Hopefully someone here can tell me what is going on. On 6/23 I had a lot of extractions done (Beginning with upper left, Second molar to upper right first bicuspid (upper right canine is impacted in roof of mouth so left alone) and from lower left second molar to lower left canine (wisdom teeth were removed decades ago)). This is actually just my first trip for extractions as all my teeth need to be removed due to extreme infection (which has cleared up thanks to current extractions and course of AB). However, the problem I am having is pain. I would think of this pain like that of dry socket, but all clots are intact and healing. So, due to that, I have no clue if what I am experiencing is normal or not.

On the 3rd day after the extractions, I started to feel a lot of pain coming from my upper gums. The area is from canine to canine and right below the nose. The pain seems to keep getting worse as time goes on (which is why I first thought dry socket) and nothing I do works. I was originally prescribed 5mg perco, and that worked (well, as long as I took 2 of them, or one of them with a fioricet) but now that I am out of them, I can't seem to find anything else to ease the pain. I have tried tylenol (650mg tabs), Aleve, 60mg of codeine sulfate, fioricet (50/325/40), and even nabumetone (750mg) (I avoided having both aleve and the nabu in my system at the same time as both are nsaids). Unfortunately, the pain continues. I have even tried maximum strength ambasol, which only helps for about 5-10 minutes.

Anyways, my main question is if this is usual. Is it just because of the location of the extractions in that area? Could there be some other problem causing this? Also, since this is the weekend, is there any other type of OTC med that I could try (I have full tolerance to ibuprofen)? Any and all timely help will be very much appreciated.

Thanks.

Hi eyanosa,

It is important for you to realize that the infection has not "cleared" up yet. The antibiotics will help and the removal of the infected teeth will also help, but the health your immune system has a lot to do with how quickly the infection clears out of your system. Removing the source of the infection was the first step and anything you do at this point forward will positively or negatively affect the health of your immune system. So it is wise to eat healthfully, avoid processed foods, soda, and sugar as all of these things will slow down the functions of your immune system. Whole fresh foods, lots of water and elimination of unhealthy food sources is key to ramping up your immune system.

Avoid applying any chemicals to your gum tissue as these things will interfere with the healing cells that are sent from the immune system. So avoid anbesol, mouthwash, regular tooth paste and any other chemical laden topicals like that. Rinse with warm salt water 3-4 times a day and use a gentle herb based toothpaste or just coconut oil on your tooth brush to clean your other teeth with.

Are you wearing temporary partial dentures? Are they rubbing against the surgical wounds?

Pain for the first week or two would be expected due to the extensive oral surgery that you have had done. The dentist may have also shaved down some of the bone which will cause additional pain in those areas. However, it would be best to see the oral surgeon who extracted your teeth to rule out further infection, dry sockets or impacted food debris.

I hope this information is helpful to you. Please check back when you can.

Soda is hard to avoid when everything else in your area is a lot more expensive and you're on a limited income, but I am taking care to ensure stuff like that avoids my gums completely. For drinking purposes, I am using a squirt bottle so the soda is never in contact with the extraction sites. As for healthy stuff, for days before the extractions, I have been taking 8000 IU of vitamin A and 500mg of vitamin C, both to help speed up the healing process. Other than the soda, I am very careful of what I eat, which is mainly tomato, cream of mushroom, and chicken noodle soups.

As for the AB's, it was a 7 day course of amoxicilin (30 at 4 times a day). I started taking them a few days before the work was done and ran out Thursday (or maybe my last one was when I woke up on friday). I know, at the very least, 90%+ of the infection is gone because I had an abscess pocket on the front of the right lower second molar. By Thursday, it was half the size it was and my jaw bone in the area no longer hurt to the touch. By Friday, it was completely gone. That was the tooth that had me going into the dentist to begin with (though it seems it will be the last tooth removed lol).

I haven't even attempted to brush my teeth, too risky in my opinion. As for the anbesol, it was out of pure desperation. I've also been trying to find clove oil but I live so far out in the boonies, that no one carries it. I do use a warm salt water rinse and as for mouthwash, I actually use biotene dry mouth oral rinse, which seems to help remove most of the pain (I am answering this after just waking up and using it. Most of the pain went away but I can now verify that the upper left second molar is a dry socket as, unlike the lower one, that has a white film growing over it, the upper one is yellowish in color, which I assume is bone). Also, the biotene is a mostly organic, non-alcoholic mouth rinse.

No. They won't give me dentures until the entire process is completed. I have medicare and medicaid so they -say- they can only make a set once.

I would agree with you regarding seeing the local dentist whom performed all of this (couldn't go to an oral surgeon as the nearest one was a 4 hour drive and had a 2 week wait, just for a consultation), but they are closed on Friday-Sunday (no one else nearby that I can go to). I'm just trying to figure out what I can do in the mean time to help with the pain until I can go to see him on Monday. While it is a lot of pain, if I can't find something to help, I can deal as this pain is not as bad as it was (considering I was constantly balled up in tears before the extractions). I am also mostly wondering if it is usual for the front top to hurt like this. I only wonder because my dentist told me there would be absolutely no pain after 2 days, which is obviously not true (and also shows why I only had 2 days of perco).

Anyways, thanks for your response Bryanna. Hope to hear from you some more.

eyanosa,

It is imperative that you take good care of yourself as your immune system is dealing with a lot. You can eat and drink healthfully on a limited income. You can drink water, it's free and you don't need to leave your house to get it. Regarding the soda... the health risks of drinking it are far worse than if it touches your gums. One can of soda has a minimum of 10 teaspoons of sugar and the worst type of sugar, high fructose corn syrup and sucrose. In addition to that, depending on the type of soda you drink, it has anywhere from 12 to 60 milligrams of salt per can. It also contains sodium benzoate which is a benzoic acid a food preservative often used in pharmaceutical drugs. There is nothing nutritious, healthy or hydrating about soda. In fact, it can contribute to the formation of kidney stones and a whole mess of other problems. So if you can, please try to drink water instead as the water will help flush out the bacterias and toxins that have accumulated in your body from the long standing oral infections.

It sounds like you are eating a lot of canned soups. Please read the ingredients, they are also loaded with sugar, salt and additives. Can you buy some fresh food instead, like fruit and vegetables? These are loaded with nutrients and will help you feel and heal better.

The symptoms with your oral infections have decreased, but the infections are not completely gone. That will take months for your immune system to handle that especially since you still have unhealthy teeth in your mouth. You also may have a dry socket. So it is best that you call the dentist and tell him your symptoms. Even though the office is closed, he has an answering machine or an answering service that takes emergency calls like yours.

Also, Biotine rinse is not organic. It is loaded with chemicals that can be very irritating to the gum tissue. It is best to rinse with warm salt water and nothing else. It is also necessary to brush your other teeth as they are accumulating plaque which contributes to bacterial infection. Don't use toothpaste, just use a dry tooth brush or use a moist tooth brush with a dash of salt on it. Rinse out with warm salt water. Don't drink it.

I cannot pinpoint why you have the pain only your dentist can do that because he was the one who did the surgery and knows what he found when he removed the teeth. So it is best not to doctor this yourself, but to call his office and leave a message about your pain so he can call you back.

Well, not drinking the soda is actually not a good idea right now. Since I have not had a cig since Tuesday, it would be very unhealthy and unwise to add caffeine withdrawal to my nicotine withdrawal (that can cause a heart attack, which is much worse then any symptom to drinking soda and no, I don't drink tea or coffee).

As for the soups, I am using the Campbell's Healthy Choice versions and the ingredients seem okay, nothing too bad in them.

As for fresh food, like I said earlier, I am in the middle of the boonies and unless I wish to drive 2 hours to the nearest real store, I have limited access to what I can get and my in town store does not carry fresh foods.

While the Biotene rinse may not be completely organic (I did say mostly), it does not irritate my gums. I was doing just a salt water rinse from Wednesday until Friday, and while I am sure it is definitely right, it alone was not helping. So, on Friday night, I tried the Biotene as a last ditch effort for the pain and found that it does indeed help. I am; however, not using it alone. I am still doing 4-5 daily salt water rinses, I just use the Biotene whenever my gums start to hurt. I don't know, maybe since it is for dry mouth sufferers (which I am), perhaps the moisturizers within it are keeping the extraction sites moist or something.

Regarding my dentist, no, they do not. I left a message on their voice mail, but they won't get it until Monday. Once again, the problem with where I live.

Hmm, I cannot edit my post, so sorry about double posting.

I almost forgot to reply to one thing you said. Regarding brushing my teeth, it does not matter if they get plaque or not because they are coming out this week as well.

As for the infection, the pain got so bad this morning that I was forced to go to the emergency room at 2am. They ended up prescribing me a 10 day (3 a day) supply of clindamycin. They agreed that the dentist should have given that to begin with instead of the amoxicilin because the infection is in the bone, something amoxicilin cannot penetrate very well.

eyanosa,

Brushing your remaining teeth will decrease the amount of food debris on those teeth. Which is very important because food debris rots on the teeth and turns in a bacteria that contributes to infection. So it is imperative to brush your teeth. It is also best to have a clean mouth when you have the rest of your teeth removed ... the less plaque there is the cleaner the surgery will be.

You really should have tried to call your dentist over the weekend. Every dentist has to be on call 24 hours a day and if they are away they have to have another dentist on call for them 24 hours a day. That is the law, irrelevant of where you live and I'm sure he would have gotten back to you.

Regarding the antibiotic... amoxicillin and clindaymcin are both effective in dealing with dental infections even when they are in the jaw bone. Sometimes the species of bacteria causing the infection are resistant to certain antibiotics. So in those cases a different antibiotic needs to be prescribed. If that is your particular case, your dentist would not have known that when he prescribed amoxicillin.

I hope you start to feel better soon.

I don't know where you live, but I have honestly never heard of such a law and I have lived in most of the states. Heck, there are normal doctors offices that don't even have such a thing. My dentist is open Monday through Thursday and if you have any issues outside of that time, you have to deal with it yourself. They also don't allow walk-ins and they run their office like a therapist office (i.e. you have an allotted time slot and they will only do work until the time expires, as with my case because he kept asking his assistant how much time was left).

90% of the time, osteomyelitis is caused by Staphylococcus aureus. When it comes to osteomyelitis, it is not about the type of bacteria, but how invasive the infection is, and, considering the dentist told me my entire jaw was infected (not just all of my teeth but upper and lower jaw bones), I should have been placed on the '500lb. gorilla of tooth abscess antibiotics'. This is because clindamycin has the second highest bone penetration of all antibiotics (only exceeded by intravenous injections of Rifampin (I've been doing a lot of research)). So yeah, based on my individual issues, he probably should have given clindamycin, though I am not saying that would be idea for everyone as my case in special since I was told 12 years ago to get all my teeth extracted and didn't due to extreme anxiety.

Anyways, we are kind of getting off topic here. So, to that effect, what could be causing the pain in the extraction locations of the front teeth? I know those do not have dry socket as I can slightly see the redish-brown clot within the very tiny holes that are left.

eyanosa,

I live in NJ and just happen to have a personal connection to the dental profession for 36 years. It is my understanding that emergency care for patients of record are the same universally. According to the ADA Code Of Ethics and Professional Conduct under Section 4 Principal Justice section 4B it reads.
<<EMERGENCY SERVICE:
Dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record. Dentists shall be obliged when consulted in an emergency by patients not of record to make reasonable arrangements for emergency care. If treatment is provided, the dentist, upon completion of treatment, is obliged to return the patient to his or her regular dentist unless the patient expressly reveals a different reference.>>

Most dental offices run their practice on a set time schedule. Unlike a hair salon that has time to fit in walk ins. So the dentist that you see is not different than most others in that respect.

So then you do you have a long standing and extensive infection in not just the teeth, past and still present, but in your jaw bone as well. This is what I had initially thought based on your original post here and why I stated the one dose of antibiotics is not going to cure the infection but rather subside some symptoms, inflammation and bacteria. Perhaps it would be a good idea if your dentist and you discussed the severity of your infection and come up with an antibiotic protocol to eradicate the infection once all of your teeth are extracted.

The pain you have can be dry socket related but it's more likely due to the infection that you have circulating through your jaw bone of which cannot be surgically debrided in its entirety, your poor oral hygiene promotes the build up of infectious bacteria and plaque and your diet is severely lacking in nutrition. All of those things contribute to post op complications, pain and slow healing.

Since you like to do research perhaps this piece of information will enlighten you...
http://www.medicaldaily.com/pulse/so...-health-319054

I will not deny that soda is bad for me. I know it is. The problem with quitting it right now is that combined withdrawal causes extreme stress on the body and is known for causing heart attacks and death. Due to that, I would rather quit smoking then quit soda as, until the chemical (caffeine or nicotine) is completely out of the system and withdrawals are over, the other cannot be stopped.

As for your statement of poor oral hygiene, I will state right now that it did not use to be that way. 12 years ago I stopped caring about my teeth and such. This was because of 2 factors. The first factor was that I was born without enamel on my teeth. This in itself is bad, but not extreme. For 25 years I brushed, flossed, and regularly used mouth rinse. It wasn't until 12 years ago that an oral surgeon figured out I had also inherited my fathers gum rot disease. This was determined because no matter what I did, my teeth still rotted and constantly broke apart. Even at that time, there was nothing that could be done and was told by multiple dentists at the time that none of the teeth could be saved. It was then that I gave up because there was no sense in caring.

As for my 'nutrition', I am a trained and certified chef. I only use natural, fresh ingredients in everything I make. I usually refuse to use anything canned as nothing tastes better than something made from scratch on your own. However, with all of the meds I am taking, it is not possible for me to drive 2 hours to the store for buying said items. So, I am forced to do my shopping close to home and all I have is a ShopKo, a store that does not carry fresh foods. I do; however, buy frozen broccoli every day and steam it until it is so tender it literally melts in your mouth. Considering I only have 2 teeth on the top that are able to be used for chewing, it is what it is. Once I have some dentures, I will switch back to my usual nutrition.

As for slow healing, the only part that is healing slowly are the two second molars, but they both have a hard shell on the inside of them, so that is most likely slowing them down. Also, as of today, all of the pain I had in any areas of my jaw bone are completely gone. I also had some more draining yesterday, which I will attribute to the clindamycin.

Now, regarding what you posted about the ADA CoE, obviously my dentist doesn't follow it. In fact, I went in there today regarding the issues and was told to come back tomorrow. So, yeah, even when they are open, they don't care about emergencies. And yes, I would find a different dentist if that was even an option.


EDIT:

Further proof that my dentist does not follow the ADA CoE. As I said above, I was told to come back tomorrow. So they obviously do not follow 4B but there is another issue now. I asked the doctor to provide something for the pain until then, after all, I've only been able to get 4-5 hours of sleep every day. I was refused and to make matters worse, the dentist called me up to tell me himself he would not give me any meds. Stated that the pharmacist informed him that I was flagged in the system as possible abuse. I find that interesting considering the only pain meds I use is codeine (which I only get 28 of and I have only filled that script 4 times in the past year) and that only works for my migraines (does not help with tooth pain in any way, shape, or form, even when I tried to take 3 of them. No effect). So, I decided I should go talk to the pharmacist about this and see whom flagged me so I could deal with it. Upon speaking to him, he informed me that he NEVER told the dentist such a thing and the only conversation he ever had with the dentist was to inform the guy that the perco he was prescribing could only be done with a physical prescription. This, at the very least, violates Principal Veracity section 5.F.2 and paragraph 4 of the Use of Opioids Statement, "Dentists are encouraged to recognize their responsibility for ensuring that prescription pain medications are available to the patients who need them". Then, to add to all of that, I get another phone call from the dentists office about an hour later with a statement saying, "The doctor has stated that he will only see you tomorrow if you are getting the rest of the work done at that time."

So, the doctor basically just a) flat out lied to me and accused the pharmacist of something he did not do, and b) refused to see me for an emergency issue unless I get more work done (guess he wants more money from my insurance or something). I really need advice on this one. Should I go ahead and let him do the work, or find someone else?