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!

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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




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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




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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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I agree.
I thought I had found a real bio dentist, but I agree that knowing about root canal (being instant beginnings of infection -I have read the research/price/etc) is not consistent with a try biological dentist. he is a "DDS" but performs many surgeries and has for many years. Supposedly this is a specialty. That's the only reason I'd drive 2.5 hours forhtis, knowing that follow ups and so forth would be challenging. I value my health above all else!!! But… this I think is proving to be a waste anyway. SO disappointed. I have so many other health issues that I was really hoping this would go smoothly AND that getting rid of long low grade infection would possibly eliminate some of my immune/ health issues .

I also found it odd that he was not understanding the pain associated with the exposed tooth. I too understand why he exposed it, but not why he isn't concerned that it's a widening gap, and hurting immensely! To 'not know' why I'm feeling extreme pain when I myself, not being an expert or having the best view has a pretty good idea seems not good.

I just picked up scripts for stronger antibiotics which I guess I'll start in the morning - but I think I will also try to get a second opinion locally about all this too. I know locally they won't be a bio dentist/surgeon, but sounds like this guy probably isn't either. He spoke a lot about holistic health etc. but I still felt like in the end I knew more than him just from researching on my own so maybe he's just sort of a "line feeder' about it and it's a marketing thing.

I went to another bio dentist - they only other in driving distance and I merely had mercury extractions and it was SO terrible a job that I couldn't go back. I was scheduled with the newest staff member, and by new I think… not yet versed in how to do a filling. They then scheduled me for that person for the double extraction! So I had to run!

Well, back to traditional I guess. I will hope it goes well. At this point it's not about mercury sensitivity (which I have, swell as nervous system issues etc…) but more about infection and healing. I can only hope a traditional oral surgeon is well versed in that.

I'll try to get into someone in the next few days for a second opinion and will let you know how it goes. I am going broke, but want to resolve this fast.

I am worried the antibiotic will put off the inevitable (infected bone graft) but it sounds like there is no way to know unless it totally fails and infection reigns.

Question: Should I NOT take the new stronger antibiotics and see if the infection reigns to prove there is one? OR should I take it and really try to battle any existing infection… meaning - will antibiotics actually have effect on a bone graft infection? or is it possible the infection is only in the gums and the antibiotic can help eradicate it?

I am not sure how to proceeded in the time between seeing another doc for 2nd opinion. (and I know drs don't like jumping into th emiddle of another persons work either, but I'm hopeful they'll at least look).

thanks again. I'm hoping I won't bug you with more questions!!! You have been SO helpful I really appreciate a second opinion!!!



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Hi annanut,

A DDS (Doctor of Dental Surgery) or DMD (Doctor of Dental Medicine) degree is not an oral surgeon degree. Both degrees indicate someone has graduated from a dental school as a general dentist. They both mean the same thing just different schools give out one or the other. An oral surgeon continues in school for another 3-6 years in the oral surgery curriculum and then usually does a couple of years interning as an oral surgeon before they go out on their own. If they go the six years they often earn a medical degree and have MD as well as the DDS or DMD.

The dentist that extracted your teeth, may advertise that he performs oral surgery (without a specialty license number) but may not actually be an oral surgeon. He may have taken some additional courses or studied under another dentist who teaches specific oral surgery techniques. Neither of which make him an oral surgeon.

In my lengthy career, I have worked with or known of a handful of general dentists who were excellent with oral surgery. But in my professional opinion, that is a rare find amongst the general dentist population.

Also I just want to make clear that I am a huge advocate for Biological dentistry much more so than traditional dentistry. I worked in that field for many years with 3 very knowledgeable and highly skilled dentists. That is the dental field that I personally use. But there are good and not so good in every profession. So please don't become discouraged about the Biological field because of this dental group that you have been associated with.

Regarding the use of antibiotics... these meds are only meant to be taken when absolutely necessary. They should not be prescribed or taken carelessly as they can wreak havoc on your immune system. Anyone in a compromised state of health, needs to be certain that they require any medication, including antibiotics, before taking them. In your case, you still don't know if or what is infected which means that depending on that diagnosis, oral antibiotics may or may not be necessary or they may not be efficient in eradicating the infection. You stated that you have a negative intestinal reaction to antibiotics in spite of taking a probiotic which means that your gut flora is already unbalanced. Therefore, an oral antibiotic can actually cause an intestinal infection. So in my opinion it is imperative to find out what is going on with your mouth before you embark on another round of antibiotics.

Re the probiotics..... you may have to change the probiotics you are taking and take more of it for several weeks and then taper down to the recommended dosage indefinitely. Most people require a probiotic supplement every day of their life. It actually helps to continuously replenish the good bacteria that is lost to chronic of acute illness, stress and poor eating habits.

What probiotic are you taking?

Also, if you are comfortable in sending me a personal message as to your location.... does not need to be exact just in the vicinity of where you will travel to for a dentist... and also give me the dentist name of who you have seen so I can look into what he really does ... I may be able to do some research for you and find someone for you to try.

Bryanna




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Thanks Bryanna for describing the difference in degrees. I will PM you (when I get on my computer-little confusing on here via phone!)

I am calling around today to see if I can get into a surgeon locally just to look at this. Im not sure what is the right/wrong thing to do from there. Just like another pair of eyes on it.

I wont start new antibiotics yet. All the reasons you embtion is why I hesitate. I rately ever take them/it been 10 years or so, but figured this was a worthy cause to prvent infection. But dont like the idea of more stronger ones unless the source of infection is ID'd, (and treated as needed first other than antibiotics if possible!)

I am not down on Bio dentistry....but this is an i dication we need BETTER and MORE of it. I cant find anyone else even within a very long drive. :-( which doesnt make the most sense if I need followup care. I feel like I need a person local and maybe a bio far away. I even thought about going to Nunnaly in TX for vacation and having work done!

had one last question. Since the "extra" bone graft fluff that was to the gills previously is gone, and gums are open... Will whatever I eat and srink just get absorbed into the graft (and real bone?) like there is no barrier at all. The hole is deep and while the graft still
Looked i tact on Xray, who knows if its going to be full of chicken soup? I only see white inside the "void" no blood clot etc.


[/QUOTE][/QUOTE]

Hi annanut,

Yes, PM me with some locations and I will see what I can find for you. I can review professional websites and usually decipher between BS and reality.

The bone graft material is put into a bloody socket of numerous cells as a means of stimulating your immune system to go through a natural bone building process. The bone graft itself does not become solid. The growth of new bone integrates with the graft material to form solid bone. So the idea is to have a healthy bloody socket with lots of healthy cells swimming around to hold onto enough bone graft material to form new bone. The more graft you lose, the less bone will form.

Everything that you eat, drink, and rinse with will enter the surgical site. It imperative to not eat near the surgical wounds to avoid food impaction and to be mindful of drinking so as to avoid disturbing that area as much as possible. Avoid using a straw as the sucking motion can dislodge the graft. Drink normal but refrain from anything other than water as sugary drinks, spicy drinks, and caffeinated drinks will irritate the oral tissue and can disturb the healing cells. Rinsing gently with warm salt water 3-4 times a day keeps bacteria down and is therapeutic for healing. Avoid alcohol and mouthwash altogether. Both of which reduce the production of saliva and slow down the healing process. If the graft and blood clot have not married (combined properly) then the end result will be bone loss, not bone growth.

The white inside of the socket can be food debris, pus or normal tissue. Do not try to dig in there with anything to remove it. The clot does not stay red as it mixes with the graft and cells, etc.

Bryanna




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