I want to include as much information as possible so excuse for a long post.

Early November I experienced pain in a Root canaled tooth, my second molar on the left hand side. I am from another country and had not been to a dentist in the USA, I did my research and found one nearby that had good reviews. I made an appointment they referred me to an endodontist who took a CBCT cone beam scan and confirmed I had a vertical root fracture thus the tooth needed to be removed.

on 24/11 I had the tooth removed by the original DDS. She was very good and talked/explained everything to me as we went along. I asked her about placing a bone graft and she said it depends on what the site looks like when they get in there. However given the CBCT scan and the xray did not show infection it would be possible most likely. She got in there and said there was a small infection present but she cleaned out the socket and placed the bone graft (which I got a discount for because I had no insurance and she felt bad for me). She said there is a slight chance the bone graft could fail, but she was just doing her due diligence and informing me of all the possibilities. I was prescribed 10 days amoxcillin and sent on my way.

After about a week two nights in a row I experienced bad pain for about 2 hours. I was concerned I phoned her on her cell phone which she had given me incase I had any concerns. She only works 1 day at the office near me however given my concerns she came in and saw me first thing in the morning before going to her other office. She looked at the site and said it looked OK but I was healing a bit slow. She said there is a chance I may need to get the graft removed but she would rather prescribe me some clindamycin and see if that helped.

I saw her three weeks later, during which time about 3 days after finishing my clindamycin prescription I noticed pus had been accumulating in the site along with a terrible taste. She looked at the site and again said I had a lot of under developed tissue, along with the pussing the best process would be to remove the graft. She went in there removed the graft, rinsed 3-5 times with a saline solution filled syringe and scrapped the site. After all of this she said it would be possible that i have slight pain up to 4-8 weeks after, given the infection and everything that has gone on. She said not to hesitate to call her if the pain got really bad or was not relieved with ibuprofen/affecting my everyday life. I was presrcibed with 7 days of amoxcillin.

I saw her after one week for a post-op check up and she said the site looked great and looked 100% better then it had previously. She said it wasn't completely closed over and that I should still be careful when rinsing/spitting and no alcohol etc.I saw her after two weeks for a post-op check up and again she said the site had closed over and it looked really good, no signs of infection.


However now it is 2 and a half weeks after this debridement and I have some concerns. I may go in and see her again on Monday (when she is there next) but I really do not want to bother her unnecessarily as she has gone out of her way multiple times - i must stress at no stage has she expressed/showed me to be a burden etc and she has been more then happy to help. I have not noticed any pussing etc at all.

My concerns are these:

1. The extraction site looks fine for the most part, 3/4 of it is kind of light purpleish color, hard to describe but something you would expect skin to look like. However part of the extraction site, the area closest to my biscupid is red. Is this normal could it just be underdeveloped granulation tissue/new tissue?It's far enough from the biscupid to not be related to plaque etc. The area gets redder after I rinse vigorously presumably because I am irritating it.

2. I am experiencing mild pain, I am not even sure if i would call it pain. The extraction site just feels irritated sometimes. It is NOT a thobbing/deep seeded pain it feels more like the pain is on top of the extraction site. Again I'm not sure pain is the right word, it feels hmm twingy?

3. Sometimes when I swallow hard I notice this odd pulling sensation from the extraction site. It's not painful it kind of just feels like some one tugging at the site. Is this simply because my mouth is getting used to no tooth being there and since there is no bone under the site things are sort of 'moving'?

4.. IF, and a big IF say I notice something that indicates an infection, would antibiotics fix it? As I understand the original antibiotics during the bone graft could have been useless because they can't get to the bone graft site? But now with a blood clot etc there more antibiotics could actually help? I really don't want to go through another debridement and recovery period.

I am travelling a lot in the next 14 days and will be returning home. So I really want this period to be pain free. IF (worst case scenario) I have another infection, will antibiotics be adequate to get me through this period?

I have attached a picture, I'm sorry it's not the best but if you look closely you can kind of see the redness I'm talking about


Sorry for the long post and thanks in advance.

Attached Thumbnails

 

I should add that I have been brushing twice a day and flossing once. I use prevident rx toothpaste and a sonicare - avoiding the extraction site obviously. I use warm salt water with q tip to clean the gum area around the extraction site. If I accidentally prod the site with my q tip or toothbrush which I will admit has happened twice, there is absolutely no pain. The gums around the extraction site are not painful at all.

I still use warm salt water rinses 2-3 times a day.

Sorry I forgot to add that the extraction was difficult, the tooth had to be cut in half. And that I do have bruxism, pretty badly, for which I have just started wearing a night guard.

Sorry I'm just trying to include as much information as possible

Hi Ab23,

Thank you for the detailed description and sticking to the facts.... makes reading it a lot easier Also the photo helps too.

I will repost your questions and answer in bold type.

>>1. The extraction site looks fine for the most part, 3/4 of it is kind of light purpleish color, hard to describe but something you would expect skin to look like. However part of the extraction site, the area closest to my biscupid is red. Is this normal could it just be underdeveloped granulation tissue/new tissue?It's far enough from the biscupid to not be related to plaque etc. The area gets redder after I rinse vigorously presumably because I am irritating it.>>

YES, THE SITE DOES LOOK GOOD. THE REDDENED AREA COULD BE IRRITATION FROM BRUSHING WITH THE ELECTRIC TOOTHBRUSH AS THE BRISTLES COVER MORE THAN JUST THE TEETH OR YOU COULD BE SKIMMING OVER THAT AREA WITH THE BRUSH AND IT'S JUST ENOUGH TO IRRITATE THE DELICATE TISSUE. OR THE IRRITATION CAN BE FROM CHEWING ON IT. ALSO BE SURE TO FLOSS THE BACK SIDE OF THE PER MOLAR.

>>2. I am experiencing mild pain, I am not even sure if i would call it pain. The extraction site just feels irritated sometimes. It is NOT a thobbing/deep seeded pain it feels more like the pain is on top of the extraction site. Again I'm not sure pain is the right word, it feels hmm twingy?>>

IF YOU ARE IRRITATING IT WITH THE TOOTH BRUSH OR CHEWING, THEN IT WOULD FEE IRRITATED OR TWINGY. THINK OF IT AS A BLEMISH OF SOME SORT THAT FEELS SORE.

>>3. Sometimes when I swallow hard I notice this odd pulling sensation from the extraction site. It's not painful it kind of just feels like some one tugging at the site. Is this simply because my mouth is getting used to no tooth being there and since there is no bone under the site things are sort of 'moving'?>>

THERE IS A LITTLE INFLAMMATION AT THE SITE OF THE IRRITATION WHICH CAN CAUSE THAT SENSATION. HOWEVER THAT WOULD BE NORMAL FOR THIS STAGE OF HEALING. THE SITE IS HEALING AND THERE IS STILL A HOLE LARGE ENOUGH TO CAUSE THE GUM TISSUE TO MOVE A LITTLE WHEN YOU SWALLOW. THE TISSUE SORT OF SUCKS INTO THE HOLE WHEN YOU SWALLOW. IF THERE IS NO INFECTION IN THE SOCKET, AND THE TISSUE IS NOT GIVING ANY INDICATION THAT THERE IS, THEN THE HOLE WILL CLOSE OVER AND THAT SENSATION WILL GO AWAY.

>>4.. IF, and a big IF say I notice something that indicates an infection, would antibiotics fix it? As I understand the original antibiotics during the bone graft could have been useless because they can't get to the bone graft site? But now with a blood clot etc there more antibiotics could actually help? I really don't want to go through another debridement and recovery period.>>

IT DEPENDS ON HOW DEEP OR SEVERE THE INFECTION IS. BUT THE GUM TISSUE IS NOT INDICATING THAT THERE IS AN INFECTION. THE ORIGINAL ANTIBIOTICS HELPED TO A POINT AS THEY DID REDUCE THE INFLAMMATION THAT WOULD HAVE OCCURRED IF YOU HAD NOT TAKEN THOSE MEDS AT THAT TIME. IT IS NEVER A GOOD IDEA TO TAKE ANTIBIOTICS UNLESS THEY ARE ABSOLUTELY WARRANTED AS THEY CAN CAUSE SECONDARY INFECTIONS TO OCCUR IN YOUR INTESTINES.

>>I am travelling a lot in the next 14 days and will be returning home. So I really want this period to be pain free. IF (worst case scenario) I have another infection, will antibiotics be adequate to get me through this period?>>

DEPENDS ON THE SEVERITY, CAUSE AND DEPTH OF THE INFECTION. I WOULD SUGGEST THAT YOU VISIT THE DENTIST ONE MORE TIME TO HAVE THE SITE EVALUATED. EVEN HAVE ONE PERIAPICAL XRAY DONE TO SEE IF THERE IS ANY OBVIOUS PATHOLOGY GOING ON IN THE SOCKET. IT IS TOO EARLY TO SEE ANY BONE GROWTH BUT THE XRAY WILL SHOW IF THERE IS INFECTION BREWING.

NEVER THINK THAT YOU CANNOT GO IN TO SEE THE DENTIST BECAUSE YOU ARE BOTHERING THEM. THEY HAVE TAKEN YOU ON AS A PATIENT AND IT IS THEIR LEGAL OBLIGATION TO SEE THE TREATMENT THROUGH TO THE END. I DON'T THINK THIS DENTIST BASED ON YOUR DESCRIPTION OF HER WILL HAVE ANY ISSUES WITH SEEING YOU AGAIN. I THINK IT WOULD BE WISE TO DO THAT BEFORE YOU TRAVEL.

I hope this information is helpful. Please check in and let us know how you are doing.
Bryanna

Hi,

Thanks for the response it is appreciated.

I wanted to add that when I wake up in the morning the site sort of looks murky, it doesn't really look like puss (as I have experienced that before the debridement) and there is no odd distaste (other then morning breath). It just looks kind of murky if I spit the murky ness goes away, my spit is a normal colour really. I presume it's just to do with saliva production when you sleep and old saliva kind of hangs around in the socket? Given that there still is an indentation/crater because it was a large molar. Add to this some amount of dehydration that occurs over night etc and hence the murky colour?

What you are saying about irritating the socket when I am brushing etc makes sense however that part of the socket kind of always looks red. Like I said if i rinse vigorously the redness is more noticeable. Is it plausible that it is just really early skin formation, I mean it has only been two and a half weeks, I can't imagine that new skin immediately looks pink right?

When can I expect the gum to turn a pink colour? I have looked on the internet, and I would say my site looks to be 'on par' with the pictures that I've seen - of course this is not great indication as everyone heals at different rates.

In terms of infection, could redness indicate this? What should I look out for? I will make an appointment to go back on Monday I think just to be safe given everything that had happened previously

Thanks again.

Hi Ab23,

Murky would be normal in the morning and for the reasons you stated. Keep in mind that is a flap of skin that is not attached to anything yet. It will close together eventually.

The area that is always red could be because it is irritated. Meaning if you hit it with the bristles of a rotating tooth brush and/or you chew on it, it is going to stay irritated until you hit it again because it is new skin and it's getting hit... !'.'! Irritated gum tissue can redden when you rinse with salt water. If it stays red after rinsing then back off on the amount of salt you are using.

The gum will turn your normal color when the site is healed. Be patient

Yes, please see the dentist for a quick look see this week.

Bryanna

Hi,

Went back to the DDS this morning. She is adamant that there is no infection and that the site looks 110% better then it did at the 3 week period before debridement (i.e when it was actually infected). Which I agree with.

She said that because the site is closed over it would be near impossible that pus would be coming out of the site directly. If it was she would see a pinhole type entrance/exit where it would be coming from. Also given the closure of the site, I would be experiencing pain and/or swelling. None of which I have experienced, other then some very occasionally slight pain - which is due to the site healing after being infected / root canaled tooth etc. Coupled with the fact that I have not seen anything in a week of observing it, other then the apparent murkiness after sleeping.

Regarding the murkiness in the morning, I managed to get a pretty good picture. She did not seem concerned, given that when I run my tounge over the site there is no odd taste or anything. Could be related to the post-nasal dripping that I have experienced.

Regarding redness, simply immature tissue that will heal with time.

Forgot to ask if I should continue salt water rinses, I think Iw ill for at least another week

Thanks for your help

Ab23,

Okay... sounds good!

Yes, keep rinsing with salt water and slowly taper off within a week or so.

If the remainder of the healing goes without a hitch, please check back with an update of your healing

Bryanna