Hi Bryanna,

It's me, nukuspot from the thread below about the root canal tooth extraction. It got so long down there and things have changed a lot so I hope it is OK to start a new thread.

Today is day 22 since the RCT extraction. The major pain is going away each day. The intense pain in my jaw is almost gone. However the original pain, which was why I got the RCT extracted in the first place, remains. It is pretty similar to what it felt like before extraction. It is a dull earache in my one ear, and a pain in the little triangle of gum that was between 19/20. Since 19 is gone, I expected the pain to go, but that triangle of gum that is now next to 20 and an empty space still hurts, especially when touched with floss, fingers, tongue, waterpik, etc.

I saw my general IAOMT dentist yesterday because I was also still having issues with #20, it was still a little loose and also had a bruised feeling when my teeth touched which made it almost impossible to eat. He took the carbon paper and had me tap and move my teeth on it, he also had me wear my night appliance and did the same thing with the paper. He said that since 19 was gone my bite had changed which is normal, and extra pressure was on one cusp of 20. He filed it down just a bit, keeping it in occlusion but just removing "a hair" of the cusp and immediately it was easier to talk and eat, though that tooth still feels strange in my mouth. He also poked around the gum around 20 at the time and I jumped when it hit that area which has been tender for the last year. He said he clinically can't see anything wrong, he does not know what is causing the gum tenderness in just that one spot (it is the side that was closest to where the RCT was, and just in the front (gum) side, not the back (tongue) side. It is very specific. No issues with the gum around the rest of the tooth.

Do you have any idea what it could be? I know I did a good thing getting the RCT out, but I admit I am bummed that it made no difference to either my ear or gum pain issues.

Finally, in the extraction site itself on the side next to #20 , there is an area of tissue coming out of the hole which looks dark pink with red flecks. Is this a normal appearance of tissue at 3 weeks post op? The rest of the hole just looks like, well, a hole. This looks like a blobby thing. It is level at the gum line and not growing very quickly. I forgot to ask him yesterday about it but since he was in my mouth I imagine he would have mentioned it if it was a concern? I googled it and it looks a lot like a small "epulis granuloma or pyogenic granuloma." I don't want to over google myself into a worry so I thought I would ask here.

I also saw my TMJ dentist while I was there who modified my night appliance to make it smaller since I could not keep that huge hard plastic thing in at all during sleep, saying it is less effective on the TMJ joint but still will prevent clenching. I don't know yet if it will work or not but he said to give it a month.

Well, that's my update! I hope you can reply when you have a chance.

Hi nukuspot,

I just answered your PM...

Okay so things are calming down, that's good. Slow but steady may not be fast enough for you but it's good for complete healing purposes.

I think the area on #20 that is sensitive to flossing and has gum sensitivity is due to some gum recession in which you have some (very little) root exposure. Even the slightest exposure of a root can cause some people to feel pain. This may go on for a long time until everything calms down including your clenching. I would suggest that you keep #20 clean but do not over brush or over floss that tooth. Be gentle and thorough and see if that helps.

Here is my theory..... RCT #19 was unhealthy and a sight of bacteria and inflammation for a long time. Keep in mind that radio graphically the mesial root of #19 (the root closest to #20) was the sickest of the two roots. It is very probable that the bacteria from the mesial root of #19 was beginning to invade the bone and ligament near #20. This would cause changes to occur with #20 in the area closest to #19. That would explain the slight gum recession and slight root exposure with #20 and in part the extreme tooth sensitivity that you had prior to having #19 extracted. You didn't have the wrong tooth removed because #19 was diseased and #20 wasn't and still isn't. Does that sound logical to you?

Regarding the tissue that is growing from the extraction site. I would not assume that the dentist noticed it... I know that sounds lame but it's best never to assume. If he did notice it and did not say anything to you about it, he still may have noted it in your chart. So I would recommend that you call his office and ask what he noted in the chart about that tissue growth and stop googleing it because there are several things it could be. If that dentist did not note it in your chart according to the receptionist, then ask to speak to the dentist as you want to know what he thinks it is. In all honesty, he should have seen it and mentioned it to you irrelevant of what it is. You could also take a photo of it and email it to the oral surgeon and ask what it is. I'm not comfortable guessing what it is because it needs to be see clinically for the proper determination.

So give the appliance a chance. Also how are you doing with your other modalities of stress reduction?

Bryanna

Hi Bryanna,
That was so fast! Wow! Thank you heaps for that quick reply.

I really like your breakdown of what you think is going on. Even though you have never seen me, it seems like you really gave an amazing summary and explanation of what might have happened/be happening. I wish my dentist was so verbal and explanatory.

As far as the theory you had about 19 infecting or irritating 20, that makes sense to me and it was what I had always kind of assumed in the back of my mind. However I really thought that getting the "source" of the issue away which was 19, then 20 would calm down. To be clear it's not like the tooth itself is constantly painful, its that triangle of gum that was between them both (is is called a papillae?) And only the side that faces towards my lip, nothing on the tongue side. The triangle of gum between 20 and 21 is fine. It's such a small area but SO painful! If I press on it or manually do anything to it, it gets worse. But it's been that way since last year. I just thought that the extraction would help it!

Am I right in getting that your theory is that it's not the actual gum itself that has an issue, but it's part of an exposed root that is UNDER the gum in that area which is painfully activated?

I have visible recession on 20 and also the same premolar on the other side of my bottom arch (I don't know the number of that one.) I have had that for years. You can see the darker bottoms of both of the root areas on those teeth. I have been told it was from agressive orthodonia at a young age which caused my teeth to be straight but did not take into account occlusion or jaw placement. As a result my teeth do not line up correctly. It is probably the root cause of my TMJ on the left side as well. I had braces from age 8-12. Very early and very agressive. I had an impacted canine tooth and a "class 3 occlusion" which they treated with braces and oral surgery to attach a bracket to both my canine teeth. Anyway that is kind of off the subject....Sorry to ramble. But yes, I do have exposed root on 20 is what I am trying to say. However my recession/exposed root areas on those two bottom premolars usually only is an issue when I eat anything sweet. As a result I rarely eat sweets, even sweet apples will cause pain in those areas. But it's a fleeting pain until I rinse my mouth. This current pain in the gum at 20 is constant, has been there for a year now. I notice it gets better after a dental cleaning or after I use my waterpik in the area, though both of those do initially exacerbate it for the first few hours. I always imagined I was flushing some irritant away...? Can an exposed root give constant pain and not just fleeting pain too? Maybe I have a different exposed surface on 20 than what is visible.

You mentioned being gentle to clean the area. Can you advise me more about that? I brush three times a day, using a natural toothpaste from my dentist called Coral White. I used to use an electric toothbrush but it was too much for that gum area at 19/20. So I use a normal extra soft bristled brush. I floss once a day (sometimes twice) and use a waterpik with the pik pocket head and baking soda in the tank. I have tried oil pulling but it irritated the gum worse, though I don't know why. I wanted to try a desensitizing toothpaste to see if it would help the issue of that painful gum but I cannot find a natural one. The Toms of Maine one is the closest but it still contains SLS so I don't want to use it. If you could advise me further about this cleaning aspect of the area I would appreciate it, because it does feel worse after brushing/flossing. But I want to keep it clean as I can. I am also still doing the salt water rinses since the extraction, even though I probably don't need to do them anymore. They keep food out of the hole and can't hurt, right?

Finally, in regards to that weird tissue in the extraction site---I am very reluctant to call the dentist. I have an anxiety issue around health care providers. It stems from years ago when I went through a long misdiagnosis period for my interstitial cystitis. I saw many doctors and was in a lot of pain. Some "fired" me because I was too needy and they didn't know what to do (because they had misdiagnosed my issue as repeated UTI.) When I finally got diagnosed after a year, it left me with a real fear of being a "problem" patient. I literally break into a sweat when I have to call a dentist or doctor. I have called both the dentist who did the extraction and my general dentist SO many times in the last few weeks, I am very reluctant to call again. Especially since the dentist who did the extraction was pretty clear that he wanted my follow ups to be with my general dentist. So I will hope and assume that he saw that tissue yesterday and it was normal, that is why he didn't mention it. It's really almost impossible to miss! You see the hole where the tooth was and half of it is filled with this pinky colored tissue with red flecks that looks totally different to the rest of my gum. I totally understand that you can't dx it because you can't see it and I am not your patient. No worries on that and no expectations you could do that. I just thought I would mention it, because it looks so weird. I am hoping it's just what new tissue looks like in an extraction site! I never looked this closely when I had my wisdoms out.

I am giving that appliance a chance and hope so much I can get used to it! As far as the other stress reduction, it's hard because I don't feel stressed so I don't know how to judge if it's working or not! But I am trying lots of things. I wish I could find a way to know if I was clenching less at night to see how it was working....

Oh I have one last question. I was thinking really hard last night about prior dental care I had. Before I switched to this IAOMT dentist I saw a traditional ADA dentist about 8-9 years ago. I remember him measuring pockets and saying that I had a 5 in that General area. I can't remember exactly which tooth but I know it was the bottom left so I imagine it could have been the 19/20 space. He had said to use a special nylon brush to clean it and if it didn't improve I woukd have to get a deep cleaning. I never used the brush because it didn't fit and made my gum bleed. I did not change anything about my oral hygiene. I never got a deep cleaning and switched dentists soon after because I wanted a more holistic approach. However since I switched to the IAOMT dentist I don't recall the hygienist ever saying I had any pockets. At my last cleaning in April I really listened as they were doing the gum numbers and my whole mouth was 1,2s. That one area was a 3 (between 19/20) but they said that was fine and just to use the water pik.

I know my current dentist does some sort of holistic deep cleaning and I had asked him if I could try it around 19/20 (this was last year when the pain started) but he said no I don't have periodontal disease.

I am wondering about the discrepancy in measurements between the two dentists. I remember the old dentist being concerned looking and trying to wiggle my teeth to see if they were loose and telling me a pocket of 5 is really bad. But then my current dentist says I don't have any gum issues.

Can dentists measure in different ways? Or is it a standard tool they use? Could I still possibly have that pocket there (from the toxic RCT that was there for so long) and that is what is causing the pain?

I am just throwing out any ideas to you because you are so smart.

nukuspot,

I just happen to be on here when you were!

I'm pretty good at analyzing a dental situation given the number cases and years I've been involved. There is also a lot of stuff that is routinely seen which for me has made them obvious.... for others perhaps not so much.

You did remove the source of the original problem which was rct tooth #19. However, prior to the removal other things were happening and #20 was one of them. This is one area where patients are often ill informed about in that infected or root canaled teeth have the likelihood of causing problems with the adjacent teeth. Sometimes those problems do not surface clearly until the source of the problem (the infected rct tooth) is removed.

That triangle of gum tissue may have some granulated or thick fibrous tissue between it and the tooth. Remember, that side of #20 was in close proximity to bacteria and inflammation from rct #19. That would account for the gum feeling irritated by a cleaning but then feeling better once it healed. Even if there is a slight bit of residual granulated tissue left in that area after the cleaning, it will grow a bit once the site heals. Each time you floss in there that tissue gets irritated. I know you are trying to keep your mouth very clean but you do not need to brush 3 times a day or floss more than once. Twice a day brushing, morning and just before bed is adequate for most people. Floss and scrape your tongue after brushing at night is also adequate for most people.

If it is not thick fibrous tissue then it could be just the opposite. You mentioned that #20 is at an odd angle. There are different thicknesses of gum tissue in different areas of the mouth. When recession of the gum occurs it is common to lose some thickness of the gum tissue. Depending on the individual, the tissue can become granulated and thick or thin and fragile. Either way, if you over do the oral hygiene you will irritate that tissue.

Gentle, thorough oral hygiene means........
Twice a day, use a soft head tooth brush and angle it at a 90 degree angle along the gum line. Gently and with light pressure, maneuver the brush head in circular motions to remove the plaque. Only direct the tooth brush back and forth over the biting surfaces, not the gum line.

If you use an electric tooth brush, follow the same directions but let the brush do the work. Do not press the brush into the gums. Just lay it snug against the gums.

Once before bed time, floss in between each tooth. Gently place the floss straight down in between, do not see saw it back and forth. Gently hug the side of the tooth with the floss and gently go down as far as comfortable. Gently elevate the floss while hugging the side of the tooth 2 or 3 times. The switch the floss to the other side of the tooth and do the same thing. Bring the floss straight up and out from between the teeth. If the contacts are too tight to bring the floss straight up, then pull the floss straight through along the gum line. Use a floss thickness that is comfortable for your particular teeth.

Water pik.... only use on a mild setting. This is meant to be therapeutic, not like a fire hose. The idea is to gently cleanse away any residual bacteria that the floss may have missed.... not cause the pocket to open up of be irritated.

Clean your tongue... either with your tooth brush or a tongue scraper. I perfer OOLIT tongue scrapers. But there are lots of different ones out there. The tongue holds TONS of bacteria and debris. Cleaning it reduces bad breath and can help prevent oral cancer. So it should be a part of daily oral hygiene.

Regarding the tissue growing in the extraction site... aside from you hesitancy about being too inquisitive because you have every right to be that way and it just does not matter what anyone else thinks about it ...... it's not wise to assume it is normal. It may be, but if it looks weird to you or continues to grow above the gum line, then it should not be over looked. FYI.... dentists and most dental staff are the most annoying patients.... because sometimes a little knowledge opens up a can of unwelcome worms. Never worry about what others think of you when you are trying to take care of yourself and need proper help to do that ... it is irrelevant what they think, just be yourself

Bryanna

nukuspot,

If you had a deep cleaning around #20 while you still had that root canaled #19, that cleaning would have set off a fire of bacteria from #19. So it was good that you didn't have it!!

The recommendation of the nylon brush indicates that you probably have some irregularity in the gum tissue in that area. This does not mean there is any pathology there. It could just be fibrous or thin gum tissue. Instead of the nylon brush, as that can be irritating, use a rubber gum stimulator to help toughen up the gum. Use it gently and only once a day. Over time the gum tissue firms up and becomes healthy. It's like a an exercise for your gum similar to an exercise to tone up saggy muscles They look like this...
http://www.gumbrand.com/gum-stimulator-600rqa.html

Regarding the measurement of pocket depths.... every dentist or other who measures pockets uses their own technique. So yes the numbers can be different from one office to another. The one common ground is that anything deeper than a 4-5 is evident upon any probing.

Try this regimen for 2 weeks and see if you notice a positive difference. Use the gum stimulator, brush 2 times instead of 3, floss once, water pik gently with very diluted baking soda and scrape your tongue....

Bryanna

THANK YOU!

Off to Amazon to buy a tongue scraper and the gum stimulator right now. I hope they have directions! I never used either. I am going to be so happy if this works.

Should I keep doing the salt water rinses after meals or stop them at this point?

What about oil pulling? I wanted to try again but wasn't sure if it was OK with the extraction hole still open. It's been 3.5 weeks since surgery now.

Ok, I went to order them. Amazon doesn't sell Oolit so I am trying a "Dr Tung" tongue cleaner. The Gum stimulator, I am trying to figure out how it could work if I don't have any tooth on the other side like I used to. Can I still stimulate the painful gum area next to the extraction site if I don't have another tooth to go between? How would I best do that? I looked at the instructions and it all shows getting the stimulator point in between the teeth so I am trying to figure out how to tweak it for my painful area, at the same time shuddering to think of using it, as even touching that gum area with my toothbrush or finger or floss is SO painful. Just that one tiny area. The rest of my gums feel fine. It's so frustrating! I feel like if I could peel that triangle back I could see what is bothering me so much. I just tried to take my 6 year old to the movies and could barely concentrate because that gum area is so uncomfortable. At least I think that is what the issue is, it's either that or the extraction site on that side (which is also where that weird tissue is). It's so close together! I know I am obsessing but I just want to be out of pain. I can't imagine ever chewing on that side again with the pain and all the sensitivity/looseness of #20. And in 6 months I am supposed to start planning a replacement for the hole. I can't imagine going through an implant in this state. But to stay positive, at least the stabbing horrific post-extracton pain I had when I first started posting here is gone. No more wishing for pain medicine each hour. I can live like this, it's just very annoying and frustrating at this point.

I finally figured out how to take a photo and upload it here! I hope this is OK---I was trying to show you 1.) The way that #20 is rotated inwards and 2.) the weird gum tissue growing in the extraction site closest to #20. I really wish I would have gotten a better angle, but it was impossible to get my camera in a better position in my mouth to be able to see the tissue. I only really can see it because I have a little dental mirror.

Attached Thumbnails

 

nukuspot,

Thanks for the picture!!

The extraction site looks good! Great color and contour and it's closing up nicely! I do see the small growth of tissue in the mesial area nearest to tooth #20 that you refer to as lumpy with red lines. I am wondering if this growth of fibrous tissue is resulting from fibrous tissue that you may have under the gum line on the back (distal) of #20 that is causing you such soreness..... ??

It may behoove you to consult with a periodontist about these two areas to see if there could be a connection and if something minor needs to be done or if time will heal them both.

Here is how I would explain the problem to whomever you see and in this sequence:

**RCT done on #19 # of years ago.
**Nagging soreness and pain in gum area between 19 and 20. Sore to floss.
**Had 5 mm pocket on distal of #20, reduced after better oral hygiene. But soreness persisted.
**Xray shows pathology with the mesial root of #19 including fragments of stray gutta percha.
**#19 removed, site scraped clean including gutta percha debris. briefly explain details of surgery and clotting factors used.
**Nagging soreness and pain persists in the distal area of the gum #20.
**As #19 site heals, an area of lumpy tissue is growing in the mesial area of the site close to #20.
**Is it possible that this fibrous tissue is also located under the gum on the distal of #20 and it's feeding the growth of the lumpy tissue in #19 site?

Do not say that you feel the wrong tooth was removed, because the xray clearly indicates #19 was not healthy. But even mentioning that, you could give the impression that you are looking to blame someone for something. If this tissue is connected between 19 and 20 in some way, then it is something that your body formed and no one is at fault for that. I just want you to be clear on that so you don't misrepresent the content of the message that you are trying to get across

Bryanna




Tooth #20... is rotated towards the lingual (tongue) pretty severely. But so is the last molar #18, just not as severely. On the lower right, is the premolar angled similarly toward the tongue?