loss from the wisdom tooth laying up against it. That may or may not get better. Only time will tell as the surgical site heals. If it doesn't improve, you may be able to have a white tooth colored filling placed around the part of the tooth that is sensitive. Sometimes that helps a lot but it would not be done until the site heals.

Regarding the intestinal issues... irrelevant of the test result about C Diff.... you have a problem that needs attention. When someone has loose stools any time during and/or after antibiotic usage, it indicates that the intestinal flora was not balanced to begin with and has now become overwhelmed with bad bacteria in comparison to healthy bacteria. Considering that our immune system is 75% of our intestinal tract .... an imbalance of bacterias can lead to all sorts of health problems

You can try to manage this on your own but you would have to be diligent and not slack off at all. If the bacteria does not become more healthy, you have a greater chance of developing C Diff.

Many patients do well when taking a pre biotic called Sacharomyces Boulardii along with a probiotic like Culturelle. The SC is 500 mgs 2 x's per day, the Culturelle is one capsule 2x's per day. This is usually done for 2-4 weeks. Then if your bowel movements have been normal for several days, just continue the Culturelle indefinitely to maintain a healthy bacteria in your intestinal tract.
Once you have loose stools due to antibiotic therapy, you are then always going to be prone to that condition making the likelihood of C Diff a concern. The best way to prevent this problem is to keep your intestinal bacteria healthy by supplementing with a probiotic every day.... for life.

Diet also plays a huge role in the balance of intestinal bacteria especially when there has been a major upset .... Foods to avoid include high-carb, high-glycemic such as sugar, sweets, foods with added sugar or sweeteners, processed flour, white flour or white rice pastas, breads, pastries, dairy products, soft drinks, sweetened yogurt and ketchup. You can google list of foods that help balance intestinal flora.


Bryanna

Bryanna,

Once again, thankyou, thankyou, and thankyou for your help and attention with this. I guess I'm just now getting my head around the notion of how serious this whole event turned out to be. Shame about the antibiotic sensitivity ending up being another side effect of this occurrence. I'll do as you suggest with the pro-biotics, AND see my primary care doctor to get his opinion as well. Again, thanks for all the help with this - it has meant a lot to have a knowledgeable person giving me input, as this whole thing has been a bit overwhelming in terms of how it affected my normal, day to day routine. I wish the best for everyone else here who visits this forum with their issues, and hope for recoveries for each and every one.