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Old 12-06-2015, 07:35 PM #1
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Hi Jan,

I have never known of any dentist packing an extraction sight repetitively for several weeks post op unless there was a specific reason to do so. In fact, some oral surgeons do not even pack a dry socket unless it is very severe because the packing can interrupt the healing. I wonder what he is packing it with and what his reasoning is for doing that for such a long period of time? Tooth sockets always heal from the bottom up even if the gum tissue closes. In fact, the gum tissue closes over (the hole gives the appearance that it is slowly growing smaller) fairly quickly in people who have no post op complications. So I'm puzzled as to the reasoning he gives you. Do you recall having a taste or smell of cloves after he packs the site?

Just to give you a simple description ..... The extraction site is similar to a deep cut on a limb that has reached the bone. Everything is done to clean the wound and then help the wound close because the closed skin protects the inside of the wound from bacteria, etc. The visible cut in the skin is superficial compared to the depth of the actual wound. The only time a deep wound is repetitively packed or left open is when it needs to drain. Otherwise it's best to close it up.

He must have specific reasons for following this protocol with you. Maybe he's using something that has healing properties because regular packing paste does not. That's why I am puzzled as to why he's telling you the sites are fine, but then continues to pack them. I don't mean to keep harping on this. I just want you to heal okay and I'm curious what he's using as it may be something that promotes healing.

Bryanna




QUOTE=JG1993;1187012]Hi Bryanna,

I will check with my insurance company and with the receptionist to make sure he isn't charging me each visit. He said the socket needs to be repacked until I am at "zero pain. not even a point one." that's what he keeps repeating and that's why I still have the sockets packed. Most of today my top site has been fine, I've come to notice it IS actually the sinus above that is causing the pressure/quite mild pain. Not sure what this means.

He said the reason for aggressively keeping the socket open after the packing comes out is to "let it heal from the bottom up and not close over from the top. Apparently if it closes over from the top I could get an abscess. So there fore, he would like me to push my gums apart for 6 weeks until it heals from the bottom. Seems like such a long time He said he gives the same instructions to every patient. I'm feeling confused about his care, but I feel I'm so close to being done, that I just want it over with.

Thank you again,

Jan[/QUOTE]
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***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 12-06-2015, 07:50 PM #2
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He says the repetitive packing is because I am not at absolutely zero pain yet. He said I need to have no pain what so ever for 48hrs with the packing in before he will take it out. He classifies even a .1 as pain. I'm really not sure why. I don't believe the dry socket was EVER severe, he has some strange very strong philosophy about preventing even the smallest amount of pain. He packs it with a gauze that is covered in oil of cloves and I think one other thing mixed in. I'm not sure completely. I know without a doubt it is clove oil though. He always says they are "looking good and the tissue looks healthy". As for the sinus pressure/discomfort, what should I make of this?

I agree that the site should be allowed to close and it puzzles me that I have to push it open 3 times a day! All my other friends say they didn't have to do that after their extractions. I just want this stuff out of my mouth so I can heal normally. I keep thinking that its no doubt I still have very mild pain in my mouth because I have open wounds that are being forced to stay open with the packing in!

What should I do ?

Jan
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Old 12-06-2015, 07:51 PM #3
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Oh, also I'm terrified now to get the packing out when I have even slight pain because he said the pain will return if I do that. I'm so confused.
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Old 12-07-2015, 01:54 AM #4
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Jan,

The only thing I can think of is maybe he is using a hemostatic agent called ActCel and perhaps he's adding tetracycline to it. Why he would add the clove oil too.... at this stage, I'm not sure.

Actcel is basically used to control bleeding. But it has been shown to reduce the incidence of dry socket in sites where there is no infection present. Because it degrades to a biocompatible state (glucose and water) it does not cause disruption in the healing process. Basically it is a water soluble sterilized cellulose (plant fiber) that expands 3-4 times its size when it comes in contact with blood. It rapidly turns into a gel like substance so it plugs up the socket pretty well. It completely dissolves in about 1-2 weeks but it can be dissolved sooner with saline or hydrogen peroxide.

He may use this routinely for 3rd molar extractions because he may be getting good results with it. Perhaps you could ask him if this is what he is using? However, the irrigation of the sockets by pushing the gum tissue open is something I would be cautious about doing... especially if the sites are healing okay.

The sinus pressure .... did he mention anything about a sinus opening or perforation when he removed your teeth? Pressure and discomfort in the sinus area generally indicates inflammation. Have you or are you getting any drainage from your nose into your mouth? Do you feel pressure or anything unusual like throbbing in your sinus when you drink water or when you put your head down towards your feet?

Bryanna





Quote:
Originally Posted by JG1993 View Post
He says the repetitive packing is because I am not at absolutely zero pain yet. He said I need to have no pain what so ever for 48hrs with the packing in before he will take it out. He classifies even a .1 as pain. I'm really not sure why. I don't believe the dry socket was EVER severe, he has some strange very strong philosophy about preventing even the smallest amount of pain. He packs it with a gauze that is covered in oil of cloves and I think one other thing mixed in. I'm not sure completely. I know without a doubt it is clove oil though. He always says they are "looking good and the tissue looks healthy". As for the sinus pressure/discomfort, what should I make of this?

I agree that the site should be allowed to close and it puzzles me that I have to push it open 3 times a day! All my other friends say they didn't have to do that after their extractions. I just want this stuff out of my mouth so I can heal normally. I keep thinking that its no doubt I still have very mild pain in my mouth because I have open wounds that are being forced to stay open with the packing in!

What should I do ?

Jan
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***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 12-07-2015, 05:00 PM #5
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None of those products sound like something he would be using, I'm really not sure. I know for sure it's cloves though, haha.

In your personal opinion should I still have the packing in if I have a bit of pain still? I'm due to get it out tomorrow but I'm scared because I have had some random pains over the last couple days...but on the other hand I really don't know that it's a good idea to keep putting packing in the socket. I guess you can't fully tell me unless you know what specifically he is using to pack it. The sinus pressure and pain seems to have gone away completely over the last day. He did not mention or perforation or anything like that. No pressure or water leakage either. I guess if the pressure/pain is gone that's good news?
Thank you so much, your replies really ease my mind.

I'm so nervous for tomorrow

Jan
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Old 12-07-2015, 06:13 PM #6
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Jan,

I don't know why he's still packing the site or what he is using so I cannot say you if he should continue to do it or not.

Intermittent pain for several weeks post op tooth extractions is normal and does not mean that there is a problem. Severe, throbbing, sharp pain and/or swelling are indicative of a problem.

You could tell him that friends keep asking you why he keeps packing the sockets if everything is healing okay. If he tells you it is to control pain.... I would ask.... what are you using that controls the pain and why would I have pain this many weeks after the extractions if everything is healing okay?

Is it possible that you gave him the inclination that you could not tolerate any pain and that's why he keeps packing it?

If the sinus has calmed down then that is a good sign. Hopefully it will stay that way and the site will heal well.

Bryanna


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Originally Posted by JG1993 View Post
None of those products sound like something he would be using, I'm really not sure. I know for sure it's cloves though, haha.

In your personal opinion should I still have the packing in if I have a bit of pain still? I'm due to get it out tomorrow but I'm scared because I have had some random pains over the last couple days...but on the other hand I really don't know that it's a good idea to keep putting packing in the socket. I guess you can't fully tell me unless you know what specifically he is using to pack it. The sinus pressure and pain seems to have gone away completely over the last day. He did not mention or perforation or anything like that. No pressure or water leakage either. I guess if the pressure/pain is gone that's good news?
Thank you so much, your replies really ease my mind.

I'm so nervous for tomorrow

Jan
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***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 12-08-2015, 01:49 PM #7
JG1993 JG1993 is offline
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Hi Bryanna,

So, I got the dressings out about an hour ago and so far so good. I've been having some discomfort from the top site this morning, but I'm thinking I will wait to see if it calms down again. I really think it's just from being packed.

My sister said that she used oil of cloves directly in her dry socket when she had the same issue. She said she just used one drop and it provided immense relief and that the socket closed in a couple days this way. Is this a bad idea? I have some oil of cloves I can use if it's a good idea

The OS did tell me once again to use the syringe to push my gums open and not let them close from the top.. however, I don't think this is a good idea based on what you and most people have told me.. So I will just gently irrigate the socket and let it close. Hopefully all heals well and I don't have to make another trip to see this OS. Oh and PS, I'm in Candada.. don't know if that makes a difference on the advice my OS has given me.

Thanks for your continued advice, it's so much appreciated

Jan
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Old 12-08-2015, 03:54 PM #8
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Hi Jan,

Thanks for the update.

Clove oil is used as a soothing agent, not a healing agent. Therefore, it is meant to be used in the early stages of a dry socket to help soothe the pain. Otherwise, it really is best to just leave the surgical socket alone and let your naturally produced healing cells take care of it. If you keep disturbing it, the healing cells will be diminished and it will take longer to heal.

Your sister most likely only needed to use clove oil once, maybe twice a day for a couple of days. You have had the surgical sites packed with clove oil and who knows what else for a month! If you can, it is best to just leave them alone and let them heal on their own.

The typical post operative protocol following wisdom tooth removal is universally similar. It can vary slightly, as it did with your os, from one dental practice to another based on a personal/professional preference.

Hopefully you will not have too much discomfort from here on out and all will heal well!

Bryanna




Quote:
Originally Posted by JG1993 View Post
Hi Bryanna,

So, I got the dressings out about an hour ago and so far so good. I've been having some discomfort from the top site this morning, but I'm thinking I will wait to see if it calms down again. I really think it's just from being packed.

My sister said that she used oil of cloves directly in her dry socket when she had the same issue. She said she just used one drop and it provided immense relief and that the socket closed in a couple days this way. Is this a bad idea? I have some oil of cloves I can use if it's a good idea

The OS did tell me once again to use the syringe to push my gums open and not let them close from the top.. however, I don't think this is a good idea based on what you and most people have told me.. So I will just gently irrigate the socket and let it close. Hopefully all heals well and I don't have to make another trip to see this OS. Oh and PS, I'm in Candada.. don't know if that makes a difference on the advice my OS has given me.

Thanks for your continued advice, it's so much appreciated

Jan
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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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