Hi,

I'm a 32 yr. old who is 18 days post-op lower right wisdom tooth removal with a bone graft. I did a round of Amoxicillin for 7 days, starting one day before my surgery. Immediately after surgery and ever since, I have had numbness of my lip/ chin area (including the teeth and gums in that area). I've had pain varying from constant, dull throbbing to excruciating, stabbing pain that usually lasts around 10 min (I think these are "zingers"). I have not been able to chew or open my mouth fully since surgery.

I went and saw the surgeon 5 days ago, and an infection was found so I am currently on Clindamycin. About 2.5 days into the new antibiotic, I had shooting pain so bad, like I was being stabbed in the face, I was literally jumping out of my seat and in tears. I've been taking ibuprofen around the clock for pain, and sometimes it dulls it, but most of the time it does nothing. I've been doing salt water rinses, tea bags, clove oil, the whole nine yards. I emailed my surgeon and told him what I was experiencing and he said that this was normal and likely the nerve healing and infection resolving, and to call the office if I still have swelling after 3 or 4 days on the antibiotic.

Today is day 5 and I still have a hard lump on my jawline that is so painful, I can barely touch it. I don't see any pus coming from the extraction site anymore (last saw some yesterday). However, last night for the first time since surgery, the pain woke me up in the middle of the night and kept me up until 5:30am. I'm starting to get extremely frustrated. Should I try and wait it out a few more days? Should I go for a second opinion? I'm very concerned about this developing into a much worse infection, and I feel like at this point, I should be much better. And I am so freaking hungry. Sorry for the novel and thanks for any advice!

The symptoms you describe are consistent with an inferior alveolar nerve disturbance. Was the surgery done by an oral surgeon or a dentist? You really need to be seen by an OS asap and ask for pain medication....

It was done by an oral surgeon. I told him I was in a lot of pain and taking OTC ibuprofen around the clock and he gave me an RX for 20 tablets of 600mg ibuprofen, which I have 8 left, and I highly doubt will last me until 2/10 (my next appt.) Not a huge deal, I can always double up on my OTC ibuprofen, but I'm kind of surprised he didn't give me something stronger.

Side note, I'm also on Prozac and I've seen comments in my quest for some resolution to this pain that it's not good to take ibuprofen long term while on Prozac? I asked my pharmacist friend and she said I should be fine, but it's another reason why I was kind of scratching my head at being given more ibuprofen. I don't know if this guy has an aversion to dispensing pain meds, I know there are a lot of RX abusers out there, but I think I have a pretty good reason to need something stronger.

One more thing I forgot to note in my above post, the extraction site is completely open. I can see down into the hole and I'm pretty sure I can see the bone graft. Could this be a reason why it's so painful? My teeth on my right side were super hot/ cold sensitive for a couple of days, but not really anymore.

I wouldn't wait till the 10th. I would call now and ask if you should go to ER or their office to have it looked at.

Thanks, Cleo. I have requested an appointment with another OS for a second opinion. I don't want to mess around with this, and my current OS doesn't seem too concerned (which maybe it really is nothing to be concerned about) but I would like someone to at least explain it to me and verify whether or not my concerns are legitimate.

As of now, I'm still in quite a bit of pain, can't chew and I'm even more limited in opening my jaw now. I mean, this can't possibly be normal for a wisdom tooth extraction, can it? Shouldn't I have improved at least a little bit by now? I haven't had any zingers since this morning, and I only had a couple. No sensation coming back yet. I'm probably getting myself worked up over nothing, but better safe than sorry.

I'm 57 and I had my two lower wisdom teeth extracted 14 years ago; I also had my #19 molar extracted about a month ago and I did not have any problem; I had very little swelling and I took only one 600mg ibuprofen twice after the surgery to control the minor pain. What you experimenting is not normal especially after 18 days! Actually my extraction site is about 30% to 50% closed after 18 days and I'm a lot older than you.
Please seek another surgeon to check it out; I know there are many incompetent dentist out there. Be careful and take care.

There are known nerve complications associated with third molar extraction. I wouldn't say its a normal complication and I doubt there is any normal in pus and a open extraction site where bone is visible almost 3 weeks later. Did the stitches dissolve or did you have to get them removed?

Hi kmd,

Sometimes when a lower wisdom tooth is removed there is an irritation to the nerves in the lower jaw bone in the area of where the wisdom tooth was located. This irritation can most commonly temporary but sometimes it can be permanent. When that happens, a variety of symptoms can occur similar to what you have described. However, these same symptoms can also occur for the following reasons:

1) If there is an infection in the bone irritating those same nerves.

2) If the blood clot was disturbed in the early stages of healing.

3) If there was chronic irritation to the deep wound from:
a) over rinsing
b) using a tea bad past the first day of post op
c) using medicament's like clove oil too often that were irritating to the wound
d) from smoking, drinking alcohol or soda.

4) Certain medications such as Prozac and continuous use of Ibuprofen can cause a decrease in saliva which predisposes the deep oral wound to becoming dry.

All of those things I have listed can cause a disturbance in the early stages of healing and in the proper formation of the blood clot, which will cause the deep wound to become dry and irritated. The result is usually radiating, shooting, sharp, and sudden pain as you have described it here.

So it is best to see an oral surgeon who is going to evaluate your situation very thoroughly. You should have an xray taken to see if there is any additional pathology occurring in the wound or around the bone graft. The bone has not yet started to fill in as that does not start to occur for several weeks or longer. The bony socket from where the tooth was removed, takes up to a full year or so to completely fill in with bone. The gum tissue generally covers a healthy extraction wound within 4-6 weeks. Some people a bit sooner, others a bit longer.

Please let us know how the appointment goes with the new oral surgeon.
Bryanna

Thank you all for your helpful replies. I called two other OS offices this morning and neither would see me as I have an active issue and they "don't want the liability." I guess I could understand that, but not really sure how someone is supposed to go about getting a second opinion then. I called my original OS office even though he is out of town on vacation and they are going to set me up with an appt. to see the OS who is covering for him, so at least it will be a second set of eyes checking everything out. It's not that I don't trust my surgeon, I think he's super capable, I just feel like something else is going on and I'm not really getting enough explanation from him.

I woke up at 2:30am in pain again, but this time I had the ibuprofen by the bedside and was able to get back to asleep within an hour or so. It's so crazy to me that I slept fine right after surgery and the following two weeks, but all of a sudden in my third week of healing I'm waking up in the middle of the night. Maybe it's just the nerve healing and I'm feeling things more now? I don't know, I don't notice any change in the numb area. It's harder to open my mouth today, my jaw just seems to be very limited.

To answer the questions asked:

-The stitches were removed last Thursday by the OS
-The area had been stitched closed so I don't know if a blood clot ever formed, but there's definitely not one there now, the socket is just an empty gap.
-I've been rinsing with salt water 4-6 times a day, not sure if that is too much
-I only did a tea bag one time (yesterday) which seemed to help a little bit but not enough for me to try it again.
-I don't smoke or drink alcohol or soda so no potential culprits there.
-The OS didn't tell me anything really about the infection (i.e. what is actually infected). There is a hard lump on my jawbone that hurts so bad I can't even really touch it. There's also a lump in the same area on the inside of the cheek, it's probably the same one. Maybe the jaw bone is infected?

What I don't understand is if I have an infection and the socket is open, wouldn't that mean the bone graft failed?

Just got back from the on-call surgeon's. Long story short, it sounds like my bone graft isn't there anymore? He rinsed out the socket and all this stuff was coming out and I asked if that was the bone graft and he said that it was actually food (!!!) and when I had it cleaned out at the other OS on Thursday most of the bone graft was probably removed then. Would've been nice if my original OS explained that to me since I paid $600 for something to get washed right out of my mouth. Anyway, apparently there's something in the socket that was catching food particles and he got it all cleaned out. None of that really hurt though, and I told him how the pain was actually coming from the lump in my cheek near my jawbone. He took what I'm guessing was a syringe and needle to it to open it up and oh my God, the pain was so bad. I was instantly crying. Cried for a good 15 min. after I left the office. He said that it was "soupy" and that it was blood and "milky" stuff. He put me on another round of steroids and extended the Clindamycin until my original OS gets back from vacation. I'm in so much pain right now, I really hope this gets better soon, this is absolutely miserable. I still don't know what this damn thing is in my cheek! I asked the assistant if it was an abscess and she repeated what the surgeon had said. I'm to call their office if there's no relief in the next day or two, otherwise he said to go to my original OS as soon as he's back in the office.