I am new here. I hope somebody can help.
I have had facial pain for years. Ct scans don't show anything wrong with sinuses. Had an ICAT years ago. Showed a moth like appearance of the bone over #3 tooth which had caused me pain 10 years ago and was suspected to have a small, but not visible on xray, crack. Had a root canal on it. Over all the years it hurt when wiggled and at times caused more significant pain. Especially during a bout of facial pain. My integrative MD has urged me to get it out. Says it isn't helping my health to have a dead tooth causing me pain.

Finally after much fear I did so. I have chronic Lyme disease and my body doesn't tend to respond well to any trauma or inflammation. I saw the biological oral surgeon both my integrative doctor and my biological dentist recommended.
I had seen him for a consult years ago to review the ICAT and he said extracting the tooth was up to me. Didn't recommend it one way or another.
So, 5 days ago he numbed me up. I didn't want general. I process the numbing agent quick so I must of had 12 injections. He pulled the tooth. And three roots. And removed the peridontal ligament. He then said the bone was infected all the way to the sinus. He said he scrapped away the dead bone. He had also taken my blood to use it for something called L-PRF platlet therapy. He inserted that. Then he put in cadaver bone and more of my platlets from the L-PRF. He then injected the area with ozone and a homeopathic remedy that's supposed to help with healing. He then stitched me up. He have me an rx for pain medication and for a ZPak. This was 5 days ago.
I am in severe pain! I went back to see him yesterday. No dry socket. Everything looks fine. Said pain is the healing process. My stitches were not dissolving and they were causing me pain. He removed them. There was a tiny ulcer next to them.
I also bleed every morning when I wake up. Blood that coagulates I guess with nighttime phlem build up. This phlem is dark red. My spit is not as dark blood. Once up the bleeding seems to stop. But every morning I spit blood. He said the bleeding is good. Means no dry socket. HOW could the bleeding be a good sign?

I have pounding pain all in the right side of my face. It feels like the bones are pounding in pain. I am sure they are! The bone at the top of the gum line is so tender it's unreal. If I run my finger along it, it feels like the most intense pain. Like it's bruised and just destroyed. There is also intense tenderness when I press on the bones in the right side of my face. Even away from where the extraction was. I also have a lot of pain inside the socket. I feel like my cheek is swollen like a chipmunk but it doesn't appear so. I don't have a fever.
He says all is fine but the pain is so bad. I don't like pain Meds. I take two Tylenol at bedtime but by 6am I wake with pounding pounding pain in the bones. Hurts so bad I cry.
I don't think this is a normal part of the healing process!
Can you please advise me on what to do? Is this normal given what I had done? What should I do? What do you think! I am worried this surgeon is a quack who doesn't know what he is talking about. He went to UCDavis and UCLA and has been doing this 30 years, but is into alternative stuff and I am worried he is just making things up he is telling me so I don't think he caused me any problems. Thank you very much.

I would think at only 5 days out for such invasive work that was done, a stronger pain med than Tylenol would be needed.
I don't know about the procedure or the healing process time frame, but it sounds fairly intense so that a Rx pain med would be needed for a week or 2 at least..

I hope you find some answers and pain resolves soon..

* An independent second opinion would be my thought , someone that can visually check it out in person..*

Hi there,
I can not give you any medical advice on this (but I am sure Bryanna, who is VERY experienced and knowledgable will get back to you), but I can share that I was in a similar situation a few months back:
I had a root canal done that fractured, causing pain on and off, but finally the infection got to the point of my cheek swelling, and my holistic dentist advised me to remove the tooth, which I had done by a holistic Oral surgeon.
I was in so much pain for about 2 weeks after the extraction, and was SURE I had dry socket or some kind of infection. But, the surgeon looked at it, took x-rays and said, it looked like it was healing perfectly fine, in fact, my gum looked very nice. After that, when the pain would not let up, I went to another dentist, just to get a second opinion for my peace of mind. Again, this dentist said everything looks wonderful and normal. Then, one day, all discomfort just vanished- and all post-surgery x-rays and exams showed, that all healed well. I have Hashimoto's, and also have trouble with healing and infections, so maybe this is related? And, I also dislike pain meds and only took tylenol once a day during that period, but it did not really help me.
So, this is just my personal experience with it, but since your extraction has just been a few days ago, pain might just be "normal".
But let's see if Bryanna gives an answer soon, ** ;-).
Wish you a speedy recovery!

Thank you for th replies. Yes, I hope Bryanna will chime in here. She seems very knowledgable.
The surgeon did rx me pain killers. It's just that medications all irritate my bladder as I have interstitial cystitis. Tonight i will take the narcotic though.

There is bone pain and then there is pain that feels like it's in the socket itself.
I am pretty scared and discouraged.
BRYANNA- any thoughts?

There is bone pain and then there is pain that feels like it's in the socket itself.
...That is how I described my pain to my surgeon: it felt like deep down in the bone, and at the same time also like an infection-kind-of pain in the socket itself. I hope you find answers soon, as I know how debilitating such pain can be. Hang in there!

Hi peaceplease,

Based on your description it sounds like the tooth infection had spread to the sinus and deeply into the jaw bone which evidently resulted in deterioration of the bone. When this occurs, the pieces of diseased jaw bone crumble when the tooth is extracted. Most often the area that suffered the most bone loss occurs along the bony ridge. So that could explain the pain that you feel along that ridge when you touch it. I would suggest to stop touching it as it is very fragile and possibly splintered so it should not be disturbed while it is healing. BTW... this bone will take 6-12 months to mend. So this may stay tender for a long time... not painful, but tender. The jaw bone itself will not grown back along the ridge but the portion of the ridge that is left will fuse together over time. The bone graft material will not replace this bony ridge, as that is meant to encourage new bone growth to fill in the socket or hole in the bone where the roots were.

When the sinus is involved with a long term tooth infection, the recovery of the tooth extraction can be difficult and a bit lengthy. It sounds like he tried to take measures to encourage your immune system to get busy dealing with this. However, placing the bone graft at the time of the extraction was a little risky in that the graft may not be taking so well due to the infection. It sounds like he tried to remove as much disease as he could visibly see and feel with the instruments and injecting your own blood platelets is an attempt to encourage immune cells to prevent the graft from becoming infected. But sometimes the site is too infected with bacteria and the graft is just too much of a burden at that time. So the graft needs to be monitored with single periapical xrays from time to time. The ulcer that formed is secondary to the infection and is most likely a result of friction and trauma. If you develop more than just one or two of those ulcers than it could be a herpes outbreak and your dentist should be made aware of that... if that occurs.

The dark red blood upon awakening..... do you feel this is coming from your extraction site or your sinus... or your throat? Has this decreased at all in the last day or so? What is your oral hygiene regimen and what are you rinsing with? Are you taking any nutritional supplements, homeopathics, or probiotics?

Bryanna:
I would rather die than have this pain 6-12 months. I KNEW I should NEVER have gotten the tooth extracted given my underlying health issues. I have chronic lyme and any inflammation cascades for me and my nervous system goes into overdrive.
What you are describing sounds like a night mare.
I saw my Integrative MD today. He did a thermograph on me and there weren't any areas that lite up a lot indicating active infection, but who knows.
The blood I have in the morning is front he phlegm that I clear from the back of my throat. It is phlegm that sits there all night and I guess the blood is coagulating with it and turning dark. This morning I seemed to have less blood.
My MD thinks all my pain is nerve related. He said that while the blood platelets are good, they can overstimulate things and for somebody like me, that can be problematic. I asked my general dentist about placing the grapht right after extraction in light of the infection and she said that with the platelets and the fact that he took it down to bleeding bone, it is fine.

I no longer know what to think. ALL I know is that the pain I am in now is HELL compared to any facial pain I ever experienced in the past.
1. Do you think I even did the right thing by extracting the tooth?
2. Should I see somebody else and have the grapht removed and put in at a later time?
3. Are you saying that I have an active infection in my bones still? My GREATEST FEAR. Please be honest.
4. The pain is pinpoint to where the upper jaw bone comes down and stops right near the center of the cheek. It is a pinpoint, intense pain! That ridge of bone that I was saying in the upper gum line just below this area also is the most sore. This area is about 1-2 teeth down from the extraction site.
5. Should I see my ENT?
6. Should I have a CT Scan?
7. Should I have an ICAT?
8. Would cold laser help with any of this pain?
9. Most important. How can it be imaged/diagnosed if the bone has fragmented?
Thank you. In tears right now from the pain!

Hi peaceplease,

Let me clarify, my statement about the bone healing over the course of 6-12 months does not mean you will be in pain that entire time. The pain should be subsiding with each day and in a short time you should feel nothing as the healing is symptom free.

Also to clarify, it was best for your health to remove this tooth because the infection was feeding the bacteria of your lymes disease so it was a constant burden on your immune system. The real problem in all honesty is that the tooth should have been removed much sooner because in doing so that may have prevented the infection from spreading to the sinus. So you did the correct thing in extracting it but because the bacteria had time to spread, now you have a more complicated recovery.

The blood in the morning is mixed with phlegm. Do you think the blood is coming from your extraction site or your sinus? Glad to hear it has lessened.

Glad to hear that you are seeing an Integrative physician. However, he is really not knowledgeable about tooth related problems so he can only give you his opinion based on instinct. I agree with him in that the blood platelets, although good, have overstimulated your immune system. What is he suggesting that you do to try and balance things out?

Your questions, followed by my answers in bold type.

1. Do you think I even did the right thing by extracting the tooth?
YES, MOST DEFINITELY TAKING OUT THE TOOTH WAS THE BEST THING TO DO. I AM NOT SO CONVINCED ABOUT THE BONE GRAFTING BUT THAT WAS WHAT YOUR ORAL SURGEON THOUGHT WAS BEST AND HE HAD A CLEAR VIEW OF WHAT WAS PRESENT AT THE TIME OF THE SURGERY.

2. Should I see somebody else and have the grapht removed and put in at a later time?
YOU SHOULD HAVE THE ORAL SURGEON WHO DID THE EXTRACTION AND GRAFTING TAKE PERIODIC XRAYS AND A POSSIBLE SCAN TO GET A RADIOLOGICAL VIEW OF THAT AREA AS IT IS HEALING TO RULE OUT PATHOLOGY SUCH AS OSTEOMYELITIS. WHICH CAN OCCUR EVEN WEEKS OR MONTHS DOWN THE ROAD... NOT JUST WITH YOUR CASE BUT WITH ANY ORAL SURGERY TO REMOVE ROOT CANALED OR INFECTED TEETH. THIS IS WHY MONITORING IT IS IMPERATIVE.

3. Are you saying that I have an active infection in my bones still? My GREATEST FEAR. Please be honest.
I HAVE NO IDEA. YOU HAVE A COMPROMISED IMMUNE SYSTEM DUE TO LYMES. YOU HAD A SEVERELY INFECTED TOOTH IN YOUR JAWBONE FOR YEARS. AS YOU KNOW WITH LYMES, IT CAN BE DIFFICULT TO COMPLETELY ERADICATE AN INFECTION ONCE IT HAS SETTLED IN. THE SAME HOLDS TRUE FOR INFECTED TEETH. SO CLINICAL AND RADIOGRAPHIC MONITORING OF THE AREA IS NECESSARY TO DETERMINE IF PATHOLOGY IS PRESENT.

4. The pain is pinpoint to where the upper jaw bone comes down and stops right near the center of the cheek. It is a pinpoint, intense pain! That ridge of bone that I was saying in the upper gum line just below this area also is the most sore. This area is about 1-2 teeth down from the extraction site.
THIS PAIN CAN BE DUE TO ANY NUMBER OF REASONS.... PATHOLOGY, NEW BONE GROWTH, ETC. IT NEEDS TO BE EVALUATED CLINICALLY AND RADIOGRAPHICALLY.

5. Should I see my ENT?
YOU CAN TO RULE OUT SINUS COMMUNICATION. SINUS SCANS DONE IN MULTIPLE SLICES IS BETTER THAN ROUTINE SINUS XRAYS.

6. Should I have a CT Scan?
IF YOU DO, IT SHOULD BE SPECIFICALLY A DENTAL/SINUS CT SCAN AND NOT JUST A CT OF YOUR HEAD. AN ORAL SURGEON OR ENT COULD RX THAT FOR YOU.

7. Should I have an ICAT?
YOU CAN. IT IS BEST TO DISCUSS THIS WITH THE ORAL SURGEON.

8. Would cold laser help with any of this pain?
IT COULD SO LONG AS THE PAIN IS NOT CAUSED BY INFECTION.

9. Most important. How can it be imaged/diagnosed if the bone has fragmented?
THE FRAGMENTATION IS IRRELEVANT WHEN IT COMES TO SCANNING. THE BONE HAS BEEN TRAUMATIZED BY THE LONG STANDING INFECTION AND THE ORAL SURGERY. YOUR IMMUNE SYSTEM IS SENDING CELLS TO PIECE THE BONE TOGETHER JUST AS IT WOULD IF YOU HAD A FRACTURED OR SPLINTERED BONE ANYPLACE ELSE IN THE BODY.

I know this is a horrible situation for you and the pain is just too much to bear every day. I understand. But I cannot tell you what is specifically wrong. People who are unwell generally have post op complications and their pain can be different than with those who are healthy. What is your instinct right now.... do you feel any improvement... if so, how and where?

Bryanna
Thank you for your reply.
I woke up at 3am, after the narcotic wore off with the WORST pain of my life. Felt like a screw was being drilled into my cheek bone and up into the socket on raw nerve. I took two Advil which seems to work better than narcotics and doesn't make me want to throw up. It helped with the pain, but I can't keep taking NSAIDs or I will get stomach issues.

What should I be asking him to do at this point?
I had little to no blood this morning. More just slightly brownish colored spit at first, but no dark blood and no pink spit.
1.Is this a good sign?
2. I just spoke to the surgeon. He said that he just scraped out the alveolar bone, not the jaw bone and he didn't use anything that would have caused the jaw bone to crumble. He doesn't feel this is likely or even possible from the work he did. He said that he is happy to take the bone grafting out and give me back my money, but he thinks this will make me worse, not better.
3. He thinks my bite may be off now that the tooth is missing and that I should get the bite adjusted. He says it could be part of the problem.
4. He said to take muscle relaxers.
5. He said he would see me on the weekend.
6. He said that the jaw bone is infected, but usually they don't cause symptoms. He doubts this is the source of the pain in my cheek.
7. In all your expertise, what is of the upmost priority to do? Should I get the grapht out? Is that best? Should I get the bite adjusted? Should I do a CT Scan of the sinuses or an ICAT? Which is better?

I AM SO FRUSTRATED, I would rather die than wake in the middle of the night to the pain I had last night.

Peaceplease,

I am going to repost some of your post and reply in bold type to clarify some things.

<<Felt like a screw was being drilled into my cheek bone and up into the socket on raw nerve. >>
THIS SHOULD NOT BE HAPPENING. MAY INDICATE INFECTION IN THE BONE, EVEN PERHAPS OSTEOMYELITIS. I AM NOT SAYING THAT IS DEFINITIVELY WHAT YOU HAVE GOING ON BUT IT IS POSSIBLE.

<<I had little to no blood this morning. More just slightly brownish colored spit at first, but no dark blood and no pink spit.>>
I DON'T KNOW WHY HAVE DISCOLORED SPIT IN THE MORNING UNLESS SOMETHING IS DRAINING FROM SOMEPLACE. TOOTH SOCKET.... SINUS?? YOUR ORAL SURGEON SHOULD BE EVALUATING THIS.

<<2. I just spoke to the surgeon. He said that he just scraped out the alveolar bone, not the jaw bone and he didn't use anything that would have caused the jaw bone to crumble. He doesn't feel this is likely or even possible from the work he did. He said that he is happy to take the bone grafting out and give me back my money, but he thinks this will make me worse, not better.>>

THE ALVEOLAR BONE IS THE PORTION OF THE "JAWBONE" THAT ANCHORS THE TEETH IN THE MOUTH. THE ALVEOLAR BONE IS THE AREA OF THE JAWBONE THAT CRUMBLES/DETERIORATES FROM INFECTION RESULTING IN BONE LOSS. IT IS ALSO THE AREA OF THE JAWBONE THAT RECEDES WHEN TEETH ARE EXTRACTED RESULTING IN BONE LOSS.
HE DID NOT CAUSE YOUR BONE TO CRUMBLE. THE INFECTION CAUSED YOUR BONE TO BECOME DISEASED AND FRAGILE WHICH RESULTS IN CRUMBLING OR DETERIORATION OF THE BONE. THE BONY RIDGE ALONG THE FRONT PORTION NEXT TO THE CHEEK IS USUALLY THE AREA THAT DETERIORATES THE WORSE AND IT IS NON REPLACEABLE. THAT IS WHAT I WAS MENTIONED TO YOU PREVIOUSLY.

<<3. He thinks my bite may be off now that the tooth is missing and that I should get the bite adjusted. He says it could be part of the problem.>>

I AGREE, YOUR BITE IS PROBABLY OFF AND YOU MIGHT EVEN BE CLENCHING OR GRINDING YOUR TEETH. THIS WOULD CAUSE OR CONTRIBUTE TO JAW PAIN, EVEN SHOOTING JAW PAIN.

<<4. He said to take muscle relaxers.>>

TAKE MEDS WITHOUT SEEING YOU TO EVALUATE THE SITE CLINICALLY OR RADIOGRAPHICALLY??

<<5. He said he would see me on the weekend.>>

THAT'S NICE OF HIM.

<<6. He said that the jaw bone is infected, but usually they don't cause symptoms. He doubts this is the source of the pain in my cheek.>>

OKAY SO HE ADMITS THAT THE "JAWBONE" IS INFECTED! ASK HIM IF IT COULD BE OSTEOMYELITIS AS THAT DOES OFTEN CAUSE PAIN.

<<7. In all your expertise, what is of the upmost priority to do?>>

GET THE ORAL SURGEON TO EVALUATE THE SITE AND TAKE A RADIO GRAPH TO CHECK FOR PATHOLOGY. THEN DEPENDING ON THOSE FINDINGS, HAVE A DENTAL CT SCAN DONE.

<< Should I get the grapht out? Is that best?>>

YOU SHOULD HAVE THE GRAFT REMOVED IF THE SITE IS INFECTED AND NOT IMPROVING AND/OR YOU HAVE OSTEOMYELITIS.

<< Should I get the bite adjusted?>>

THE BITE ADJUSTMENT MIGHT HELP SO LONG AS THEIR IN NO BREWING INFECTION OR OSTEOMYELITIS.

<< Should I do a CT Scan of the sinuses or an ICAT? Which is better?>

YOU SHOULD ASK THE ORAL SURGEON WHICH HE FEELS IS BEST TO DETERMINE THE PATHOLOGY GOING ON IN THE "JAWBONE".

<<I AM SO FRUSTRATED,>>

I THINK YOU NEED TO BE A BIT MORE ASSERTIVE WITH THIS AND GET THE ORAL SURGEON TO CLINICALLY AND RADIO GRAPHICALLY EVALUATE THIS.

No one can just guess or assume what is going on. You are in a lot of pain and that needs to be diagnosed.