[nabber]

Hey all and especially the queen of helpfulness Bryanna. I am kinda worried and I would love some feedback on my case. I am 34 years old, otherwise in perfect health and I had my right lower molar extracted 3.5 weeks ago (upcoming Friday will be the 4th week). It was nearly horizontally impacted. The procedure took around 30 mins, didn't feel a thing, but some bone was needed to be removed my dr said.
First two days i was a bit swollen, the usual cheek swell, but that subsided pretty much. I had some trismus, but was recovering.

My issue is that 1 week ago, that swell that I had turned to a little lump (like the size of a nickle wide, more like a hard pad on my cheek than a lump) that I could feel, went to the doctor, she said she can't see anything suspicious, but she could feel the lump, maybe on the masseter she said, so she put me on amoxil 500mg 3 times a day for 8 days. She added that she doesn't feel the lump to be filled with puss, plus she poked around my socket and said no puss coming out and everything was fine looking.

Anyhow, today, after 8 days of Amoxil, the lump is gone, I feel much better, trismus is minimal, only issue is that the center of that "lump" is still bit tender to touch, but I am afraid from all the stories I read that this my recovery istemporary and that I need to have my would reopened to clean up any infection. Should I visit another dentist? Should I stop worrying that it will swell again and wait to see if it actually does? Should I take a preemptive X-ray just to be sure? Please advice, I am scared, it could be from osteomyelitis developing to sub masseter abssess to I don't know what else!

PS: Recovery was fine, doctor removed my stitches on 5th day later after surgery, 2 days earlier than expected, cause I went for checkup and she said wound was healing very good.

[Bryanna]

Hi nabber,

Thanks for the title.... queen of helpfulness

Usually when an impacted tooth is removed, some of the bone is removed as well. Also if the tooth was infected, then some bone is removed then too.

It is a good sign that the lump has gone down in size and that no pus was evident and that you feel good. The residual tenderness in the center of the remaining lump may be normal at this stage. If the tenderness and the lump does not go away completely within a week or two, then see the dentist. Of course if it gets larger or more painful, don't wait to see the dentist and yes have an xray done at that time. Ideally it should continue to dissipate and be gone in about a week or so.

Hope that helps!

[nabber]

Thanks a lot for the fast response! Well, about my comment regarding you, you have nearly a decade of reassuring people and probably saved some lives too on your free time, so yes you deserve some kind of nice comment -the least we can do.

The issue is you think it was an infection? Surgery infection or due to food collection afterwards? Socket infection or deeper within? I know it's very hard to tell, I just want your insight from experience. Plus, if it was an infection wouldn't there be pus? Could it just have been an inflammation of my muscle area due to the trismus, general soreness from the surgery and maybe me trying to open my mouth too soon? Antibiotics could have some anti-inflammatory effect to that area I suppose.

I am asking this, because I cannot really clean the socket cause its back there at the end of my mouth if u know what I mean, so I just irrigate (but not with a syringe) with salt mixed in plain tap water at room temperature 3-4 times a day.

Thanks again and be assured that I will be updating this

[Bryanna]

Hi nabber,

There is no way for me to know if it was infection but that possibility should not be ruled out. Pus is not always present or visible with infection and sometimes the pus is only present at certain stages of an infection.

At this stage of healing, rinsing 3-4 times a day with warm salt water is perfectly adequate.

Yes, an antibiotic can reduce inflammation and severity of infectious bacteria. Both of which would result in less swelling.

You can develop a swelling and tenderness from an inflamed muscle and this often takes several weeks to completely subside. Especially if the muscle is used often as in chewing, speaking.... etc.

Your current symptoms are all positive signs of healing. So unless something changes for the worse and if the area becomes less tender and smaller... it's probably fine.

Yes, I have been on this site for almost a decade.... and only 3 decades in the actual field!! )

[nabber]

Hey,

I am back. So it's been 4 days after I stopped the antibiotics and I feel a bit worse. I have a small pain when swallowing and the little lump is still very little but its there. So, I went to the dentist and the findings were:

1) My socket seems to be healing fine.

2) she said that my swallowing pain is due to a small bony fragment left, that might need to be opened up and cleared, but she said it usually reforms on its own, so its better to wait. She touched that fragment and it was the pain I feel during the swallow, so I guess that's it.

3) She felt the lump, it was much smaller but still there, so she insisted that we take a panoramic x-ray, which I went ahead and did. She took a brief look at it and said it doesn't seem to be any abscess etc from any tooth, but she ll look into detail through the weekend and I have an appointment Monday.

The issue is i have developed a low grade fever (~99.5F/37.5C) and I don't feel that good, and I feel the general area a bit fuzzy/buzzy, minor pains now and then, but no apparent swelling. What is your suggestion? Should I rush to the ER? I am afraid...

[nabber]

Hey, weekend was alrite, I didn't have to go to the ER, my fear was bigger than my fever. I was getting cold/hot flashes and a lot of worry of what might be happening to me, no fever above 37.5C. Anyhow, she saw me again today, the lump doesn't seem to be a lump anymore, and its less tender when she touched it. We saw the x-ray together, show no signs of infection, abscess etc.

Her opinion is to take muscle relaxants for one more week and if I still feel that swollen thing on my face (it's a feeling I got, its not really swollen anymore, maybe VERY little compared to the other side) she will open my gum or take liquid sample off it to see what it is. She thinks that if it is an infection it will grow again, if not, its a muscle spasm cause its at a point between my jaw and my gum a lot of muscles meet she said.

So, what is your opinion in all this? Should I be worried for osteo? Its been 4.5 weeks after my surgery, won't it have appeared on the x-ray by now?

[Bryanna]

Hi nabber,

If the lump is dissipating and there are no clinical or radio graphic signs of infection, then it may be best to wait it out a few more weeks. If the lump reappears, you get swollen, develop pain ... then obviously don't wait to see the dentist.

Osteomyelitis does not necessarily show symptoms at the early stages. It can be asymptomatic for a long time. So the area should be monitored with a dental xray at your cleaning appointments to monitor the progress of the healing. This way if you remain asymptomatic but something does show up radio graphically it can be treated before it turns into a bigger problem.

[BarryPoint]

Originally Posted by Bryanna

Hi nabber,

If the lump is dissipating and there are no clinical or radio graphic signs of infection, then it may be best to wait it out a few more weeks. If the lump reappears, you get swollen, develop pain ... then obviously don't wait to see the dentist.

Osteomyelitis does not necessarily show symptoms at the early stages. It can be asymptomatic for a long time. So the area should be monitored with a dental xray at your cleaning appointments to monitor the progress of the healing. This way if you remain asymptomatic but something does show up radio graphically it can be treated before it turns into a bigger problem.

Same thing here. I had a tooth removed and now there's some swelling. I'm not sure if it's an abscess or what. I hate going to the dentists. Do you think I could pop it with a sterile needle?

[Bryanna]

BarryPoint,

Please do not pop the swelling with anything... sterile or not.

It's important to keep in mind that the extracted tooth was embedded in jaw bone. So irrelevant of whether the gum is sutured or not, the bone is open where the tooth was and bacteria can easily migrate into that open area. This is not a superficial issue to mess around with.

Please see the oral surgeon to evaluate the site asap.

Bryanna

Originally Posted by BarryPoint

Same thing here. I had a tooth removed and now there's some swelling. I'm not sure if it's an abscess or what. I hate going to the dentists. Do you think I could pop it with a sterile needle?