Hello Hive,
I'm not sure how to navigate this forum well yet, but I've read quite a few threads with Bryanna and hope she catches this!

So,I am experiencing significant pain 5 days after extraction. Much more than the couple days after!

I got two back lower molars extracted last Tuesday. They were both root canal teeth, and there was infection in the jaw bone. I was assured that they would thoroughly clean / deride the area before placing the bone graft, which they did in the same appointment.

On day three, my stitches failed and sort of "caved INTO the void" of where my teeth were. The next day, the large 'double wide' gap opened, and I'm not sure if stitches are still in there or not. I've been doing the salt water rinses etc and following protocol to a T this whole time.

I also put a dental mirror in there (without stretching anything-no worries) and noticed that there was also a wide open deep deep cut along my last existing tooth on that side, and it seems that that tooth might well be pretty exposed. I have a picture but not sure I can post. The gums (which are basically a giant pocket) are very red, and separated. I'm sure I've lost some bone graft matieral- as there had been a bunch of stuff pack in the void which is no longer there. One of the teeth he extracted he said was very difficult and complications were had. A endo a long time ago 'buried' a broken file in my root. That made for removal chalgnes.

This of course all happened over a weekend. I'm heading in tomorrow, but I'd love a bit of perspective before I go.

It hurts like, nervy pain. Like sort of dry socket (which I've had before) but then there is also a pain radiating up my ear, and I swear I feel a bit of numbness on that side of my tongue - is that weird? IT's throbbing. Also the gums are extremely red and raw- and feel warm. So - I am worried about infection . I don't do well with antibiotics- meaning, I've been taking them as prescribed but they mess up my gut - even with probiotics. I now feel sinus running and sore throat… which also makes me thing maybe infection. Would 6 days be enough for bone graft to reject itself/infection to show up? or is it maybe just dry socket? I don't have a fever though the site feels hot. Maybe just because it's angry and inflamed?

I do have immune system issues, I was actually hoping that maybe ridding my body of this long time low grade infection in my jaw would HELP. So far… not so much.
VERY grateful for any comment!

Attached Images

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Hi annanut,

Thank you for posting the picture.

Yes, it appears that you have an infection. Based on your description of the history of these teeth, the infection that was brewing in your jaw bone was severe. Therefore, removing the teeth was the first step in a process of removing the infection and healing. The jaw bone area needed to be thoroughly debrided of all visibly diseased tissue and bone once the teeth were removed. The bone graft should have only been placed if after the debridement the existing bone was found to be healthy. Otherwise, the sites should have been debrided, irrigated with saline, sutured and left to heal for a few weeks or so before a second surgery was done to place graft material.

When a surgical site of an infected root canaled tooth is not thoroughly debrided and the bone graft is placed too soon, the infectious bacteria still residing in the jaw bone and tissue will take over the graft and the infection will become more virulent. This may be what is happening with your case.

Did you see a general dentist or an oral surgeon for the extractions?
FYI... Your oral surgery should have been done by an oral surgeon due to the longevity and severity of the infection because these are the dentists who are the most knowledgeable and experienced in dealing with cases such as yours. If you went to a general dentist for the extractions, it is still best to see an oral surgeon for the existing situation. If you choose to see the oral surgeon, it is important to bring your pre operative xrays to that appointment.

I'm sorry you are enduring such pain and complications. I really hope you get the proper help you need to take care of this. Please keep us posted.

Bryanna

Thanks so much for your thoughts. MY dentist, I sought out soecifically for his surgical experience and holisimtic knowledge of these situations. He ensures me he debrided all the infection, (as I asked about waiting on the bone graft). Yet he also mentioned "preserving as much bone as possible" which makes me wonder if he realllllly got it all.

Its going to be my concerns vs his certainty I think. I think this is infection, maybe with a dash of dry socket. My concern is he'll just treat dry socket and send me off to have an infection explode as aoon as my ammox run is over (two days left).

Should I insist on removing the graft? Is there a way to locally treat the graft
For infection without removal? Ugh. He is two hours away, I guess I might have to settle for someone closer but without holistic angle if Ill need more and nore appts. (There are non around here)

Ugh, Ill keep you posted. Thanks so much for your reply. Are there any "key" differences that coukd prove infe tion vs just dry socket?

QUOTE=Bryanna;1132797]Hi annanut,

Thank you for posting the picture.

Yes, it appears that you have an infection. Based on your description of the history of these teeth, the infection that was brewing in your jaw bone was severe. Therefore, removing the teeth was the first step in a process of removing the infection and healing. The jaw bone area needed to be thoroughly debrided of all visibly diseased tissue and bone once the teeth were removed. The bone graft should have only been placed if after the debridement the existing bone was found to be healthy. Otherwise, the sites should have been debrided, irrigated with saline, sutured and left to heal for a few weeks or so before a second surgery was done to place graft material.

When a surgical site of an infected root canaled tooth is not thoroughly debrided and the bone graft is placed too soon, the infectious bacteria still residing in the jaw bone and tissue will take over the graft and the infection will become more virulent. This may be what is happening with your case.

Did you see a general dentist or an oral surgeon for the extractions?
FYI... Your oral surgery should have been done by an oral surgeon due to the longevity and severity of the infection because these are the dentists who are the most knowledgeable and experienced in dealing with cases such as yours. If you went to a general dentist for the extractions, it is still best to see an oral surgeon for the existing situation. If you choose to see the oral surgeon, it is important to bring your pre operative xrays to that appointment.

I'm sorry you are enduring such pain and complications. I really hope you get the proper help you need to take care of this. Please keep us posted.

Bryanna[/QUOTE]

Hi annanut,

I understand the dilemma that you have. Is he a Biological Dentist or Holistic Dentist? Generally these dentists are well versed in the need to thoroughly debride the oral socket after the tooth is removed. However, I do have some concern that he may have been too conservative with the debridement as his priority may have been to preserve the bone..... which is okay in many circumstances but at the very same time diseased bone cannot be preserved. He may have rushed into placing the graft and again some dentists do that so the patient does not have to come back for a second surgery. The problem again lies with the fact that a bone graft cannot integrate with diseased bone. So the real priority is to be as certain as possible that the bone was scraped clear of visible disease.

If you developed a dry socket with the bone graft in place then that indicates that the blood clot was either dislodged or did not form properly. Again indicating that the socket may not have been "ready" to receive the graft. The bone graft will not heal the socket if it is infected and the graft will not integrate with diseased bone.

So you need to have the site clinically evaluated along with an xray to see if the graft is still present. A healthy bony socket with a bone graft takes months to heal and up to one full year for the graft to integrate completely with your own bone. If infection in present then the site will not heal properly, new bone will not grow enough to allow the graft to integrate with the jaw bone.

Bryanna




[/QUOTE]

Thank you. Well bio dentist but, I also just found out they do root canals there so… there's that.

So - he took an xray and it seems the graft material is still in the sockets. I lost a lot from the top but apparently he isn't concerned. He also said it looks okay. I thoroughly disagree. It is very red and swollen compared to 1-3 or 4 days after surgery (the gums). Swelling went down, and now is on the rise again. He had no answer for that. He also said he couldn't see any reason for my having ACUTE pain. Obviously this concerns me. Were I just having discomfort or even significant pain that I thought were part of the healing process I'd not have called. I'm not a worrying type, and my threshold for pain is pretty high.

So, no stiches, no packing, no nothing just rinsed me out and wrote a script for stronger antibiotics (even though he doesn't think it's infected)?? and vicodin for the pain he can't find the cause of. I am very disheartened. I looked so hard to find what I thought was to be a good oral surgeon/dentist. This is supposed to be a specialty.

Also, I am concerned about the adjacent tooth. I can SEE IT ALL THE WAY down into my gums. There was a large cut along the gum there, (top to bottom) and now it's is so wide, I'd say nearly 1/8 inch, and I can see exposed tooth. I asked if that was the sensitivity / nerve pain I felt when I drank water etc and he said no. That also seems to make no sense! ANd, since it's getting bigger and wider instead of healing/getting closer isn't that bad?

He just left it all as is. He gave it a rinse and some ozonated olive oil. That's it. I was hoping for some kind of packing or stitches or something. I realize it has to heal and with a huge hole you don't' want to close it up, but it seems at least along the tooth he could do something?

Should I try to quickly find a second opinion? There are zero bio dentists around here, but I'm wounding if just a reputable traditional one might be worthy.

Also, how would we know if the bone graft is infected? Pain, (check), swelling (check) … other? It looked fine on digital X-ray, but I don't think infection shows up that quickly. How do I ask someone to check? If it is infected… I just want it out. I don't want to take all these antibiotics to only have it RAGE back at me and have to battle again. Does that make sense ? I feel like I should get an opinion like, tomorrow before I even start taking next round of antibiotics.

I might be overreacting. I'm just not impressed with this visit at all. ANd it's a 2.5 hour drive!

THNK YOU for any further help.


I understand the dilemma that you have. Is he a Biological Dentist or Holistic Dentist? Generally these dentists are well versed in the need to thoroughly debride the oral socket after the tooth is removed. However, I do have some concern that he may have been too conservative with the debridement as his priority may have been to preserve the bone..... which is okay in many circumstances but at the very same time diseased bone cannot be preserved. He may have rushed into placing the graft and again some dentists do that so the patient does not have to come back for a second surgery. The problem again lies with the fact that a bone graft cannot integrate with diseased bone. So the real priority is to be as certain as possible that the bone was scraped clear of visible disease.

If you developed a dry socket with the bone graft in place then that indicates that the blood clot was either dislodged or did not form properly. Again indicating that the socket may not have been "ready" to receive the graft. The bone graft will not heal the socket if it is infected and the graft will not integrate with diseased bone.

So you need to have the site clinically evaluated along with an xray to see if the graft is still present. A healthy bony socket with a bone graft takes months to heal and up to one full year for the graft to integrate completely with your own bone. If infection in present then the site will not heal properly, new bone will not grow enough to allow the graft to integrate with the jaw bone.

Bryanna




[/QUOTE][/QUOTE]

Hi annanut,

Is the biological dentist specifically an oral surgeon or is he a general dentist who does extractions? There is a difference in their education, their knowledge and their experience.

Also, some dentists will call themselves holistic or biological and still condone root canal therapy. When a dental professional makes the effort to learn above and beyond their traditional dental school curriculum and delves into whole body (holistic or biological) dentistry, a major aspect of that education includes the indisputable facts about the systemic risks and short comings of root canal therapy. For that individual to then turn around and perform the root canal procedure is a strong contradiction of the additional education that they have elected to learn. Unfortunately, there are plenty of dentists who market themselves as holistic or biological and are truly not much different than a traditional dentist. I think you may have stumbled upon one of those dentists.

Once a bone graft material is placed in a tooth socket, it is not held in the socket by anything other than the blood clot and possibly a collagen plug or membrane. In my professional experience as an oral surgery chair side assistant, during the early stage of healing, it is never wise to put anything into that socket or irrigate that socket with anything as it can cause bacteria to be pushed into the graft material. I am confused as to what he has done and why he has done it. So I cannot really comment on what he hopes to achieve.

The xray may have shown some of the graft still being present. Which would be a good sign if you were not experiencing so many symptoms. Also the slice of gum tissue that you write about exposing the other tooth... this sounds to me like he made a deliberate incision to gain more access to the bone so he could remove the tooth next to this one. This is commonly done. However, that slice of tissue should be coming together at this point, not getting wider. It sounds like their is so much inflammation that the incision cannot close. Also, I would think that you would have pain in that area when you drank something because the opening of that incision exposes the root of that tooth. I am puzzled as to why he did not explain that to you.

I can only offer you the information that I have and not really anything further because it sounds like it is getting worse not better and it seems like he is basically dismissing the obvious irritation, etc. I think the surgical areas should be evaluated by an oral surgeon, not another general dentist.

Bryanna




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