what would an xray show? I can ask for one if needed but I would want to know why I was asking....

I have seen two dentists and spoken to the office of the one that did the extraction. No one seems particularly concerned....I don't think I can walk into an random oral surgeon at this point who is unrelated to the whole thing?

Thanks for the replies!

nukuspot,

Your wisdom teeth were much different extractions compared to the removal of this infected molar. Irrelevant of symptoms, this root canaled tooth had been infected for several years which means bacterial changes occurred in the surrounding bone over that course of time. So the healing from this surgery is going to be very different and more complicated than it was with your wisdom teeth.

It is obvious that you need to see the dentist who did the oral surgery as he is the only one who knows for certain what he found while doing the surgery and what took place during the surgery. All of the other dentists obviously do not want to get too involved because they do not want to interfere with what has been done and then be blamed for additional complications. You need to follow up with the dentist who did the surgery.

Generally the pain from a dry socket does not occur until day 3-4 post op. According to your statements, you have had pain continuously since the surgery. Even if dry socket were suspected, none of the dentists other than the one who did the surgery, is going to want to treat it for the reasons I mentioned above.

There is also very good chance that you are having TMJ problems and a very good chance that you are grinding/clenching your teeth... perhaps you just don't realize you are doing it. If that is occurring, then taking anti-inflammatory meds will temporarily subside the pain. But as you continue to clench/grind your teeth, the problem will continue. It becomes a vicious cycle.

Taking NSAIDS for an extended period of time is not a good idea because they can cause intestinal bleeding and toxicity issues to certain organs. So although it is convenient to pop a couple advils, it is not without risk of side effects. The pain definitely needs to be managed but at the same time the root cause of the pain needs to be diagnosed because the meds may just be masking the real problem. You need to see the dentist who performed the surgery.

Regarding a dental x-ray... it will show if there is abnormal pathology (infection or over growth of scar tissue) occurring in the surgical socket and bone.

Unfortunately that the the downside of traveling very far to find a IAOMT dentist who does these type of extractions. He is a 3++ hour drive each way, and I don't have the ability to drive for over 6 hours both when I'm in pain but also when I have small children. When we went up for the extraction I had to take my whole family and spend the night.

I probably was not clear about the relationship between the dentist who did my extraction and my general dentist in the big city North of me who I saw yesterday for the suture removal and follow up. They have a relationship where he does the followup and post op for the dentist who did the extraction. The dentist who did the extraction hashis office in a very strange part of the state, so most people get the work from him and the follow up from my normal dentist in the big city. so its not like I'm seeing a random person who doesn't want to get involved. The only random person I saw was my kid's dentist but I just wanted to make sure there wasn't an infection or emergency and he was close.

The main pain I am experiencing at the moment is in my ear and cheekbone on the same side as the surgery. Of course the site hurts and also my jaw but the most pain is in my ear and cheekbone.

I understand the risks of taking Motrin, I hate it. I discussed it with my ND and she said that the amount I'm using is fine for 2 weeks. I'm even using less than that, as I'm now only taking 400mg before bed and just dealing with pain during the day.

Right now as I type this the site feels not too bad but my ear really really hurts. I am wondering if you are right and it could be TMJ. I already have an appliance for TMJ that was given to me a few months ago when I was dealing with the pain before having the tooth out to see if it helps, but I find it very uncomfortable. I subconsciously take it out in my sleep. Perhaps I should try it again and see if it helps the ear pain, hopefully I can keep it in at night.

Also the pain was worse from day 3-7. It's been slightly better yesterday and today.

It's not that the other dentists would not be comfortable treating dry socket, it's just that my general dentist I saw yesterday said it was healing fine and he didn't see any sign of dry socket.

I will call on Monday if the pain is still so bad and ask for an X-ray to check for infection like you suggested. But that would still not be with the dentist who did the extraction. It was pretty clear to me that he was just doing the procedure but I would be doing all follow ups with my general dentist.

If it is TMJ what else can I do? Any other ideas other than the appliance at night which I will try? The ear pain is the worst of all the pain.

Any gutta percha left near the nerve canal would glow on xray.. It's not uncommon for an OS to clean up a mess left behind by a dentist.

Cleo,

What do you mean? I am confused. The original root canal was done 20 years ago by a family member general dentist when I was a teen.

Because of pain in the gum near that tooth starting 8 months ago and also what I know now about root canals in general after reading Price and Mening, I decided to get it extracted. All of the xrays taken (apical xray and 3d galileos) before the extraction showed no sign of infection or anything abnormal except a broken dental file. That alone made me want to get it out. There was no gutta percha visible on the scan or xray.

I drove 3.5 hours to a very highly recommended holistic dentist. I was told he was one of the few people in my state that would remove the tooth in a safe manner, that is, removing the periodontal ligament and any infected bone, down to healthy bleeding bone. Both my general dentist and my ND recommended him. They both refer all their patients to him for extractions and cavitation diagnosis/cleaning. He supposedly has people coming from other states for his extractions as well. So yes he is a general dentist but he also does oral surgery and has done for many many years. He was not the cause of the gutta percha in the socket, he found it when he extracted the tooth. He said they were small like "splinters" and that was why they were not visible on xray.

I hope that clears any misconception up. I know my story is complicated and easy to get confused!

I have been texting with him today (the guy who did the surgery.) I just sent him some photos of the extraction site to review. It's the best I can do in lieu of going up there again.

nukuspot,

Most dental xrays or scans do not pick up the infectious bacteria in the tiny canals, called dentin tubules, of a root canaled tooth unless that bacteria eroded the tooth enough to be picked up radio graphically. Just because it cannot be seen, does not meant it wasn't there. The symptoms of the gum irritation and pain are indicative of the infection that has proliferated from the root canaled tooth. This is referred to as a perio/endo abscess and is often seen with root canaled teeth.

The broken rc file and the slivers of gutta percha were all constant irritants and sources of bacteria to the tooth and the tissue they were embedded in for the entire time that tooth had been root canaled.

From a dental perspective, your case is not really complicated meaning it is fairly common to see this exact situation with root canaled teeth.

The bite appliance that you have, if it is not comfortable to wear, then don't wear it because it will only cause further irritation to the TMJ. Have your dentist refit the appliance to your new bite. It is common to have bite appliances adjusted from time to time.

I understand the professional arrangement between the surgeon and your general dentist. However, no general dentist is going to feel comfortable touching that surgical site irrelevant of dry socket or not, for concern of being blamed for post op complications. The only one who is responsible for treating post op problems is the surgeon who removed the tooth and only he or another oral surgeon should be the one to perform a debridement or further surgery in that same area. This may seem unreasonable to you, but this is generally how these situations are handled.

I just texted the dentist who did the extraction. I sent him pictures of the extraction site with my phone.

He does not think I need to see him again. He just wanted me to follow up with my Naturopath to see if a virus was affecting the extraction site since I had some canker sores nearby!?

So now I don't know what to do. Should I still make an appointment to go see him? That's a long day drive if he just says nothing and sends me home.

And I totally agree about the root canal having lots of long term issues! When through the pain I am glad I have it and that broken dental file out. I'm just scared because I don't know why I still hurt so much. Smiling with my mouth closed makes it worse, pushing pressure on the gum around the extraction site.

still in pain. Texted with the dentist who did the extraction all day yesterday. Saw local dentist (dentist who did the extraction knew I was seeing him) who took apical xray of extraction site at my request, nothing abnormal. He examined me again and everything was normal. He said he doesn't know and wonders if neurologic cause. Saw my MD who checked my ears and said they look fine even though the left one feels like it is being stabbed with sharp object. Ear, jaw, facial pain on extraction side is insane. If it is neurological I don't know how I am going to deal with this. The dentist who did the extraction says that he doesn't see any reason that I should drive all the way up to see him, as he wouldn't be able to do any better testing than the local one did. And he also does not know what is causing the pain.

Should I request an empiric trial of antibiotics? I have rarely taken them (twice in the last decade) but I am getting desperate and don't know what to do. It's not like I can just live like this forever.

I have no swelling, no fever, extraction site looks good, healing going normally. It's just intense pain stemming from the gum area on the cheek side of the site around the base of my jaw and up to my cheek, ending in the ear where it feels like either the eardrum is going to burst or be stabbed.

I think it started so badly over the weekend because I made myself get off the motrin, and the motrin must have been giving whatever is causing it an antiinflammatory effect. Today is day 11 post extraction.