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Old 04-10-2014, 09:02 PM #1
nyuszisue nyuszisue is offline
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Default gums feel puffy 4 1/2 weeks after a simple upper molar extraction

I had tooth #2 ( upper right side, second tooth to last one ) pulled 4 1/2 weeks ago. It was a simple extraction by oral surgeon, went without problems, this tooth was root canaled about 17 years ago. Had pain since then, on and off, x- ray never showed anything wrong. After the extraction I took motrin 600 mg when I needed it for pain, which wasn't too bad. But I had that pain on and off for 2 weeks, and on the 11-th day I woke up with this puffy feeling in my gums, around the extraction site. On the 14-th day I went back to the OS, he said it's healing well just a little red in the socket, but because I have this pain, just in case I need to take clindamycin, and give it a week or two. I wasn't happy about the antibiotic, but I took it. Nothing changed, 3 weeks after the extraction I went to my regular dentist, it was a day after I finished the antibiotic, she took an x-ray, said it looks ok, still little red, but healing well, give it a week or two more, I'm just a slow healer. Yesterday I went to an ENT dr. because I feel this fullness above where the tooth was pulled, had a sinus ct scan, everything looks ok. Is this normal ? Still feeling this puffiness in my gums, even if it doesn't look swollen ? Please, help ! Thank, You !
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Old 04-11-2014, 07:15 AM #2
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Default bryanna, please read my tread for 4 1/2 weeks gum puffiness

please , I read all your posts , I"d like to hear your opinion
thank you !
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Old 04-11-2014, 08:23 AM #3
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Hello
Bryanna is sure to reply when she is next online here.
She does have a full time job in the dental field and so she only comes on here when she has time to.
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Old 04-11-2014, 10:23 AM #4
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Hi nyuszisue,

Many dental problems have little to no obvious symptoms until the problem is severe. Frequently an infected tooth (root canaled or not) that has been draining through a deep pocket will tend to have vague symptoms (as you stated) until the inflammation reduces the opening of the pocket which can then cause obvious swelling or pain. This is commonly seen in aged root canaled teeth. The bacteria that resides inside of root canaled teeth is mainly inside the tiny accessory canals which cannot be picked up on most dental xrays until it has greatly proliferated beyond these canals. So that is why many dentists will tell the patient the tooth looks good and not diagnose the brewing infection until more symptoms or pathology develop.

It is very typical to have some complications after an infected tooth is extracted. Whether or not it had been root canaled does not diminish the fact that the tooth was diseased and in your case your tooth was unhealthy for at least entire 17 years. So you can imagine how sick that tooth was and how inflamed the bone and tissue in that area had become over all that time.

The intensity of the post op complications often depend on how progressive the bacteria had become. Dental xrays and even CT scans do not always show the extent of the problem... sometimes the problem is still in a microscopic phase and cannot be picked up by radiation ..... other times the dentist feels the site looks "typical" and prescribes antibiotics and takes a wait and see approach.

Sometimes an extraction site is no longer diseased but it may be more inflamed and traumatized than it would be if the tooth had not been so ill. In those case the healing will take longer.

The fact that you seemed to get worse on the 11th day post op is indicative of a possibly unresolved bacterial issue. This could mean there is still some bacteria lurking in the bone, the tissue, or the sinus. If it is not detectable (yet) on an xray or scan it will be difficult to diagnose and treat. If this is the case it may progress or it may resolve. It is hard to determine which way it will go. Antibiotics may not help much because the bacteria may not be sensitive to the meds prescribed. The only sure way to know what antibiotic to prescribe would be to culture that extraction site and send to the lab for testing.

A few questions....

Are you getting any drainage from that side of your nose? Does the nasal passage on that side feel inflamed or closed off? Were you prone to any of those things prior to the extraction? Do you feel pressure, pain or an achy feeling in that side of your face beside your nose? Any pressure in or under that eye?

Did the oral surgeon or your dentist say anything to you about the tooth being close to the sinus or a sinus perforation or that your sinuses were low in that area?

Any chance you could post the pre and post op xrays of this tooth???

Are you rinsing with warm salt water? Are you using any mouthwash or peroxide or irrigating the site with anything? What tooth paste are you using to brush your teeth with... and do you floss?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 04-11-2014, 10:51 AM #5
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No drainage from the nose, pressure is above where the tooth was not in the nose, nasal passage don't feel inflamed, no pressure or pain under the eye. Unfortunately I don't have any of the x-rays ( can I ask for them for myself ? ).
I use beotene toothpaste and the mouthwash sometimes ( sometimes I have dry mouth, that's from before ), I did rinse with salt water I tought I don't have to it anymore, and I rinsed few times with chammomile tea.
They never said anything about the sinus perforation or the tooth being close to sinuses for sure, my general dentist said "maybe" I have a mouth sinus connection or how you call that, but if it happened it will heal, couldn't see that on the x-ray she did. The OS is very unprofessional, when I called back after finishing the antibiotic and nothing changed with the puffiness he just said give it a week or two, or come back to reopen and reclean it. If that's going to happened, Bryanna, how is that done, is it painfull,etc. ? how long shoud I wait for this to improve ?
Thank you so much !
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Old 04-11-2014, 12:01 PM #6
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nyuszisue,

Okay good signs that you have no drainage, nasal passage seems clear, and no pain/pressure under the eye.

The xrays are your property. If they were digital, you can tell the dentist office to email them to you and then you can post them here. If they are not digitial then the diagnostic quality after copying them is not always that great.

Okay so you have chronic dry mouth... an ongoing problem... yes? Do you have Srogren's syndrome or are you on medications that dry out your mouth. Do you smoke?

Chronic dry mouth can slow down the healing process from a tooth extraction causing the site to remain sore and red for an extended amount of time.

Biotene products have some harsh chemical ingredients which can actually irritate the oral tissue. Some people find relief of their dry mouth when they increase their water consumption on a daily basis. Rinsing your mouth with a teaspoon of coconut oil can also be therapeutic in so many ways and help with healing the extraction site.

Yes, keep rinsing with warm salt water until the site closes over.

So the general dentist mentioned a possible sinus communication....? If that is the case, then it may be small enough to close on it's own. However, you will need to be mindful of that possibility and take some precautions to allow the perforation to heal closed. For the next two weeks .... very gentle blowing of your nose if at all, do not smoke, do not drink from a straw, and drink plenty of water.

If the surgeon has to reopen the site and clean it out, you will be numbed up for that procedure. Generally these issues resolve within a couple of weeks and it really helps when the patient follows the post op directions as I have outlined for you. If you feel that the problem is progressing, then do not wait to see the oral surgeon. If you are not comfortable with that dentist, then see a different oral surgeon.
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Old 04-11-2014, 12:20 PM #7
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Hello ! I don't smoke I never did. I was border line on Lupus test 2 years ago, no medications so far, and the dry mouth is not that bad. I'm on birth controll pills and I had the extraction the day before my period started, does that make any difference in the healing ?
If the OS reopens the wound there is a chance for dry socket again ? and how long that debridement procedure takes ? local anestethic is enough during the procedure ?
Thank you !!
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Old 04-11-2014, 01:31 PM #8
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Why the puffy feeling if the gums don't look swollen ? You said if I feel the problem is progressing not to wait, but if everything stays the same that's not good either ? this puffy feeling is a sign that something is wrong, right ?
I appreciated your answers so much, thank you Bryanna !
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Old 04-12-2014, 08:26 PM #9
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nyuszisie,

Having any type of surgery just prior to your menses can slow down the healing from the surgery.

If the OS opens up the site there is a chance of developing a dry socket. The healing would be similar to that of the extraction. The debidement takes a few minutes and yes a local anesthetic is adequate.

Bryanna

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Originally Posted by nyuszisue View Post
Hello ! I don't smoke I never did. I was border line on Lupus test 2 years ago, no medications so far, and the dry mouth is not that bad. I'm on birth controll pills and I had the extraction the day before my period started, does that make any difference in the healing ?
If the OS reopens the wound there is a chance for dry socket again ? and how long that debridement procedure takes ? local anestethic is enough during the procedure ?
Thank you !!
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Old 04-12-2014, 08:30 PM #10
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nyuszisie,

The puffy feeling could be inflammation within the tissue which may not make the gums appear to look swollen. The inflammation could also be higher up than the gums.

If you are not getting any worse over the next couple of days and then things start to improve that is normal. If things get worse over the next couple of days or you develop new symptoms then see the OS.



Quote:
Originally Posted by nyuszisue View Post
Why the puffy feeling if the gums don't look swollen ? You said if I feel the problem is progressing not to wait, but if everything stays the same that's not good either ? this puffy feeling is a sign that something is wrong, right ?
I appreciated your answers so much, thank you Bryanna !
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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