Hello. On Jan. 15, I had teeth #17 & 18 extracted. The molar had fractured under its crown and the other was a horizontally-positioned wisdom tooth; there was some infection brewing between the two teeth as well.

The healing process seemed pretty much uneventful; I wound up with a dry socket, had it packed twice and the oral surgeon commented that things were healing up nicely. However, pain that I had attributed to the dry socket began to increase; after a few days of waiting for it to resolve and taking the prescribed meds for pain, I went back in to see the oral surgeon.

He examined the area and explained that the "tissue wasn't healing correctly" over the extraction area. The only lay person way to describe the tissue was that it was blob-like and it looked as if it was rebelling against what it was expected to do naturally. The surgeon said he needed to open the area, debride it and then take biopsies; due to his busy practice, the first appointment that he could get me in was a full week out.

I counted down each day with anticipation---I was so uncomfortable and in such freaking pain. On the day of the surgery, I looked at the area one last time, and noticed that the area had grown more since the surgeon had examined the tissue a week ago. It was primarily pink with a little pinkish white at the ends.

After the surgery, I didn't have a chance to speak with the doctor about what his impressions were, but the nurse assured me that the biopsies were on their way and that it would take 2 week to get the results. I have a follow-up appointment scheduled with him this Thursday, March 12th to check on the surgery area---the biopsies won't be in until March 10th.

As I sit hère and type this note, I am still in pain. Pain in my mouth, jaw; on the outside of my cheek it's warm to the touch and I do get relief by applying a cold pack. My cheek is yellow in that same area; it looks as if a bruise is in it's healing phase. Part of the pain can be attributed to getting what I think is yet another dry socket, which I will have to have packed tomorrow. I am afraid to admit that the other pain that I feel is similar to what I felt the last time around---prior to noticing that the tissue wasn't healing correctly.

As of tomorrow, I will have taken a total of 25 days worth of the Clindamycin. I
have also been on a high-quality probiotic as well in order to preserve the rest of my system. I guess it's safe to assume that the antibiotic isn't kicking whatever it is that's kicking my mouth/tissue/jaw area. I'm allergic to penicillin and bactrim---maybe there is something else that could help eradicate this stuff…germ, bacteria, etc…...

I realize that once the biopsy results arrive, the surgeon will have a clear idea of what is going on with me and we'll develop a plan of attack-----but I am really concerned because I haven't a clue what to think about everything that's been going on. I also fear not getting relief from all of this discomfort…it's hard to find anyone who'll really speak up with a solid, professional opinion and that scares me.

*One other footnote worth sharing. Several days after I had the extractions done, I was scheduled for my regular 6-month cleaning and check-up with my dentist. I explained to her how I was feeling and I described the pain that was creeping in… She picked up one of my x-ray films that they had just taken and pointed to this vertical thing that was very clear. She said "maybe this is your problem." I didn't know what to say because when I normally look at x-rays I don't see much. Anyhow, it resembled the lead from inside a #2 pencil---a short little piece for sure. When I explained what my dentist had shown me on an x-ray taken a few days prior to my visit to the oral surgeon, he never said a word, nod his head, or anything. He didn't even look at me. ??? Did I miss something?

I apologize for being so long-winded. Thank you for reading this post. Take care! Laughter

Hi Laughter,

I am in the dental field and can offer you some information here.

You obviously have had some post op complications following the extraction of both teeth which was attempted to be addressed. However, the initial attempt was unsuccessful and then the lag time until the second debridement was not ideal in that you had obviously developed further granulation tissue. The pain must have been awful!

It sounds like this surgeon is awfully busy and may not be spending enough time with you and he really should be explaining the situation better. It is good that he did the biopsy, hopefully he took a specimen for a bacterial culture so that the proper antibiotic can be prescribed.

It is normal for the site to be sore and tender for a few weeks post op. But the actual pain should be less after the 3rd day post op and continue to decrease thereafter. It is normal to have some facial bruising which will go away in a week or so.

Make sure that the surgeon knows the full extent of the location, duration and type of pain you are experiencing. If it seems like he is not taking this too seriously, then perhaps it would be wise to seek an opinion from a different oral surgeon, one that is not associated with the treating surgeon.

Regarding the clindamycin... it is a very powerful antibiotic. It may or may not be the proper antibiotic for this infection. So hopefully the surgeon had a culture done that will determine what antibiotics are best to treat the bacteria. Clindamycin is one of many antibiotics that has the potential to cause an intestinal infection called Clostridium Difficile or C.diff for short. This is a serious infection and can occur even weeks after you stop the drug. It is not a good idea to be on this for any long term unless it is absolutely necessary. Continue on the probiotic ideally indefinitely as you not only need to retain some healthy bacteria in your gut but you need to replenish what is being killed off by the meds.

Just a note about your 6 month dental visit... if the surgical site of the two extractions was still open at that visit, the hygienist should not have cleaned your teeth. That is not something you would have known, but she should have known better. If that were the case, then the cleaning should have been postponed until the sites were closed.

Regarding what the hygienist saw on an xray at your hygiene visit... it sounds like there is either a bony fragment that may have fractured off of the jaw bone during the extractions which means a piece of splintered bone is lodged in there ... and/or the image on the film could have been a piece of tooth that fractured off and was not removed. Either of those things can cause or contribute to improper healing of the extraction sites and infection. The oral surgeon should not have shrugged this off. He should have evaluated it further and spoke to you about it. The fact that he seem to dismiss it, concerns me because he knows the importance of being thorough with his oral surgery and if he left anything behind, he needs to inform you of that and be diligent in taking care of it.

I think you are trying to be nice and go along with whatever is being done. However, I think it would be wise to be a little bit assertive with the oral surgeon and expect some answers about the delay in healing and question what that image was/is on that xray. It is imperative that the surgical sites be clean of all fragments of the teeth and diseased tissue including the periodontal ligaments and any visibly unhealthy bone. Ask him out right... if he did those things. Anything shy of doing those things is not acceptable and can further the infection.

If the oral surgeon does not have that new xray... get a copy and bring it with you when you see him.

Hope this information helps.

Bryanna

Hello Bryanna,

I first have to say that I sincerely appreciate the expertise, time and energy that it took to post your reply to my original questions. It's a rarity to find someone like yourself who is so giving of their time and energy in order to make such a difference in other people's lives. Thank you for being Y-O-U.

A bit more detail is needed---Surgeon A did the original extractions. He was booked solid and in a super hurry; my procedure took a total of 15 minutes, which shocked my designated driver.

When I followed up with him a week later to check the surgery site and to look at what I knew was a dry socket, he said that he felt I had a blocked submandibular gland. He said for me to suck on tart candy and to massage the jaw/neck area in order to convince the gland to begin flowing once again. He also said that he "wanted to keep an eye on it" and that he was leaving for a month the next day. He said I would be fine in his partner Surgeon 2's hands.

I came back in pain and saw surgeon 2. He determined that I in no way had a blocked salivary gland; that he didn't see any evidence of why I was having such pain (the granulation wasn't visible) besides being related to the dry socket so he sent me for a CT scan.

By the next time I saw Surgeon 2, the granulated tissue was visibly running wild and he determined that I needed to return to have that debrided and biopsied. We were still waiting on the CT results.

After a week of waiting, I had the second surgery done by Surgeon 2. He said that I would owe $0.00 for this entire procedure and he'd only collect whatever my insurance was willing to pay.

I returned to Surgeon 2 for a check up about 10 days after the surgery and things had finally taken a turn for the better. A day or so prior to the appointment, I began feeling better than I had in what seemed like a long, long time. So, I let him know that I was actually beginning to feel like my old self and felt as if I was gradually on the mend. The CT results were in and they stated:

"Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious."
It also said "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension."

The biopsy results were also in and here is what it says:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.

Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.

Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.

Bryanna, you hit the nail on the head when you said that basically I was being a passive, wimpy chicken. lol Well, in all fairness, you did word things a bit differently. To be candid, I am petrified of dentistry in general, so when these issues began to rear their ugly head, I just did what I had to do and tried to go with the flow. My focus was to be done with everything….yesterday!

I did not have a copy of the X-ray that showed that little vertical image-----however, do you think that the description of the biopsy results reflect what was visible on my dentist's X-ray?

I'll wrap this up for now. Thank you again, Bryanna. I appreciate you!
~Laughter

Laughter,

Thank you for the kind words

I didn't mean to imply that you were being a chicken.... it's okay to be a chicken My intention was for you to take a hold of the situation as I felt you were being jerked around a bit.

I am re posting the biopsy report and answering in bold type.

<<"Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious.">>

INTERPRETATION:
AN EXTENDED OR EXPANDED AREA OF THE LOWER JAW BONE AND TOOTH SOCKET IN THE 3RD MOLAR REGION. CONTAINING DEAD CELLS AND A HOLEY APPEARANCE WITH UNDEFINED MARGINS OF THE MEMBRANE COVERING THE BONE. IN OTHER WORDS YOU HAD A TOOTH OR TWO REMOVED, IT WAS A TRAUMATIC EXTRACTION MEANING FORCEFUL AND THE SOCKET WAS NOT DEBRIDED THOROUGHLY.

THIS BIOPSY CONFIRMS INFECTION AND INFLAMMATION REFERRED TO AS OSTEOMYELITIS AND MYOSITIS.

IT ALSO INDICATES THAT YOUR MASSETER MUSCLE, THIS MUSCLE IS USED TO OPEN AND CLOSE YOUR JAW, IS ALSO INFLAMED. THIS COULD BE FROM THE SURGERY, THE INFECTION AND/OR YOU ARE GRINDING YOUR TEETH.

<<It also said "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension.">>

INTERPRETATION:
YOU HAVE SWOLLEN LYMPH NODES SCATTERED ON BOTH SIDE OF YOUR NECK. LARGER ONES ON THE LEFT SIDE WITH 2 OF THEM BEING PREDOMINANTLY LARGER THAN THE OTHERS.

IN OTHER WORDS, YOU HAVE AN INFECTION AND YOUR LYMPHATIC SYSTEM IS TRYING TO DEAL WITH IT. THE INFECTION WAS LIKELY PRESENT LONGER THAN YOU MAY HAD REALIZED PRIOR TO HAVING THOSE TEETH REMOVED. SO THIS WILL TAKE TIME TO SUBSIDE COMPLETELY.

<<The biopsy results were also in and here is what it says:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.>>

EXACTLY, OSTEOMYELITIS MOST LIKELY DUE TO LONG TERM INFECTION AND INFERIOR DEBRIDEMENT OF THE BONY SOCKET WHEN THE TOOTH WAS REMOVED.

THIS IS WHY I CANNOT STRESS ENOUGH TO EVERYONE.... MAKE SURE YOU TELL YOUR ORAL SURGEON TO BE THOROUGH WITH THE DEBRIDEMENT!

<<Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.>>

INTERPRETATION:
LOWER MANDIBLE 2ND AND 3RD MOLAR REGION.
SEVERAL SPECIMENS OF VARIOUS TEXTURE, COLOR AND SIZE WITH SOME BONE ATTACHED TO THEM.

IN OTHER WORDS... DEEP BONE INFECTION WITH BUMPY GRANULATION TISSUE AND INFLAMMATION OUT THE YING YANG!

So you had a severe infection brewing in that area prior to the extractions and even after the extraction due to an incomplete debridement of the bone. The cause of the infection, the teeth, were removed but the site was not able to heal properly because the infected tissue had not been removed. Given the lapse of time before the site was finally debrided, the infection went deeper. Hopefully you are on the mend now. Another thing that disturbs me is that there was no bacterial culture taken according to this biopsy report. Which is just plain irresponsible because that would have determined the proper strain of antibiotic to use. Were there any other reports with this one?

<<Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.>>

FORGET SURGEON #1.... HE COULD HAVE DONE A BETTER JOB. BEING IN A HURRY WHEN PERFORMING ROUTINE ORAL SURGERY IS NOT ACCEPTABLE AS FAR AS I AM CONCERNED. THE HEADACHES, RANDOM ACHES AND PAINS COULD BE DUE TO THE INFLAMMATION FROM THE BONE AND MASSETER MUSCLE. ARE YOU GRINDING YOUR TEETH?? IF SO, I SUGGEST THAT YOU APPLY WARM MOIST HEAT ON THE LEFT SIDE OF YOUR FACE, HEAD AND NECK TO ENCOURAGE BLOOD FLOW AND REDUCE INFLAMMATION. ESPECIALLY BEFORE YOU GO TO SLEEP AT NIGHT.

THE LYMPH NODES CAN REMAIN TENDER FOR SEVERAL WEEKS. THE LYMPHATIC SYSTEM IS DOING ITS JOB OF RIDDING YOUR BODY OF THE TOXINS FROM THE INFECTION. HOWEVER, YOU NEED TO MONITOR THE SEVERITY OF THE TENDERNESS AS TO IF IT IS GETTING BETTER OR NOT. IT SHOULD GRADUALLY IMPROVE UNTIL COMPLETE DISSIPATION. IF IT SEEMS LIKE IT'S NOT IMPROVING OR IT'S GETTING WORSE THEN SEE YOUR ORAL SURGEON #2, NOT OS #1, AND POSSIBLY YOUR PHYSICIAN FOR A WBC AND SED RATE BLOOD TEST.

Hope this info helps. Please keep us posted...

Bryanna

Hello Bryanna,

I appreciate your very helpful response. Yes, I am a chicken---I have the feathers to prove it and I have a pretty impressive “Bock, bock, bock” when it's called for!

I understand the concept of being jerked around a bit; I can tell you that based on the things that have taken place, it's clear that someone was in a hurry, took shortcuts and then someone else was assigned to clean up the mess. Your detailed information has made me realize that neither oral surgeon did what was expected of him from a very logical, thorough approach. Maybe they are overbooked; on their way out of town for a month; too booked to have a patient come in right away for a procedure that will relieve them of pain galore (yes, that unhealthy granulated tissue HURT, SQUARED) ; not thinking of and doing everything possible (like taking a bacterial culture during surgery) to assure the best outcome for the patient. But those are the types of unacceptable issues you address and prevent from taking place in your business especially since you're dealing with people's health. Ok, now I'll calm down.

From my CT results: "Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious." <---for some reason, Surgeon 2 had a problem with that statement while reviewing the CT results. He said “What is could be? Is it either reactive or is it infectious???”

Bryanna breaks it down: INTERPRETATION:
AN EXTENDED OR EXPANDED AREA OF THE LOWER JAW BONE AND TOOTH SOCKET IN THE 3RD MOLAR REGION. CONTAINING DEAD CELLS AND A HOLEY APPEARANCE WITH UNDEFINED MARGINS OF THE MEMBRANE COVERING THE BONE. IN OTHER WORDS YOU HAD A TOOTH OR TWO REMOVED, IT WAS A TRAUMATIC EXTRACTION MEANING FORCEFUL AND THE SOCKET WAS NOT DEBRIDED THOROUGHLY.

THIS BIOPSY CONFIRMS INFECTION AND INFLAMMATION REFERRED TO AS OSTEOMYELITIS AND MYOSITIS.

IT ALSO INDICATES THAT YOUR MASSETER MUSCLE, THIS MUSCLE IS USED TO OPEN AND CLOSE YOUR JAW, IS ALSO INFLAMED. THIS COULD BE FROM THE SURGERY, THE INFECTION AND/OR YOU ARE GRINDING YOUR TEETH. I looked up where the masseter muscle is located and NOW something else finally makes sense. During my one follow up appointment with Surgeon 2, I complained about (what felt like) a big hard bump on the inside of my mouth. It felt as if I had stuffed the inside of my cheek with something solid but I couldn't remove it. That issue was brand new---and most definitely due to the surgery somehow. I've never felt anything like that before or since. Anyhow---the masseter muscle is EXACTLY where the issue is... Surgeon 2 examined the area I was pointing to and said that it was just scar tissue that I had accidentally bitten over a long period of time. Wow. The good news is that it isn't as “tight” as it originally felt.

From my CT results: "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension.">>

Bryanna breaks it down: INTERPRETATION:
YOU HAVE SWOLLEN LYMPH NODES SCATTERED ON BOTH SIDE OF YOUR NECK. LARGER ONES ON THE LEFT SIDE WITH 2 OF THEM BEING PREDOMINANTLY LARGER THAN THE OTHERS.

IN OTHER WORDS, YOU HAVE AN INFECTION AND YOUR LYMPHATIC SYSTEM IS TRYING TO DEAL WITH IT. THE INFECTION WAS LIKELY PRESENT LONGER THAN YOU MAY HAD REALIZED PRIOR TO HAVING THOSE TEETH REMOVED. SO THIS WILL TAKE TIME TO SUBSIDE COMPLETELY. I had an appt. with Surgeon 2 today (3/19). He told me that he wants me to take a copy of the CT results to an ENT and ask him to look at the lymph nodes. He said that he was pretty certain that the ENT wouldn't need to do anything whatsoever, but that it'd be good for me to go to see one (I swear, I'm not making this up. Lol).

From my biopsy results:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.>>

Bryanna breaks it down: EXACTLY, OSTEOMYELITIS MOST LIKELY DUE TO LONG TERM INFECTION AND INFERIOR DEBRIDEMENT OF THE BONY SOCKET WHEN THE TOOTH WAS REMOVED.

THIS IS WHY I CANNOT STRESS ENOUGH TO EVERYONE.... MAKE SURE YOU TELL YOUR ORAL SURGEON TO BE THOROUGH WITH THE DEBRIDEMENT!
I have a question; if the debridement process is successful/done right, is it capable of removing all of the osteomyelitis?
Would it have been a good idea for Surgeon 1 to take a bacterial culture during the original extraction procedure? (Honestly, I had never heard of debridement until a month ago; obviously, I had no idea that it was a part of having an extraction done. I really do learn something new all the time...).

From my biopsy results: Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.>>

Bryanna breaks it down: INTERPRETATION:
LOWER MANDIBLE 2ND AND 3RD MOLAR REGION.
SEVERAL SPECIMENS OF VARIOUS TEXTURE, COLOR AND SIZE WITH SOME BONE ATTACHED TO THEM.

IN OTHER WORDS... DEEP BONE INFECTION WITH BUMPY GRANULATION TISSUE AND INFLAMMATION OUT THE YING YANG!

So you had a severe infection brewing in that area prior to the extractions and even after the extraction due to an incomplete debridement of the bone. The cause of the infection, the teeth, were removed but the site was not able to heal properly because the infected tissue had not been removed. Given the lapse of time before the site was finally debrided, the infection went deeper. Hopefully you are on the mend now. Another thing that disturbs me is that there was no bacterial culture taken according to this biopsy report. Which is just plain irresponsible because that would have determined the proper strain of antibiotic to use. Were there any other reports with this one? No other reports are available. I can only assume from that and the fact that Surgeon 2 has never made a comment regarding a bacterial culture.

<<Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.>>

FORGET SURGEON #1.... HE COULD HAVE DONE A BETTER JOB. BEING IN A HURRY WHEN PERFORMING ROUTINE ORAL SURGERY IS NOT ACCEPTABLE AS FAR AS I AM CONCERNED. THE HEADACHES, RANDOM ACHES AND PAINS COULD BE DUE TO THE INFLAMMATION FROM THE BONE AND MASSETER MUSCLE. ARE YOU GRINDING YOUR TEETH?? IF SO, I SUGGEST THAT YOU APPLY WARM MOIST HEAT ON THE LEFT SIDE OF YOUR FACE, HEAD AND NECK TO ENCOURAGE BLOOD FLOW AND REDUCE INFLAMMATION. ESPECIALLY BEFORE YOU GO TO SLEEP AT NIGHT. Bryanna, I have never been known to grind my teeth at night. I have no reason to think that I ever have nor has anyone ever told me I did...I have known people who did grind their teeth during the night and it made me about pass out. lol

THE LYMPH NODES CAN REMAIN TENDER FOR SEVERAL WEEKS. THE LYMPHATIC SYSTEM IS DOING ITS JOB OF RIDDING YOUR BODY OF THE TOXINS FROM THE INFECTION. HOWEVER, YOU NEED TO MONITOR THE SEVERITY OF THE TENDERNESS AS TO IF IT IS GETTING BETTER OR NOT. IT SHOULD GRADUALLY IMPROVE UNTIL COMPLETE DISSIPATION. IF IT SEEMS LIKE IT'S NOT IMPROVING OR IT'S GETTING WORSE THEN SEE YOUR ORAL SURGEON #2, NOT OS #1, AND POSSIBLY YOUR PHYSICIAN FOR A WBC AND SED RATE BLOOD TEST. Question; What would each blood test reflect? The WBC would show if there was any infection, right? I will definitely have those tests done at the Internists appointment.

Hope this info helps. Please keep us posted... Bryanna

Based on your advice, I decided to work with Surgeon 2 and forget about Surgeon 1 altogether. My appointment today with Surgeon 2 was scheduled because I wanted to make sure there wasn't any infection taking place and that I wanted to update him on how I've been feeling. We are 2 weeks out from the surgery.

I said that I had a decent amount of pain whenever I ate, sometimes drank and whenever I yawn.
I showed him where my mouth, jaw, side of face and ear aches on occasion and hurts on and off as well. I told him that I have been experiencing frequent headaches which are more intense on the left side of my head.
He asked if any of it woke me up through the night and I told him that the lymph nodes in my neck do.
He examined me for any signs of infection; he said that he saw nothing that would lead him to believe that infection was present. He said that he took a lot of time with me and made sure he got everything out that needed to be removed.
He asked if I was taking anything for the aches and pains. I told him that I take either Tylenol, Motrin or the Norco he prescribed as needed.
He asked for me to be patient. He doesn't want to go back in surgically unless he “knew what he was looking for.” He wasn't going to prescribe antibiotics just in case there might be an issue that isn't visible. He asked for me to give it 2 weeks and to come back in to see him. He said that he hopes by then I will be just fine.
He said if I had trouble between now and then to not hesitate to come in...

He asked me to go see an ENT (I mentioned that in the CT results area above).

He also asked me to see my Internist regarding a non-dental related comment on the CT results.
“Incidental note made of azygous lobe in the right upper lobe of the lung. There is an ill-defined 1.4 cm lymph node in the superior mediastinum in the right paratracheal region.”

That's about everything that I can share at the moment. It goes without saying, but I'm open to any feedback whatsoever.
Thank you again for listening and for helping me to better understand what the heck is going on.

~Laughter (Bock, bock, bock)

Hi Laughter,

I've been known to cluck a time or two.... ~:>
I always take fear and apprehension seriously whether it be coming from myself or someone else! I think kindness and competency of those in charge of the situation go a long way with us <<chickens>>

Your question about osteomyelitis.... When an infected tooth is extracted there is no guarantee that the bone will be completely healthy once it has healed, especially if the infection was long standing. So it is always best to have a thorough debridement of the bony socket and ideal to do that at the time of the extraction to give the patient the best chance of a positive outcome. It is also ideal to have a culture of the bacteria taken at the time of the extraction so that the proper antibiotic can be prescribed. I only know of a handful of dentists who do that routinely... makes no sense not to, but what can I say :/

I am glad that os #2 is spending some quality time with you. He knows that things were not ideally done initially and since he took your case on he is now obligated to see it through. I agree that you should see your internist for an evaluation of the lymph nodes and I would do that soon. Bring the written results of the CT scan with you and the films also. He will refer you to a specialist if necessary. If the dr does not suggest blood work, then it may behoove you to ask him for it. There are different tests to measure for infection and inflammation in the blood. Just talk to him about doing that as you are concerned about residual infection.

The symptoms that you have on the left side, headaches etc... sound mainly muscular to me. The fact that the tightness is easing up is a good sign! Try the warm moist compresses and see if that makes a difference. Also, you could be grinding or clenching your teeth and not know it. The person that sleeps with you.... could be a sound sleeper and not hear it...?? You mentioned that os#2 thought you had some scar tissue due to a chronic chewing habit in a certain area. If you think about that.......... ...... .... that could be a habit that you do without thinking, like clenching or grinding. As a matter of fact, in order to chew the tissue enough to create scar tissue, you would really be working that masseter muscle which is similar to what happens when you clench or grind your teeth. Make sense??

Keep us posted... and take good care of yourself.
Bryanna

Hello again, Bryanna!

I hope that life has been treating you well.

I would like to ask you about the extraction site that I had had debrided and biopsied roughly a month or so ago.

Over the last week, the tissue that's till in the healing process, began to sting. I gingerly peeked to see what was going on, and there appears to be more unhealthy granulated tissue present. It began bleeding so I just left it alone in order to let it heal up. It's roughly 1/3 of the size of the original tissue that had to be removed.

Yesterday, I felt what I thought was a loose piece of skin pressing against the side of my tongue at the extraction site. Once again, I carefully look in to see what the heck is going on, and it's the same area of tissue, but it was filled with pus. Just from the pressure of my opening my mouth, the thing opened up (and of course, that's when I did my infamous spider dance---which I use whenever something freaks me out). Since yesterday, it's still doing the same thing and there is also a small amount of blood that surfaces.

Bryanna, can you please explain what is going on---and why it's happening? Is this a common problem after having had the 2nd procedure to remove all the “bad stuff”? Is the presence of pus a sign that my body is trying to get rid of additional infection?

Lastly, I am now hesitant in going back to the same Oral Surgery Center where I had the original procedure with OS 1 and then the follow-up procedure with OS 2. What do you recommend that I do----go to see OS 2 (I will never go to see OS 1 again) or see a new OS who works with a new group of OS's?

As always, I appreciate your help, expertise and time. Thank You!!!

Laughter

Hi Laughter,

I know the "spider dance" well!! I have done that a time or two and not just for stuff pertaining to myself.....!!! Sometimes it makes the patient feel better to dance with them Sure wish it made the icky problem disappear though "-"

Okay so you still have some infection brewing there. It could be as simple as something close to the surface of the gum line like a piece of granulation tissue or a bony fragment that has worked its way up. But without a clinical and radio graphic evaluation, you cannot be sure of what it is.

So....... it would be wise to see oral surgeon #2 again. It's okay, I am dancing with you ~'.'~

Hopefully it is just a mild issue and once remedied the site will heal up well. Keep me posted.


Bryanna

Hi again Bryanna,

Well, I saw the OS this past Saturday. The panoramic and PT x-rays show that "there is something in there" <----the OS's words, not mine. He agreed that the unhealthy tissue is also back, although it isn't as big as the most recent time that I had to have surgery.

He confirmed the pus and blood factor as well (bleck). Long story short, I have to go in this Saturday (May 9th) to have same surgery again, Bryanna. Is my situation common? How often do patients have this many issues/procedures after having two teeth extracted?

I'm not a happy camper. Cluck,cluck, cluck. ~Laughter

Hi Laughter,

Well this is not really a laughing matter.... :/

I re read your CT results and it is possible that you still have or have recurrent osteomyelitis and perhaps your body keeps making granular tissue because it is confused by the bacteria. New tissue and bone always form after an extraction but when there is bacteria that is irritating the new growth, the new tissue grows lumpy and actually prevents the bone from filling in. That's why it needs to be re surgerized.

This problem is most commonly seen when the extraction site was not debrided thoroughly at the time the tooth was removed. In some cases, the problem goes on for months, even years before it is diagnosed properly.

I must say, your CT scan was hugely helpful in that it gave a clear picture of what was going on. Sometimes the bacteria has really set up house and it can be difficult to eradicate completely. The only thing the surgeon can do is go in again and really clean the site out as best as he can.

I would suggest that you request a biopsy AND culture be taken at the time of this surgery. The biopsy determines the bacteria and cells that are present and the sensitivity culture determines what antibiotic is most appropriate. Truthfully, both of those things are imperative and should be done. So put away the chicken suit and put on the roaster.... !!

I am sorry that you are going through this. We could look back and say... what if the dentist did this or that and what if the initial follow up care had been better. But it won't make the problem go away and it just uses up valuable energy. So try to look forward to getting this taken care of and be (gently) assertive with what you expect to have done. I think this surgeon wants to help you and I feel he would welcome your taking the role of your own advocate.

Be sure to have a soft food diet planned ahead of time so you don't have to think about it when you don't feel like thinking about it

Hang in there... and keep us posted.
Bryanna