I'm 59 and until recently still had all my wisdom teeth. When I was a child, my fmaily dentist watched them erupt, said "things are a little tight but look OK" and eventually decided things were good enough.

About 15 years ago both upper 3rd molars developed cavities and which were filled. Since then, my dentist noticed decay under one of those fillings and said it would be advisable to do an extraction rather than play with root canal, filling, etc in a basically inaccessible area.

Exactly 1 month ago my dentist began the extraction and failed, as the wisdom tooth shattered as he was trying to pull it. It was not impacted. He made me an appointment with a local oral surgeon that afternoon, and he completed the extraction. I was on antibiotics for 10 days afterwards. On a repeat visit on Day 5, the surgeon said the socket was closing nicely and sent me on my way.

In the following weeks the pain improved. Until about 1 week ago I noticed a sweet-salty taste (tissue fluid?) from the area of the socket, particularly after toothbrushing, which disappeared the next morning. There is no blood, smell, or bad taste.

I am now back to a pretty much regular diet, brushing my teeth with mild toothpaste as I found that strong mint near the open socket caused a stinging pain. What bothers me is the fact that I am still getting intermittent aching pain which resembles a mild toothache, from the buccal side of my gums just behind the maxillary tuberosity. I am concerned because, if I run my finger along the gum line between my cheek and jaw,and compare the side of the extraction to the other, they are not the same. The gums over the 2nd molar are firmer and bulge more along that ridge, and if I press lightly there I think I can reproduce the toothache-like pain. If i press too hard, I feel it for severar hours afterward.

I have read a lot dental patient information sites in which they tell you what to expect, and nobody seems to cover this except to say that there is bone remodeling which can take months, and sometimes spicules of bone may erupt from the socket and need to be snipped. I have not seen this.

Whould I be worried about local tenderness and maxillary tenderness 4 weeks after an extraction?

Hi Mike_s,

Thank you sharing detailed information about your dental situation.

I just want to mention that it is good to know that your general dentist was not too "proud" to get you in to see the oral surgeon since he was unable to complete the extraction. That was a very smart move on his part and completely to your advantage

Wisdom teeth can be a bit tricky to remove. Their root system is often irregularly shaped and they can be densely embedded or ankylosed in the bone. The older we get, the more dense the bone becomes which can increase the possibility of a bone fracture and/or post op complications. Most jaw bone fractures that occur during a tooth removal, especially those where the bone is not displaced, will heal on their own. However the discomfort associated with that healing, which is often described as an aching pain, may not become apparent until a few weeks post op. The fracture can occur along the buccal or lingual ridge or in the tuberosity area.

Other things that can occur from a tooth removal are some splintering of the jaw bone, which may not be clinically visible until or if the bone pokes through the gum tissue. Also in some cases an unexpected amount of scar tissue forms under the gum along the bony ridge or in the tuberosity area which may or may not cause a long term problem.

The salty taste may indicative of a tiny communication between the sinus and extraction site. These often heal on their own but sometimes they become problematic because they remain open. Did either dentist mention anything about a sinus communication or sinus perforation?

The only way to rule out any of those things that I have stated would be to see the oral surgeon for a clinical exam and a panoramic radio graph. Sometimes symptoms subside or disappear even though the problem still exists. So symptoms or the lack of them are not always ideal indicators of an ongoing problem. Best to have the surgical site, bone and sinus evaluated radio graphically by the surgeon.

Hope this information is helpful to you. Please keep us posted.
Bryanna





QUOTE=mike_s;1156462]I'm 59 and until recently still had all my wisdom teeth. When I was a child, my fmaily dentist watched them erupt, said "things are a little tight but look OK" and eventually decided things were good enough.

About 15 years ago both upper 3rd molars developed cavities and which were filled. Since then, my dentist noticed decay under one of those fillings and said it would be advisable to do an extraction rather than play with root canal, filling, etc in a basically inaccessible area.

Exactly 1 month ago my dentist began the extraction and failed, as the wisdom tooth shattered as he was trying to pull it. It was not impacted. He made me an appointment with a local oral surgeon that afternoon, and he completed the extraction. I was on antibiotics for 10 days afterwards. On a repeat visit on Day 5, the surgeon said the socket was closing nicely and sent me on my way.

In the following weeks the pain improved. Until about 1 week ago I noticed a sweet-salty taste (tissue fluid?) from the area of the socket, particularly after toothbrushing, which disappeared the next morning. There is no blood, smell, or bad taste.

I am now back to a pretty much regular diet, brushing my teeth with mild toothpaste as I found that strong mint near the open socket caused a stinging pain. What bothers me is the fact that I am still getting intermittent aching pain which resembles a mild toothache, from the buccal side of my gums just behind the maxillary tuberosity. I am concerned because, if I run my finger along the gum line between my cheek and jaw,and compare the side of the extraction to the other, they are not the same. The gums over the 2nd molar are firmer and bulge more along that ridge, and if I press lightly there I think I can reproduce the toothache-like pain. If i press too hard, I feel it for severar hours afterward.

I have read a lot dental patient information sites in which they tell you what to expect, and nobody seems to cover this except to say that there is bone remodeling which can take months, and sometimes spicules of bone may erupt from the socket and need to be snipped. I have not seen this.

Whould I be worried about local tenderness and maxillary tenderness 4 weeks after an extraction?[/QUOTE]

Bryanna, thanks for the detailed reply. I had posted a long reply yestersday; even read it online; later in the day it simply vanished. So I waited. Now it's tomorrow and it isn't there still, so I'll summarize.

The oral surgeon did a Panorex before undertaking to finish the extraction. He showed me how close the roots were to the maxillary sinus - not unexpected after years of growth in someone my age. He cautioned me not to sneeze, blow my nose, etc. for a week or two until some healing had occurred; I followed this religiously. I actually had some nasal stuffiness on both sides for a day or so immediately after the extraction but not since, and no real signs of a sinus infection.

I intend to go back for an opinion, especially if films would help; was just looking to see how emergently this might be needed. I am also developing temperature sensitivity at the back of the adjacent 2nd molar; perhaps he can give me some treatment besides the usual "sensitive teeth" toothpastes.




[QUOTE=Bryanna;1156518]Hi Mike_s,

Thank you sharing detailed information about your dental situation.

I just want to mention that it is good to know that your general dentist was not too "proud" to get you in to see the oral surgeon since he was unable to complete the extraction. That was a very smart move on his part and completely to your advantage

Wisdom teeth can be a bit tricky to remove. Their root system is often irregularly shaped and they can be densely embedded or ankylosed in the bone. The older we get, the more dense the bone becomes which can increase the possibility of a bone fracture and/or post op complications. Most jaw bone fractures that occur during a tooth removal, especially those where the bone is not displaced, will heal on their own. However the discomfort associated with that healing, which is often described as an aching pain, may not become apparent until a few weeks post op. The fracture can occur along the buccal or lingual ridge or in the tuberosity area.

Other things that can occur from a tooth removal are some splintering of the jaw bone, which may not be clinically visible until or if the bone pokes through the gum tissue. Also in some cases an unexpected amount of scar tissue forms under the gum along the bony ridge or in the tuberosity area which may or may not cause a long term problem.

The salty taste may indicative of a tiny communication between the sinus and extraction site. These often heal on their own but sometimes they become problematic because they remain open. Did either dentist mention anything about a sinus communication or sinus perforation?

The only way to rule out any of those things that I have stated would be to see the oral surgeon for a clinical exam and a panoramic radio graph. Sometimes symptoms subside or disappear even though the problem still exists. So symptoms or the lack of them are not always ideal indicators of an ongoing problem. Best to have the surgical site, bone and sinus evaluated radio graphically by the surgeon.

Hope this information is helpful to you. Please keep us posted.
Bryanna

Hello mike_s
I checked the log and there is no record of a 2nd post submitted by you, so I am thinking you might have used the "preview" mode to see your post (which appears then exactly as it would on the forum) but then not clicked submit.

Hi mike_s,

Sorry about your vanishing reply. I think Chemar may be correct in that you may have previewed it without actually posting it. I've done that a few times myself :/

I understand that a panorex was taken pre operatively. However, a month has gone by and you have developed latent symptoms. So other than taking another panorex he would not be able to see what is occurring in the bone area or the sinus.

The temperature sensitivity on the second molar is not unusual as there may be some plaque build up on that area of that tooth which would irritate the gum tissue causing it to pull away from the tooth just enough to cause some root sensitivity. Be sure to brush and floss thoroughly around the circumference of that second molar... not aggressively, just thoroughly. Also it is possible that some gum recession is developing. The gum tissue shrinks up towards the new level of bone as the extraction site is healing. This does not mean that the tooth will remain sensitive forever. It all depends on how much recession occurs during the healing phase. Keeping it clean will reduce the amount of recession.

To evaluate your latent symptoms appropriately, it would be best to see the oral surgeon, rather than your general dentist. The oral surgeon will know what to look for and be able to diagnose the panorex more effectively.

Regarding the urgency of your symptoms... if you feel that they are becoming more widespread or are not really subsiding, then do not wait to have it evaluated. If they seem to be improving with each day, then it is your choice to wait it out for a week or so.

Bryanna



[QUOTE=mike_s;1156770]Bryanna, thanks for the detailed reply. I had posted a long reply yestersday; even read it online; later in the day it simply vanished. So I waited. Now it's tomorrow and it isn't there still, so I'll summarize.

The oral surgeon did a Panorex before undertaking to finish the extraction. He showed me how close the roots were to the maxillary sinus - not unexpected after years of growth in someone my age. He cautioned me not to sneeze, blow my nose, etc. for a week or two until some healing had occurred; I followed this religiously. I actually had some nasal stuffiness on both sides for a day or so immediately after the extraction but not since, and no real signs of a sinus infection.

I intend to go back for an opinion, especially if films would help; was just looking to see how emergently this might be needed. I am also developing temperature sensitivity at the back of the adjacent 2nd molar; perhaps he can give me some treatment besides the usual "sensitive teeth" toothpastes.