I did'nt do my homework at all. Wish I had looked into something like this forum before I had all my teeth pulled out! Nevetheless, my questions now are: how long does it usually take for the initial facial swelling to go down after full mouth extraction, is there some certain criteria governing the number of days a dentist would prescribe something for the pain, how long should it take for the socket holes to close/heal assuming no dry sockets?
Any advice on healing these gums/sockets would also be appreciated.
Thanks

Hi 2snaggleteeth,

It really is hard to do homework about something you know little about.... it's like where do you begin if you don't know what to look for? Therefore, it is really up to the dentist and his staff to be your source of information without asking them to be. It is a pet peeve of mine that many people leave their dental office confused or at best, not well informed. IMO, there is no reason that should ever happen. Without question, not everyone is going to listen or completely understand what they are told, but that doesn't mean they shouldn't be informed....... ok, I'm off my soapbox, sorry for the rant..

Here is cyberspace, it is hard to give you precise answers to your questions without knowing your dental background and what lead up to the removal of all of your teeth. The post operative healing process differs from one person to another when taking into consideration what their dental problems were as well as their overall health. If you would like to share that here, that's fine. If not, then I can give you a ball park of what to expect but it may not apply to your particular situation completely.

<<<how long does it usually take for the initial facial swelling to go down after full mouth extraction>>>
Anywhere from a few days to a few weeks. Swelling occurs from trauma and inflammation. If there was infection and/or bone removal, there will be alot of inflammation. If you had Alveoloplasty, which is a recontouring of the bony ridge in preparation for a denture, the swelling can last several days. If your immune system is compromised for any reason and/or you smoke, swelling and pain can linger for several days to a few weeks.

<<<is there some certain criteria governing the number of days a dentist would prescribe something for the pain>>>
Generally percocet or vicodin are prescribed for pain for the first 3-7 days. After that, it's really best to take OTC meds like tylenol, motrin, advil or aleve. A good homeopathic remendy to use for pain is called Arnica. It is sold in health food stores in small vials. Place the recommended number of pellets under the tongue and allow them to dissolve, several times a day for several days. Do not eat or drink for at least 20 minutes after each dose. It does not interfere with any other meds and it does reduce pain and swelling.

<<<how long should it take for the socket holes to close/heal assuming no dry sockets?>>>
Assuming you don't smoke or drink alcohol, take meds or have a condition that causes a lack of saliva and are relatively healthy ....... the extraction sites (the gum tissue only) will close within 2-3 weeks. Sometimes less, sometimes more. The actual bony sockets where the teeth use to be gradually fill in with some bone over the course of a year. If bone graft material was placed in "healthy" sockets then they heal in with solid bone in about half that time.

<<<Any advice on healing these gums/sockets would also be appreciated>>>

Rinse several times a day with warm salt water for several weeks. This will speed the healing of the gum tissue and keep the sites clean.

Rinse with Xylitol in water twice a day in addition to the salt water rinses and this too will speed up the healing of the gum tissue.

Do not use peroxide to rinse with. It can burn the surgical tissue and cause excessive irritation.

Also, stay away from any dental products (mouthwashes) that contain alcohol, like Listerine. These products will cause more inflammation and can actually burn the tissue. They also cause a decrease in salivary flow which will delay the healing.

Do not use herbal based or essential oil mouthwashes until all surgical sites have healed completely. These too can cause irritation to the wounds.

By any chance are you wearing temporary or immediate dentures? Were teeth removed in both your upper and lower arches?

I hope this information is helpful, please check back with us soon.

Bryanna

I'm new to this forum stuff and don't even understand what a thread is. I suppose I'll pick it up as I go along. Thanks for your helpful info. I tried to write a reply to byanoceanbreeze but the program would not allow it. I'm not sure what I'm supposed to do to be allowed to reply or if replies are strictly your department. ... Some basic background. I am a smoker. My dentist is particularly uninformative even when I think to ask a question or have any issue that he doesn't feel needs resolving. Very frustrating! I had moderate gum disease at the outset. No loose teeth. No bone loss was mentioned to me by my dentist. I'm not sure that he even examined me for bone loss or what kind of exam would be involved in determining if there was bone loss. The only dental visits I have had over the last 20 years were to address painfully decayed teeth. Never went for regular treatment/prevention. Over the last 20 years I have had three extractions and two root canals with crowns, no cleanings, no deep scaling as was once recommended. When I presented myself to this dentist it had been over 5 years since last visit to any dentist and I had one molar that had rotted and broken off below the gumline. I had lived with this tooth in this condition allready for 2 years.
I told this dentist that I would like to get full set dentures rather than the even more costly proceedures involved in repairing and restoring what existed. He said he could do the extractions and place the permanent dentures as a same day procedure. What little bit of homework I had done on dentures lead me to believe that this was the most recommended approach to full mouth dentures. While sitting in his exam room a video was playing that promoted a sort of snap on denture with four to eight implants to attach the denture to the mouth. When I expressed that I would prefer to have that kind his answer was that I was not a candidate for those because I am a smoker. No more or no less explanation than that. The subject was closed. He moved on to tell me what he would do and a very brief description of the process, with the usual disclaimers that the timing of progress is different for different people and that of course the solution to all my current and future problems would be to quit smoking.
The swelling, bleeding, and pain that I had after the extractions was shocking! Even in this dentist's experience my situation was "unusual" and he had not had a patient with the same experience I was having. Three days post extractions I still had quite a bit of bleeding. The swelling was so severe I could not have smoked a cigarette (yes I tried). The swelling went from the top of my neck all the way to my eyes, including pressure behind the eyes. I had considerable bruising to my face as well. Co-workers and family alike told me I looked as though I had been beaten to near unrecognizability. No joke, no exageration. Though he had planned on removing the dentures the next day (a Friday) to examine the gum progress he knew with one look that would not be possible so he set me up to look at them again on the coming Monday (post extraction day #5). Over the weekend there was no way of doing any salt water rinses that he would normally have recommended because the swelling was too severe for me to attempt to remove the dentures. That excruciating visit on day 5 he did get them out and instructed me to remove them twice daily to do the salt water rinses. And to continue wearing the ice pack that originally was only recommended for the first 2 days. I wore the ice pack for six days and ten nights (it had just become too inconvenient to continue to wear it at work - 2 jobs). Another "unusual" aspect of my progress was that I kept re-swelling. By day 8 when I was able to say I think the swelling and pain are getting a little better, it was short lived. With no apparent trigger or consistancy the swelling would go right back up for 2-8 hours before I would sense it coming back down. By day 14 the bruising to my face finally began to turn from black to greenish but friends and co-workers still claimed that they could not see that the swelling had diminished. By day 20 they thought they finally could. It is now 5 3/4 months post extraction. The swelling is gone. The reswelling is gone. In fact the gum has shrunk so far down that there is almost nothing left on the lower for a denture to hold on to. I still have three socket holes on the lower right that just WONT close. I use salt water once daily and listerine 2-3 times daily. I use a denture soak at night but put the top ones back in for sleeping. I don't know where to get a zyletol rinse. Any suggestions? I have six very small ulcers that I can't get rid of and others that come and go with different small adjustments made by me at home and made by contuing shrinkage of the gums. Sorry for the TMI background book but I don't know how much is helpful in getting more accurate advice. Thanks for your help.

Hi 2snaggleteeth,

Ok, now the picture is clearer, thanks for sharing the information.

From your description, your mouth was very unhealthy prior to your extractions and the smoking is adding fuel to the fire. Periodontal disease is a progressive infectious bacteria that is strong enough to deteriorate the jawbone. Your dentist may not have mentioned bone loss to you, but any long term case of periodontal disease will undoubtedly cause severe bone loss. Also FYI, tooth decay is a progressive infection also. It can lead to nerve death of the teeth and then progress into the jawbone. Broken teeth with decay are very sick teeth. So you can see your dental situation had progressed to an unrestorable one, at least from a practical viewpoint.

Given the long term periodontal disease and loss of bone, you are not a candidate for dental implants because there is just not enough bone to work with. The smoking definitely puts you in high risk failure rate for dental implants even if you did have an adequate, healthy jawbone.

My professional opinion about your post operative surgical pain, swelling and bleeding were due to the extensive infections in your mouth, your smoking and your overuse of ice packs. Infections and smoking prohibit the body from healing properly and ice should only be used for the first 24 hours if at all. NEVER use ice more than 24 hours as it will only prevent the blood from circulating properly which increases pain and swelling and slows down the healing process.

The reason the extraction sites have not healed after almost 6 months time could be from the smoking and the rinsing with Listerine. The chemicals in tobacco deprive the mouth of oxygen, restrict the red blood cells and decrease salivary flow. All of which are imperative during the healing process. The Listerine has alcohol and other (chemical) drying agents in it which decrease the salivary flow and cause irritation and inflammation to the gum tissue. Listerine will prevent the surgical areas from healing completely.

Perhaps the biggest health concern at this point are the openings of those extraction sites after nearly 6 months of healing time. Chances are, the bone in those areas has not healed properly either and bacteria is able to get into those holes. This is not a good thing because infection that occurs in jawbone can end up systemically as well. The mouth is extremely vascular and whatever is going on in the mouth is traveling through the blood to other areas of the body. An unhealthy mouth and a compromised immune system from smoking can lead to some very serious health problems.

My suggestions would be......
Stop rinsing with the Listerine completely. It is causing harm not good. Not to scare you but to inform you....... A study just came out about the link between alcohol based mouthwashes, it named Listerine in particular, to oral cancer. The combination of the chemicals in Listerine and cigarettes....... not good. Those ulcers that won't heal and the open extraction sites need to be checked by your dentist asap.

Stop adjusting your own dentures. You will ruin the integrity of the fit and they will be useless.

Stop smoking. There are so many ways to help people stop smoking. Please seriously consider your options...... they could save your life.

I hope you can work with your dentist on getting your mouth healthy. If it were me, I would not wait.

All the best to you.....
Bryanna


************To other people who are reading this post, I think it's important to know that this persons situation is not uncommon in people who have severe peridodontal disease and/or smoke. Full mouth extractions do not have to be painful or debilitating and healing from them can be quite miraculous in healthy people. Bryanna

BRYANNA..
U ARE AMAZING! ARE U A DENTIST??
U have so much great information to give to people..and u make everything so understandable...I wish my dentist was like you..explaining everything in detail!! I FEEL SOOOOOOO THANKFUL TO HAVE FOUND U ON THIS MESSAGE BOARD..maybe G'd is sending me an angel to help me through my pain and misery..and worry.
So..here are my questions (and worries)...I hope u can lay my mind to rest.

6 days ago, I had tooth#14 extracted. (This tooth had had a root canal 2-3 yrs prior, {which I never had the crown placed on}, so I developed an abscess in the pulp tissue, most likely from a microscopic crack that had developed in the tooth from not being protected by a crown. However, I actually believe there had been an infection in the pulp tissue, even BEFORE the root canal was done. Too late now, however, to go back in time and try to determine when the abscess had developed, and why.)

Ok..so the tooth was extracted 6 days ago, and the dentist did a bone graft and skin graft on the same day. This dentist did not tell me at all what to expect after the extraction, and he also failed to tell me that he had done a skin graft by taking skin from my cheek and stretching it over the extraction site, to cover the bone graft! PLEASE TELL ME IF THIS IS A NORMAL, AND/OR POPULAR PROCEDURE!!!!!???? I have never heard of such a thing, and the pain and discomfort I am in is being caused by the inflammation and swelling of the cheek skin being stretched out over the extraction site. Not to mention (but I will) that my jaw is in severe pain, and I have bruising and swelling on both the upper and lower jaw and next to the corner of my mouth.

I havent found ANYONE who has had a skin graft over a bone graft, by taking cheek skin and pulling it over an extraction site. Im in misery and very worried that the swelling, and lump of gum tissue that I have connected from the cheek to the extraction site, is going to stay that way indefinitely...swollen, sore, and causing tightness, pain and discomfort to my cheek, upper sinus area and jaw. (I have been told I also have TMJ, but I am starting the think that the problem with tooth #14 was causing alot of my jaw pain, but I am not sure yet.) I have much more jaw pain since this extraction, than I ever had before. (It feels like my sinus area and jaw were hit very hard, and then filled with cement.)

PLEASE tell me if this skin grafting procedure is normal, and, if it is, (which I HOPE it is), how long will it take to heal, feel normal...and will the tissue that is connected from my cheek to my gum over the extraction site, ever look and feel like the other side of my mouth again??

Also..I am having burning where the stitches are...what can I do to relieve the burning pain??

Thank u so much..I will eagerly await your expertise reply!!

Sincerely,

Kimberly (**)

P.S. Ever since this procedure was done, I also have even more of a pulling feeling that goes from my jaw into my throat/thyroid area, which I had before, but not to this extent.

Hello Kimberly!

Well......... thank you for your kind words ;-)
To answer your question..... no I am not a dentist. I have alot of education in the dental field along with 30+ years of chair side assisting. I really do understand the shortcomings of this profession and the fear that most people endure..... so I try my best to help educate people as much as possible.

First to clarify your sick tooth #14...... don't let anyone tell you it became abcessed because it was not crowned. That is a bunch of BS. If the tooth were cracked prior to the root canal, it would have remained cracked. A crown may have covered the crack but the tooth still would have been sick because some amount of infected nerve material is always left behind in the canals after a root canal procedure. So it was not your fault.

I am concerned about your swelling and pain after 7 days. When an abcessed tooth is removed, especially one that has a long standing infection such as a root canaled tooth, it is not always wise to place a BONE graft at the time of the extraction. Sometimes it is better to remove the tooth, debride the bone thoroughly and put the patient on antibiotics. Then in about 2-3 months or so reopen the extraction site and if the bone is healthy, add the bone graft material. To add bone graft material to an infected surgical site will cause pain, swelling and rejection of the graft material. However, there is no way for me to know if your bone was ready for a bone graft or not. Only your dentist can answer that one. Unfortunately, some dentists are in too much of a hurry to just get the procedure done and don't put too much concern into having to readdress the infection later on. Meantime, the patient goes through alot of unnecessary dental pain and procedures.

About the skin grafting and using your cheek as the donor graft?? What????? Are you certain this is what he did? Perhaps he took a piece of oral tissue from either gum area near your palate (roof of your mouth) that you are unaware of? Sometimes they do that and then when they suture the graft over the extraction site, a suture or two or three (!!) gets caught in the cheek tissue. Sometimes the bone level is so low or flat that there is little room to suture the skin graft and they grab some cheek tissue in the suturing process. This is sometimes unavoidable It can cause a tight, pulling sensation until it heals closed and no, the cheek will not feel like it did before the procedure.

The burning pain may be indicative of either a canker sore that has developed, which is a common occurance, or a sensitivity to the suture material. Are you rinsing with warm salt water? It would be a good idea to do that about 4 times a day especially after each meal and before bed. When do you go back for a post op check?

Bryanna

BRYANNA...
THANK U SO MUCH FOR YOUR PROMPT RESPONSE!! I did not check my email here until just now..at 2:25am, Monday morning. I wish I had checked before, because I would've written back sooner...
U are sooooooooo amazing...how much time do u put into this website?
U should be getting paid for your expertise here, but if u were, I wouldn't be able to pay for your advice, because my dental bill has made me go BROKE!

Ok..I am VERY SCARED right now...
I HAD NO SKIN taken from the roof of my mouth at all..the ONLY skin that was taken from my mouth (to graft over the bone graft, over the extraction site) was cheek skin, pulled taught, over my tooth #14 extraction site.
It is STILL SWOLLEN and very sore..with a feeling that someone punched me hard in the face, and then filled that area with cement...a very sore, strange, tight, feeling.....
I am SCARED BEYOND BELIEF right now that I am in a TERRIBLE PREDICAMENT that will never heal. I am panicking..and last night, I broke down crying..in terrible pain, wondering if this nerve pain through my face and jaw will ever stop...or heal properly.
I have ALREADY suffered from facial nerve pain and TMJ since the age of about 14..and, as an adult, this facial nerve pain worsened (BEFORE this extraction procedure), most likely due to my teeth not coming together perfectly...and/or a neck problem causing the jaw and teeth not to come together perfectly. (If u saw me, you would think I have a perfect smile..with straight teeth, that look like I have always taken care of them.)

I have not met ANYONE who has EVER heard of this "taking the skin from the cheek" procedure and stretching it out over a bone grafted tooth extraction site". And, to make matters worse...my dentist is now gone for a whole week, probably enjoying his $4,500 vacation that I paid for...lovely, huh??
(I will, however, try to talk to whatever dentist he hopefully has on call while he is away.)

I swear to you..there was NO skin taken from the roof of my mouth.
(That, by the way, sounds just as painful!! Is it??)
On another note, I dont understand why, if a dentist is using cadaver bone for a bone graft, why that same dentist can't use tissue from a cadaver (or other material) to do the skin graft! WHY DO DENTISTS NEED TO USE A PERSON'S OWN SKIN to fill in a bone grafted extraction site?? Doesnt the skin grafting cause UNNECCESSARY pain?? I mean, isnt a tooth extraction painful ENOUGH on its OWN??

Right now, I sit here with nerve pain going through my whole face...WORSENED BY THIS CHEEK SKIN PULLING PROCEDURE (that apparently my dentist made up???)
If u look at a diagram on Wikepedia.com, of the facial nerves...my entire facial nerve has been affected (and my past facial pain of the past 25 yrs DOUBLY worsened) by this so-called procedure. The pain runs from my jaw area, into the cheek around the sinus cavity, down the cheek bone, into the middle of the lower jaw..and down around the lower teeth, towards the chin. I am NOT A HAPPY CAMPER, to say the least.

PLEASE..there has to be SOMEONE who knows of this procedure my dentist used...
I am so scared...
Is there anyone you can think of who might know?? (I doubt it, because u seem to KNOW EVERYTHING ALREADY!!)

In the meantime, I am trying HARD not to let myself panic. I am trying hard to tell myself that this dentist MUST have a reason for what he did..that I WILL HEAL in time, but there is alot of fear that sits inside of me, because of all the pain I have ALREADY been in throughout the years, and the pain I was already in BEFORE my tooth extraction, with my jaw and face.

THANK U for being here for me...I am not sure what to do with myself for a whole week before my dentist returns from his well paid for vacation...

Maybe u can give me some pro-active advice??
Thanks so much...
Kimberly

P.S. Have a great day...u really are the best...

Bryanna..
Sorry that I forgot to ask these two questions before..

1.) I have heard about the dangers of NOT closing up an extraction site right away, when there was an infected tooth extracted.
This dentist removed the tooth (in 4 pieces)..according to him, my tooth did not break, and came out in 4 pieces, all in tact. When the tooth was extracted, you could clearly see the infection, stuck to the tooth. (I even saw it..it looked like red jelly, stuck to the tooth. Now that I think about it, could that have been pulp tissue I saw, and NOT the infection, or abscess?)

The dentist told me that, after he extracted the tooth, he debrided some of the bone, to clean the bone area of infection, before he did the bone graft. My question is, can a person still have some infectuous bacteria left in there, that might NOT be visable to the human eye, or is ALL bacteria able to be seen by the dentist, once an abscessed tooth is extracted? My abscess was deep in the pulp, around the tooth, as far as I know. Do u think its possible that I could have some infection left inside my gums, that the dentist might not have been able to see?? And..if so, can that infection escape by use of anti-biotics, or will it stay in there, wreaking havoc on my immune system?? (By the way...my gum/cheek area is still very sore and swollen inside my mouth..it feels extremely weird when I run my tongue over it, as I can feel that my cheek was sewn around my extraction site, and it is really FREAKING ME OUT, to say the least.)

2.) Last question...is there any way to email u directly, on this site, or
otherwise?
It seems that the only way to contact u through this site is to send u a
message through someone else's posts? Maybe Im wrong?

THANKS AGAIN...
SINCERELY,
KIMBERLY

Kimberly, when you've been with us a little longer, you'll be able to contact any member here on the site by sending them a PM (personal message).

When able, you can click on a member's name and then you'll be taken to their profile page. Once there you'll see under their user name, the option to send a message. Click that and a drop down menu will open. Click send a private message to: and go from there.

I hope that helps.

Hi Kimberly,

Thank you again for your kind words. I would like to spend more time on here but I work...... crazy hours and only have certain times to check in. So I do the best that I can and sometimes I wish I had more time!

I don't want you to be scared. Yes, this is very uncomfortable and the radiating pain is making you anxious and scared, I understand. I think it would be wise to see another dentist asap, don't wait for yours to get back. Someone should look at the surgical site and explain to you what exactly was done. IF there is an error, it can probably be fixed now before it heals.

With regard to bone grafting....... there are several types of bone graft material that can be used. One is from a cadaver, another is from the acutal patient, and others are synthetic pieces of calcium made in a laboratory. You couldn't take skin from a cadaver to cover the surgical site because it would be rejected. So you either use a piece of skin from the patient or a synthetic membrane material made from collagen.

Skin grafting from the palate (roof of the mouth) can feel like a pizza burn and it heals very quickly. It depends on how large a piece is taken. But yes, it is uncomfortable in addition to the other surgery.

Again, if it were me, I would get in to see another dentist asap to evaluate your situation and see if there is a problem or not. You need an explanation of what has occured for sure.

Keep me posted...... I'll read your other note now

Bryanna