[anneva]

I have found a lot of useful information on here but I need some input on what to do next...like tomorrow morning.

History: 2 failed root canals on #3. Extracted by Oral Surgeon on 09/11/2014 placed bone graft. He said everything went well and to come post op 2 weeks. Prescribed lortab for pain as needed.

09/13 continuous pain that I thought was normal but then developed slightly larger than eraser head hard bump above #4. Extremely painful. Touching it makes me feel like i'm going to pass out. Horrible breath, swollen from eye down to neck, swollen lymph nodes. 2 dozen mouth ulcers, I have been dealing with salt water rinse and oragel. I feel that these are under control.

09/15 went back to OS because temp remained low at 96 and I felt I had the flu. Constant throbbing pain at extraction site and bump over #4. OS said sounds like dry socket but it couldn't be because I have a graft. He gave me anti-biotics and sent me home.

09/17 Pain is so bad I can barely function. Bump over #4 is slightly larger. Pain at #4, extraction site, palette where sutures are, and some pain with #1. OS said he could debrive the site and treat as dry socket, but that it was completely impossible that was dry socket and I would have wasted the graph and may not be able to have an implant in the future. He suggested that it was a two-tooth problem to begin with and my problem is the #4 tooth. He recommended I have a root canal done on #4 before I remove the graph.

I scheduled a root canal with an endodontist and called my regular dentist to keep her in the loop. She wanted to see me and take x-rays (since the OS didn't.) She felt the bump over my #4 and said it felt hard like a bone fragment, possibly mine or from the graft. She performed a pulp test on all upper teeth and #4 responded similar to all others and she said it is a viable tooth. She thinks my body is rejecting the graph and that's why I have so much pain and tenderness around the extraction site and the bone fragment is causing #4 to be extra sensitive. She recommended a removal of the graph, an excision of the bump, and to just let the extraction site heel and to worry about a graph or implant later. She spoke with the OS and he is certain that the graph isn't the problem and I should just go ahead and have a root canal. He said removing the graph will almost ruin any chance at a healthy implant and doesn't want to excise the bump because "that's unreasonable to think it's a piece of bone."

I have to make this decision tonight. This is my thinking and my dentist agrees but doesn't know if it's going to be correct.....
1. The bump over #4 is definitely a hard bony-line mass. It's jagged if you press on it.
2. The extraction site and all sutures are very painful 7 days post op

So, if I opt to have the graph removed and insist that he excise the bump, I may not be able to have the implant later (at this point I don't care) but I should be pain free in a few days because there won't be any foreign objects in my mouth. Do I ask him to pack it like a dry-socket with the medicated stuffing or just stitch it up?

If I don't have the graph removed and opt to have a root canal on #4 (a viable tooth) , this is what the OS wants, then I may continue to have the same problem and pain with the graph. I have an apt with OS for graph removal at 9:30 am and root canal apt at 2 pm. So, I have overnight to figure this out.

This pain is a 10 and that's saying something since I've had my spine fused.

[anneva]

About 930 tonight I started to feel a bit better. I am taking my antibiotics as prescribed. And still rinsing with salt water. The severe throbbing has decreased significantly in the past few hours. The mass over 4 is still there and painfull but everything else has sorta calmed down. Should I still have the os remove. The graft? Or just excise the bump? Pain has decreased to a 4

[elvenflow]

If you google "osteomyelitis" that might help with your decision?

[anneva]

It's 5 am and I was just woke up by severe shooting pain through my #1-4 area. I can barely touch it to put orajel and an ice pack on it. I'm not sure what to do?

[Bryanna]

Hi anneva,

My suggestion would be to see a different oral surgeon asap. Not one that is associated with either of your dentists. It is best for him to have your pre op xrays of the upper right quadrant and also take new ones to see where that graft is sitting and what #4 looks like radio graphically.

The bump over #4 needs to be properly diagnosed. Is it a fistula from an infection in #4 ... is it a bony protrusion or a splintered bone from the extraction?? I would do nothing with that bump until it was diagnosed.

Root canaling #4 is not going to solve your problem. In fact it will exacerbate it because it will definitely cause #4 to become infected if it is not already. Root canals do sterilize a tooth, they do not cure the infection inside of a tooth, they create further problems down the road just as you have experienced with #3. Root canals do not fail... that is something patients are told but the fact is that they are a flawed procedure as there is no access to the tiny canals that remain chronically infected. That is why you can rc a tooth a hundred times and the tooth will remain infected.

Regarding the placement of the graft at the time of the extraction... a graft should only be placed in bone that is healthy. A tooth that has been root canaled twice has undoubtedly be sitting in diseased bone. Therefore, that graft may be exacerbating whatever other problems you have going on in that quadrant. Do you have any other teeth in that quadrant root canaled?

You should have been informed that replacing an infected root canaled tooth with a dental implant carries an elevated risk of failure due to the long term disease in that area of bone from the chronically infected tooth. So you may not end up being a good candidate for the implant in the long run anyway.

I hope you see this before you head out to the dentist today. I would see a different oral surgeon for evaluation before letting anyone do anything else to this area.

Please keep in touch here...
Bryanna

Originally Posted by anneva

I have found a lot of useful information on here but I need some input on what to do next...like tomorrow morning.

History: 2 failed root canals on #3. Extracted by Oral Surgeon on 09/11/2014 placed bone graft. He said everything went well and to come post op 2 weeks. Prescribed lortab for pain as needed.

09/13 continuous pain that I thought was normal but then developed slightly larger than eraser head hard bump above #4. Extremely painful. Touching it makes me feel like i'm going to pass out. Horrible breath, swollen from eye down to neck, swollen lymph nodes. 2 dozen mouth ulcers, I have been dealing with salt water rinse and oragel. I feel that these are under control.

09/15 went back to OS because temp remained low at 96 and I felt I had the flu. Constant throbbing pain at extraction site and bump over #4. OS said sounds like dry socket but it couldn't be because I have a graft. He gave me anti-biotics and sent me home.

09/17 Pain is so bad I can barely function. Bump over #4 is slightly larger. Pain at #4, extraction site, palette where sutures are, and some pain with #1. OS said he could debrive the site and treat as dry socket, but that it was completely impossible that was dry socket and I would have wasted the graph and may not be able to have an implant in the future. He suggested that it was a two-tooth problem to begin with and my problem is the #4 tooth. He recommended I have a root canal done on #4 before I remove the graph.

I scheduled a root canal with an endodontist and called my regular dentist to keep her in the loop. She wanted to see me and take x-rays (since the OS didn't.) She felt the bump over my #4 and said it felt hard like a bone fragment, possibly mine or from the graft. She performed a pulp test on all upper teeth and #4 responded similar to all others and she said it is a viable tooth. She thinks my body is rejecting the graph and that's why I have so much pain and tenderness around the extraction site and the bone fragment is causing #4 to be extra sensitive. She recommended a removal of the graph, an excision of the bump, and to just let the extraction site heel and to worry about a graph or implant later. She spoke with the OS and he is certain that the graph isn't the problem and I should just go ahead and have a root canal. He said removing the graph will almost ruin any chance at a healthy implant and doesn't want to excise the bump because "that's unreasonable to think it's a piece of bone."

I have to make this decision tonight. This is my thinking and my dentist agrees but doesn't know if it's going to be correct.....
1. The bump over #4 is definitely a hard bony-line mass. It's jagged if you press on it.
2. The extraction site and all sutures are very painful 7 days post op

So, if I opt to have the graph removed and insist that he excise the bump, I may not be able to have the implant later (at this point I don't care) but I should be pain free in a few days because there won't be any foreign objects in my mouth. Do I ask him to pack it like a dry-socket with the medicated stuffing or just stitch it up?

If I don't have the graph removed and opt to have a root canal on #4 (a viable tooth) , this is what the OS wants, then I may continue to have the same problem and pain with the graph. I have an apt with OS for graph removal at 9:30 am and root canal apt at 2 pm. So, I have overnight to figure this out.

This pain is a 10 and that's saying something since I've had my spine fused.

[anneva]

On 09/18 I went back to the OS. He excised the bump, said nothing was in it and put in three non-dissolve stitches. He removed the bone graft and put in a collagen medicated pack in the extraction site, stitched it in with dissolve able sutures. Said that should clear things up and to come back in two weeks for a follow up.

I felt good until late 09/19. The stitches were causing incredible irritation and pain. I was using the "magic mouthwash" and oragel to control the pain. I was out of town and happen to be at a function with a friend that is a dentist. I explained all of my symptoms and he said it definitely sounded like dry-socket and yes it's possible to have dry-socket with a graft. He said if I really needed to I could remove the stitches. Since I was out of anti-biotics he called me in a script of Clindamycin and Chlorhexidine mouth wash.

09/21 My husband removed the stitches over my #4 tooth, it felt much better. The stitch over the extraction site is still very irritating.

09/22 The pain is excruciating. I could not sleep, my temp is 96.2. I have extreme pain in my right ear and jaw area. I have called my dentist, waiting for response.

[Bryanna]

Hi anneva,

I am editing one statement in my previous reply to read:

<<Root canals do NOT sterilize a tooth, they do not cure the infection inside of a tooth, they create further problems down the road just as you have experienced with #3.>>

[Bryanna]

Anneva,

What was the outcome of your phone conversation with your dentist?

Bryanna

Originally Posted by anneva

On 09/18 I went back to the OS. He excised the bump, said nothing was in it and put in three non-dissolve stitches. He removed the bone graft and put in a collagen medicated pack in the extraction site, stitched it in with dissolve able sutures. Said that should clear things up and to come back in two weeks for a follow up.

I felt good until late 09/19. The stitches were causing incredible irritation and pain. I was using the "magic mouthwash" and oragel to control the pain. I was out of town and happen to be at a function with a friend that is a dentist. I explained all of my symptoms and he said it definitely sounded like dry-socket and yes it's possible to have dry-socket with a graft. He said if I really needed to I could remove the stitches. Since I was out of anti-biotics he called me in a script of Clindamycin and Chlorhexidine mouth wash.

09/21 My husband removed the stitches over my #4 tooth, it felt much better. The stitch over the extraction site is still very irritating.

09/22 The pain is excruciating. I could not sleep, my temp is 96.2. I have extreme pain in my right ear and jaw area. I have called my dentist, waiting for response.

[anneva]

09/22 My dentist called and referred me to a 2nd OS. I met with him and he removed all stitches because he could see the inflammation and how tight they were. He packed in a medicated pack to help with the pain. He was very kind and asked me a lot of questions. Like was it a long and difficult extraction-no, i don't think so. He wondered why the 1st OS cut my gums up so far, didn't take any x-rays, and thought I needed a root canal on #4. He said it looked very messy and painful and just needed to heal. The last thing I needed was another procedure. He said my #4 is a completely healthy tooth and absolutely did NOT need any work, especially a root canal. He said the antiseptic rinse, antibiotics, salt rinses, and continued treatment with tylenol alternated with IB profen is exactly what I need to be doing. If ice helps then use it, if it doesn't then don't. He said it will be at least 10 days of healing and I should expect pain. I go back in on 09/25 for a follow up and another medicated pack if necessary.

That pack was such a relief yesterday. I was able to work and sleep most of the night. I woke up in pain, I think I need to sleep with my head elevated.

Should I cancel my FO up with the 1st OS? I feel that he was very arrogant and blaming me for not taking care of my teeth. The #3 is the only tooth I have ever had a problem with and I almost had a root canal on a healthy tooth because of him. The 2nd OS didn't understand why I even had a graft in the first place. Because the 1st OS said I did and I haven't been to dental school. What was I supposed to do? I'm out over $1,000 and was in horrible pain for 11 days.