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Old 08-03-2015, 09:57 PM #1
toothtroublesgal toothtroublesgal is offline
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Default Recurrent infection almost 2 months post wisdom tooth extraction

I am an 18 yr old female who had all 4 unerupted wisdom teeth (and as far as I know none were impacted) removed on June 17, 2015. I was prescribed ten days of cephalexin post-op and while I seemed to have sort of a painful recovery, it was otherwise all right and my oral surgeon said things looked good at a 7 day followup.

About a week and a half later, around the beginning of July while I was on vacation out of state, I developed a tender, hard, lump on the left side of my lower jaw accompanied by some trismus. There was relatively no swelling and it didn't have palpable borders like a cyst. I figured it might be masseter muscle irritation (TMJD runs in my family) and left it alone since I had no other symptoms of infection like pus or bleeding or fever. Around July 15, I developed this strange tissue growth up around the extraction site and my second molar. It didn't hurt, but bled when poked and seemed flappy, not firm. I was concerned about how it looked (and still had that lump in my jaw) so I decided to head back to the oral surgeon on July 20th. I was almost 5 weeks post op at this point. Upon examination, he declared that the area around my second molar was "unhealthy." Some background info: I have a very small mouth and have always had gum tissue covering the surface of my left second molar (I believe it's called an operculum). I saw this same oral surgeon when I was around eleven or twelve for the "gum flap" covering my second molar, and he decided against any treatment since I was asymptomatic. Back to the present. In addition to the "unhealthy" gum area, he said that I had an infection because the gum covering the molar was harboring bacteria that migrated into my wisdom tooth extraction site. He never said exactly what the strange looking tissue was, but proceeded to perform a debridement of the area and scrape the socket to reintroduce bloodflow. When I asked about the jaw lump, he said it was in response to the infection and "unhealthy" area. The whole visit, he stressed that this infection was due to my anatomy, not based on any fault of my own in keeping the area clean. I was prescribed another 10 day course of cephalexin, and by the time I saw him again a week later on July 27th, the jaw lump was totally gone, the extraction hole looked great, and I thought things were finally getting better.

On July 29th, the day I finished my course of antibiotics, I felt the jaw lump and trismus beginning to return. I was once again out of state on vacation, so I wasn't able to get in to see the oral surgeon until today, August 3rd. When I saw him, he said the extraction site looked good (none of the strange tissue had grown back) but that an infection must be persisting if my jaw inflammation returned. He recommended another debridement procedure, and this time in addition a removal of the gum tissue covering my second molar (an operculectomy by my research-he never uses the medical terms for anything). I underwent both, this time with a much deeper debridement of the tissues in my wisdom tooth hole and cheek and a lot more "cleaning out." He did comment during the procedure that my bone looked healthy and that he was glad "he could get in there" because "this was doing a lot more good than the antibiotics would be able to." Honestly, I feel like he never explains properly what the situation is because of my age. There is a suture holding a small vertical incision in my gum above my extraction site, making me think that he really got deep into my cheek. I suspect there was an infection in my cheek and he was cleaning out the infected tissue. I don't know for sure, though. Once again, he prescribed me cephalexin, this time a 14 day course.

He has not made this entire affair seem terribly serious, and he's said that he's confident the infection will be resolved by the time I leave for college on August 20th. I'm not so sure, though.

Is this more serious than he's making it out to be? I really don't have any symptoms of a serious infection, and I do believe him when he says it's the operculum that keeps causing the infection of the extraction site and underlying tissues. I basically would just like to know if I should be more worried or seek a second opinion. This seems like a neverending saga and I'm really tired of it.

Thank you and sorry this is a novel!
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Old 08-04-2015, 10:12 AM #2
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Hi toothtroublesgal,

Anytime the oral surgeon has to go back in an debride the surgical site it is considered a serious issue in that it will need further follow up monitoring for a few months or so to be sure that the problem is resolving.

It is a good sign that he found the bone to be healthy when he did this last debridement. It is also good that he did a very thorough debridement which can be more effective than just antibiotics alone.

The incision that he made was done in an area that allowed him to gain access to the bone without causing too much more trauma to the area. It sounds like the over growth of tissue with the second molar was problematic in that debris was getting caught underneath and causing irritation to build up. So hopefully removing that tissue will help the area to heal better and you will be symptom free from here on out. If all goes well, it would be a good idea to see him or your dentist on your first break from college for a clinical look see and a periapical xray to make sure the area is doing okay.

Regarding the antibiotic.... It would be best for your overall health to supplement with a probiotic starting immediately and continue for at least 3 months or longer. Many people, myself included, take a probiotic supplement on a daily basis as a routine thing to reassure that the intestinal bacteria is consistently abundant in healthy bacteria. Antibiotics kill off the good intestinal bacteria in order to get to the bad bacteria. Unless your diet consists of a lot of healthy fermented foods on a daily basis, you will be deficient in good bacteria. Therefore, it is essential to replenish the good bacteria with a supplement to avoid an intestinal infection or other health problems. One product that is easy to get a drug or food store is called Culturelle. You can buy it online too. Take one per day first thing in the morning or last thing at night on an empty stomach. If taken in the AM, be sure to take the antibiotic an hour or so after the probiotic to avoid cross reaction.

I hope this information is helpful to you. If you have any further questions or concerns, let us know. Otherwise... hope all goes well and have fun in college!!

Bryanna



Quote:
Originally Posted by toothtroublesgal View Post
I am an 18 yr old female who had all 4 unerupted wisdom teeth (and as far as I know none were impacted) removed on June 17, 2015. I was prescribed ten days of cephalexin post-op and while I seemed to have sort of a painful recovery, it was otherwise all right and my oral surgeon said things looked good at a 7 day followup.

About a week and a half later, around the beginning of July while I was on vacation out of state, I developed a tender, hard, lump on the left side of my lower jaw accompanied by some trismus. There was relatively no swelling and it didn't have palpable borders like a cyst. I figured it might be masseter muscle irritation (TMJD runs in my family) and left it alone since I had no other symptoms of infection like pus or bleeding or fever. Around July 15, I developed this strange tissue growth up around the extraction site and my second molar. It didn't hurt, but bled when poked and seemed flappy, not firm. I was concerned about how it looked (and still had that lump in my jaw) so I decided to head back to the oral surgeon on July 20th. I was almost 5 weeks post op at this point. Upon examination, he declared that the area around my second molar was "unhealthy." Some background info: I have a very small mouth and have always had gum tissue covering the surface of my left second molar (I believe it's called an operculum). I saw this same oral surgeon when I was around eleven or twelve for the "gum flap" covering my second molar, and he decided against any treatment since I was asymptomatic. Back to the present. In addition to the "unhealthy" gum area, he said that I had an infection because the gum covering the molar was harboring bacteria that migrated into my wisdom tooth extraction site. He never said exactly what the strange looking tissue was, but proceeded to perform a debridement of the area and scrape the socket to reintroduce bloodflow. When I asked about the jaw lump, he said it was in response to the infection and "unhealthy" area. The whole visit, he stressed that this infection was due to my anatomy, not based on any fault of my own in keeping the area clean. I was prescribed another 10 day course of cephalexin, and by the time I saw him again a week later on July 27th, the jaw lump was totally gone, the extraction hole looked great, and I thought things were finally getting better.

On July 29th, the day I finished my course of antibiotics, I felt the jaw lump and trismus beginning to return. I was once again out of state on vacation, so I wasn't able to get in to see the oral surgeon until today, August 3rd. When I saw him, he said the extraction site looked good (none of the strange tissue had grown back) but that an infection must be persisting if my jaw inflammation returned. He recommended another debridement procedure, and this time in addition a removal of the gum tissue covering my second molar (an operculectomy by my research-he never uses the medical terms for anything). I underwent both, this time with a much deeper debridement of the tissues in my wisdom tooth hole and cheek and a lot more "cleaning out." He did comment during the procedure that my bone looked healthy and that he was glad "he could get in there" because "this was doing a lot more good than the antibiotics would be able to." Honestly, I feel like he never explains properly what the situation is because of my age. There is a suture holding a small vertical incision in my gum above my extraction site, making me think that he really got deep into my cheek. I suspect there was an infection in my cheek and he was cleaning out the infected tissue. I don't know for sure, though. Once again, he prescribed me cephalexin, this time a 14 day course.

He has not made this entire affair seem terribly serious, and he's said that he's confident the infection will be resolved by the time I leave for college on August 20th. I'm not so sure, though.

Is this more serious than he's making it out to be? I really don't have any symptoms of a serious infection, and I do believe him when he says it's the operculum that keeps causing the infection of the extraction site and underlying tissues. I basically would just like to know if I should be more worried or seek a second opinion. This seems like a neverending saga and I'm really tired of it.

Thank you and sorry this is a novel!
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-04-2015, 12:24 PM #3
toothtroublesgal toothtroublesgal is offline
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Quote:
Originally Posted by Bryanna View Post
Hi toothtroublesgal,

Anytime the oral surgeon has to go back in an debride the surgical site it is considered a serious issue in that it will need further follow up monitoring for a few months or so to be sure that the problem is resolving.

It is a good sign that he found the bone to be healthy when he did this last debridement. It is also good that he did a very thorough debridement which can be more effective than just antibiotics alone.

The incision that he made was done in an area that allowed him to gain access to the bone without causing too much more trauma to the area. It sounds like the over growth of tissue with the second molar was problematic in that debris was getting caught underneath and causing irritation to build up. So hopefully removing that tissue will help the area to heal better and you will be symptom

free from here on out. If all goes well, it would be a good idea to see him or your dentist on your first break from college for a clinical look see and a periapical xray to make sure the area is doing okay.

Regarding the antibiotic.... It would be best for your overall health to supplement with a probiotic starting immediately and continue for at least 3 months or longer. Many people, myself included, take a probiotic supplement on a daily basis as a routine thing to reassure that the intestinal bacteria is consistently abundant in healthy bacteria. Antibiotics kill off the good intestinal bacteria in order to get to the bad bacteria. Unless your diet consists of a lot of healthy fermented foods on a daily basis, you will be deficient in good bacteria. Therefore, it is essential to replenish the good bacteria with a supplement to avoid an intestinal infection or other health problems. One product that is easy to get a drug or food store is called Culturelle. You can buy it online too. Take one per day first thing in the morning or last thing at night on an empty stomach. If taken in the AM, be sure to take the antibiotic an hour or so after the probiotic to avoid cross reaction.

I hope this information is helpful to you. If you have any further questions or concerns, let us know. Otherwise... hope all goes well and have fun in college!!

Bryanna
Thank you so much for your quick and helpful reply! I am definitely taking probiotics and I know they're helping my digestive system handle the antibiotics a little better. I'm glad to know that you think my surgeon is handling this correctly, and it helps to get some peace of mind from an informed source.

I do have one more question. While my surgeon is fairly confident the operculectomy will resolve the repeated infection issues, he said that if this continues to be a problem or the gum flap grows back, I may have to get that second molar pulled and possibly the corresponding top second molar to resolve the problem. He says that most people don't have enough room for wisdom teeth in their mouth, but I don't even have enough room on that side for my second molar (which does seem likely.) Would this be a reasonable course of treatment if the area cannot heal properly?
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Old 08-04-2015, 02:29 PM #4
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Hi toothtroublesgal,

You are welcome

Based on your description of the size of your jaw, I can tell you that the oral surgeon had a heck of time removing your wisdom teeth. Again based on the information you have shared here, you have done really well considering.

I would agree with his general assessment about your second molars. He was not implying that you should run out and have them removed. He was trying to forewarn you about the complications that can arise due to the inability to keep that area clean and healthy. If you were to remove the lower second molar and not replace it with an implant, the upper molar that bites against this lower one would drift downward into the open space below because there would be nothing preventing it from doing that. Regarding the implant to replace the molar, if it should come to that.... depends on the health, depth, and width of the bone in that lower right molar area as to if it is sufficient to hold the implant.

So it seems that the best course of action you can take is preventative. The surgeon has removed the excess tissue so to try and prevent or minimize the problem from reoccurring, you may need to alter your brushing habits a bit.
Use a child size soft head toothbrush or a child size electric toothbrush. Make sure to angle the brush so that the bristles are angled against the back portion of that molar and use a circular motion to clean that area. It will take some practice to get the hang of it. Using an electric brush may be easier for you because all you have to do is angle the brush and it will do the work for you. The idea be thorough but not aggressive as you do not want to injure the tissue. The idea is to repetitively, gently shock the tissue so that it does not want to grow back and so that the gum line toughens up as this will inhibit the tissue from over growing.

As soon as the extraction site and newly surgerized area feels comfortable, start the new brushing routine. Initially it may bleed a little, but that's okay. You do not want to make it sore, so let that be your guide as to when you should be more gentle.

Do you use an electric toothbrush?

Bryanna



Quote:
Originally Posted by toothtroublesgal View Post
Thank you so much for your quick and helpful reply! I am definitely taking probiotics and I know they're helping my digestive system handle the antibiotics a little better. I'm glad to know that you think my surgeon is handling this correctly, and it helps to get some peace of mind from an informed source.

I do have one more question. While my surgeon is fairly confident the operculectomy will resolve the repeated infection issues, he said that if this continues to be a problem or the gum flap grows back, I may have to get that second molar pulled and possibly the corresponding top second molar to resolve the problem. He says that most people don't have enough room for wisdom teeth in their mouth, but I don't even have enough room on that side for my second molar (which does seem likely.) Would this be a reasonable course of treatment if the area cannot heal properly?
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-04-2015, 03:07 PM #5
toothtroublesgal toothtroublesgal is offline
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Quote:
Originally Posted by Bryanna View Post
Hi toothtroublesgal,

You are welcome

Based on your description of the size of your jaw, I can tell you that the oral surgeon had a heck of time removing your wisdom teeth. Again based on the information you have shared here, you have done really well considering.

I would agree with his general assessment about your second molars. He was not implying that you should run out and have them removed. He was trying to forewarn you about the complications that can arise due to the inability to keep that area clean and healthy. If you were to remove the lower second molar and not replace it with an implant, the upper molar that bites against this lower one would drift downward into the open space below because there would be nothing preventing it from doing that. Regarding the implant to replace the molar, if it should come to that.... depends on the health, depth, and width of the bone in that lower right molar area as to if it is sufficient to hold the implant.

So it seems that the best course of action you can take is preventative. The surgeon has removed the excess tissue so to try and prevent or minimize the problem from reoccurring, you may need to alter your brushing habits a bit.
Use a child size soft head toothbrush or a child size electric toothbrush. Make sure to angle the brush so that the bristles are angled against the back portion of that molar and use a circular motion to clean that area. It will take some practice to get the hang of it. Using an electric brush may be easier for you because all you have to do is angle the brush and it will do the work for you. The idea be thorough but not aggressive as you do not want to injure the tissue. The idea is to repetitively, gently shock the tissue so that it does not want to grow back and so that the gum line toughens up as this will inhibit the tissue from over growing.

As soon as the extraction site and newly surgerized area feels comfortable, start the new brushing routine. Initially it may bleed a little, but that's okay. You do not want to make it sore, so let that be your guide as to when you should be more gentle.

Do you use an electric toothbrush?

Bryanna
I do not use an electric toothbrush, but coincidentally I just started using a child size toothbrush a few days ago after throwing my old one out thinking it probably wasn't good to be using the same toothbrush after an infection. I think having a smaller head on the toothbrush is really helping me clean the area better and fit in all the tiny nooks and crannies in my mouth

I am also doing salt water rinses after I eat today. The oral surgeon said I should begin irrigating the extraction hole tonight with my syringe, would it be beneficial to use salt water to do this too?

Thank you for your help!
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Old 08-04-2015, 06:32 PM #6
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toothtroublesgal,

I think you will find the smaller toothbrush much more effective. After the site heals, invest in spin head or a small head electric brush. I really think you will be amazed at how well they work!

Regarding irrigating the socket... you can use warm mildly sated water in the syringe. The syringe is meant to be used very gently and not forcefully. It is suppose to be a gentle irrigation, similar to the same force you get when you rinse. If you irrigate too hard, it will hurt and you can reopen the wound. So steady and very gentle.

Bryanna




Quote:
Originally Posted by toothtroublesgal View Post
I do not use an electric toothbrush, but coincidentally I just started using a child size toothbrush a few days ago after throwing my old one out thinking it probably wasn't good to be using the same toothbrush after an infection. I think having a smaller head on the toothbrush is really helping me clean the area better and fit in all the tiny nooks and crannies in my mouth

I am also doing salt water rinses after I eat today. The oral surgeon said I should begin irrigating the extraction hole tonight with my syringe, would it be beneficial to use salt water to do this too?

Thank you for your help!
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-04-2015, 07:04 PM #7
toothtroublesgal toothtroublesgal is offline
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Quote:
Originally Posted by Bryanna View Post
toothtroublesgal,

I think you will find the smaller toothbrush much more effective. After the site heals, invest in spin head or a small head electric brush. I really think you will be amazed at how well they work!

Regarding irrigating the socket... you can use warm mildly sated water in the syringe. The syringe is meant to be used very gently and not forcefully. It is suppose to be a gentle irrigation, similar to the same force you get when you rinse. If you irrigate too hard, it will hurt and you can reopen the wound. So steady and very gentle.

Bryanna
Okay I will try to be gentle! Thanks again for your help and I will update Thursday when I go back to the oral surgeon.
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Old 09-18-2018, 09:20 AM #8
Olivia Doug Olivia Doug is offline
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Default Wisdom tooth patient

Quote:
Originally Posted by toothtroublesgal View Post
I am an 18 yr old female who had all 4 unerupted wisdom teeth (and as far as I know none were impacted) removed on June 17, 2015. I was prescribed ten days of cephalexin post-op and while I seemed to have sort of a painful recovery, it was otherwise all right and my oral surgeon said things looked good at a 7 day followup.

About a week and a half later, around the beginning of July while I was on vacation out of state, I developed a tender, hard, lump on the left side of my lower jaw accompanied by some trismus. There was relatively no swelling and it didn't have palpable borders like a cyst. I figured it might be masseter muscle irritation (TMJD runs in my family) and left it alone since I had no other symptoms of infection like pus or bleeding or fever. Around July 15, I developed this strange tissue growth up around the extraction site and my second molar. It didn't hurt, but bled when poked and seemed flappy, not firm. I was concerned about how it looked (and still had that lump in my jaw) so I decided to head back to the oral surgeon on July 20th. I was almost 5 weeks post op at this point. Upon examination, he declared that the area around my second molar was "unhealthy." Some background info: I have a very small mouth and have always had gum tissue covering the surface of my left second molar (I believe it's called an operculum). I saw this same oral surgeon when I was around eleven or twelve for the "gum flap" covering my second molar, and he decided against any treatment since I was asymptomatic. Back to the present. In addition to the "unhealthy" gum area, he said that I had an infection because the gum covering the molar was harboring bacteria that migrated into my wisdom tooth extraction site. He never said exactly what the strange looking tissue was, but proceeded to perform a debridement of the area and scrape the socket to reintroduce bloodflow. When I asked about the jaw lump, he said it was in response to the infection and "unhealthy" area. The whole visit, he stressed that this infection was due to my anatomy, not based on any fault of my own in keeping the area clean. I was prescribed another 10 day course of cephalexin, and by the time I saw him again a week later on July 27th, the jaw lump was totally gone, the extraction hole looked great, and I thought things were finally getting better.

On July 29th, the day I finished my course of antibiotics, I felt the jaw lump and trismus beginning to return. I was once again out of state on vacation, so I wasn't able to get in to see the oral surgeon until today, August 3rd. When I saw him, he said the extraction site looked good (none of the strange tissue had grown back) but that an infection must be persisting if my jaw inflammation returned. He recommended another debridement procedure, and this time in addition a removal of the gum tissue covering my second molar (an operculectomy by my research-he never uses the medical terms for anything). I underwent both, this time with a much deeper debridement of the tissues in my wisdom tooth hole and cheek and a lot more "cleaning out." He did comment during the procedure that my bone looked healthy and that he was glad "he could get in there" because "this was doing a lot more good than the antibiotics would be able to." Honestly, I feel like he never explains properly what the situation is because of my age. There is a suture holding a small vertical incision in my gum above my extraction site, making me think that he really got deep into my cheek. I suspect there was an infection in my cheek and he was cleaning out the infected tissue. I don't know for sure, though. Once again, he prescribed me cephalexin, this time a 14 day course.

He has not made this entire affair seem terribly serious, and he's said that he's confident the infection will be resolved by the time I leave for college on August 20th. I'm not so sure, though.

Is this more serious than he's making it out to be? I really don't have any symptoms of a serious infection, and I do believe him when he says it's the operculum that keeps causing the infection of the extraction site and underlying tissues. I basically would just like to know if I should be more worried or seek a second opinion. This seems like a neverending saga and I'm really tired of it.

Thank you and sorry this is a novel!

Dear patient, our daughter has close to the EXACT same situation as you had!! She is very swollen today on the bottom right side 2 1/2 months after she had her wisdom teeth out. The doctors keep telling her that her jaw is not big enough. Gum tissue has grown all over her back molar and now infected with a large puss filled ball. We are very worried. She has been on Amoxicillin twice. After you had the area thoroughly cleaned out again did it get better or did you have to do anything after this? We appreciate your help!!
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