Dry socket and the healing process
 

Hi everyone.. I am new here but was very impressed by the forums and wanted to get some help and advice from people who might have dealt with this. Here is the background.. Had my molar ( the last one) on the top left extracted on August 8 2011. I had to go back later to have the dentist pack it because I lost the blood clot. The next day I had this weird hollow pain when air hit it and was examined and said it was healing. They did give me an antibiotic and wanted to see me the next day. I went back and was checked again and they said it was healing. Well the following Monday I went back cause the weird pain was still there. It only hurt when I spoke certain words and air got in it. Well it was confirmed that I had a dry socket. I was told upper dry socket pain can be different than lower pain and that is why I thought something else was going on. Well I went back on Wednesday to have it rechecked and it was healing slowly and I had to be patient. So as it will be 3 weeks on August 29th it looks as though it is starting to fill in nicely but the darn thing is so sensitive. I went to see the dentist for a checkup this past Thursday and he said it is healing really nice, I still have some ways to go but it is really on it's way. I have sjourens disorder so I also think that is why my clot did not hold cause my mouth was to dry. I am in my late 30's. I have always had teeth issues and never understood why until I was diagnosed. Now I have this other issue going on and I need to know if anyone else experienced this,. For the last week and a half when I speak my other tooth on that side is experiencing sensitivity kind of like a vibration feeling. It is not loose. To give you a visual of which one it is. The last molar extracted, the one next to it is also gone and then it is that one freestanding. I hate my teeth and I am so young for so many teeth missing but I have the rest it is just that side. Also these last 2 days it has been very tight and a little sore and a few people one being a nurse said it could be because the gums are healing up and starting to constrict together causing almost like a tint feeling. So I was wondering anyone who has had any experience with a dry socket and it's healing could please give me a little insight as to did they experience anything like this and if there are any professionals that can give me some more insight would be awesome. I am done with this..it has caused me so much mental anguish.i cry a lot from not being able at times to be myself and I have two kids and a loving husband and I just want to go back to being me.. I am scared to go to sleep at night because i am scared the dry socket will come back and I hope for it to completely go away and I am let down when it does not. Thanks everyone for any help you can give me..

Hi,

So if I understand you correctly, the dentist finally diagnosed you with a dry socket, did he treat the socket with any medicated dressing? Did you tell your dentist that this other tooth is now bothering you? IF so, what was his response?

Sometimes after a molar is removed, the adjacent teeth (in your case, you are missing two molars in that area) become very sensitive because they are being overused when chewing. One way to see if this is the problem is to avoid eating on that side for at least a week, if possible, and see if that tooth feels better. If it does, then slowly start eating on that side again but not excessively. This may be something that you have to continue to do to avoid the tooth from being overused and getting sore.

Hope this information is helpful to you... let us know how you're doing!

Bryanna

Hi Bryanna,
Yes the dentist did diagnose with a dry socket and no packing was done. They said it was healing and had me come back 2 days later to check it again and at that time they were going to see if they thought I needed to see the oral surgeon and they both confirmed that I did not, it was on the right track.
So today I woke up and the tight feeling was not that tight as it was for 2 days and looks as though it closed a little more.
I did call the office today but I think they were not in due to hurricane Irene because all I was able to do was leave a message. Around 5pm I was eating a yogurt and as I swallowed i felt air go onto my socket. I then closed my mouth and slightly sucked in air and can feel it go up there but I do not feel it anywhere else. So now I am panicking that I have a sinus opening.. This is why I called them to see if I can see my we'd morning.
So my question is this:
How can I tell if there is a perforation or a communication problem? I rinse with salt water all day and never have anything go through my nose and I have no pain in sinuses as of yet? And is that normal for air to go up it being that it is not closed completely?
Bryanna,
I am not normally this anxious but this has been a really bad experience and I am scared I will not heal. It is taking so long
Thanks
Btw real name is nicole

Hi Nicole,

The air feeling could just be related to the open wound, which would be normal. If you feel that the salt water or anything else is going up into your sinuses, or you get a salty taste in your mouth or back of your throat, then that would indicate a perforated sinus. If that were to occur, don't panic. Most sinus perfs are small and heal on their own.

You should be rinsing 3-4 times a day with salt water... but no more than that and try to refrain from blowing your nose until another week just as a precaution.

I know this can be scary.. but it sounds like you're probably healing ok.

Bryanna

Hi Bryanna,
Thanks your reply. No salty taste in the mouth or the back of the throat. I rinse after every meal and before bed. Usually about 4 or 5 times depending on what I eat. I was not given a syringe and told to clean it after I eat. I will see him tomorrow at 2:30 I just hope for good news and I will keep you informed.
Thanks
Nicole

Hi Bryanna,
So I went to the dentist today and told me I felt the air and he looked at it and said it looked great. He did a test for a sinus perforation. He squirt water into the socket and pinched my nose and had me blow out. I did feel bubbles and he said he did not see anything. He did it many times. I was scared to blow hard so I did blow but not hard. He said even if I never mentioned anything to him, and there was it would be so small that it will heal on it's own. He said we can do another test next week when he sees me again to check it. He did not seem concerned at all about it. He said if it was they type that needed surgery you would see other things going on and he would be able to see it. He assured me that this will all heal and I will be myself again one day soon. I was just so concerned about the sinus issue. But doubt i blew hard enough..
Nicole

To help you feel more reassured, it wasn't necessary to blow hard to evaluate the sinus. You did fine. If there is a small opening it will most likely heal on it's own.

Just continue to do what you've been doing... ok :)

Bryanna

Hi Bryanna,
Well I went to see an Oral surgeon today, Board certified everything and I have seen him in the past so the trust is there. He did a panoramic and said no nerves or anything is left in the sinus. I still feel air going up and down and he did the test again and you can actually hear the air hissing out of me. I immediately started crying and getting upset and he told me to not get like that because even though it has been 5 weeks I had a dry socket on top of it and the hole (gum) is closing. He said that normally these can take a while to close up and that the pain in the nerve area 2 teeth down is referred pain and once the gums mold back to the way the they are supposed to be that should diminish ( i hope so). He gave me an antibiotic and a decongestant and said to see him in one week. He wants to treat this from the beginning and keep everything clear and dry. I still have stiffness in the gums and tightness but that means the gums are healing I hope. Everything else looks fine and he kind of implied that this would have happened regardless of who took it out because of the way the roots were, but who knows.
In your experience how long can one of these really take to close? He said give it a few weeks I guess the 10 days of antibiotics and decongestants and he said we will see how things are than. He explained the procedure to fix it and he gave me the impression that it is fairly simple. He also said it is rare for them not to close on their own because he does feel it is small.
I feel better about everything I am just so scared and concerned. I feel like now I am fighting 2 things. The healing gums and nerves of a dry socket and now a sinus communication.
Thanks
Nicole

Hi Nicole,

If it is a small perforation and there is no infection in the bone or sinus, it most likely will heal on it's own. The antibiotic is given to hopefully clear up any residual bacteria from having the dry socket. The decongestant is given to reduce the sinus inflammation so the perforation can close.

Small sinus perforations are common when an upper back tooth is removed....especially if a dry socket developed.

You can help with the healing if you... keep your mouth clean by brushing and flossing, rinse a few times a day with warm salt water only.... no mouthwash that contains alcohol/dyes/preservatives/essential oils, drink plenty of water throughout the day, and take the antibiotic and decongestant. Taking a probiotic daily would also be helpful, especially since you are on the antibiotic. Just take one probiotic a day, 2 hours before or after the antibiotic. I recommend to our patients the probiotic called Culturelle... it can be bought at most drug stores or online.

I know this is a bit scary, but it can take several weeks to heal...and that's ok, it's going to be ok :)

Bryanna

Bryanna,
I have a quick question. I did something stupid today. As you know I have the sinus communication and am recovering from the dry socket which of course has healed by now. I felt lightheaded so I checked my sugar, I do not have diabetes I have hypoglycemia and it was 66. I grabbed a Capri sun sucked through the straw and realized what I did and put it in a cup. When I sucked nothing came out my nose but I am petrified that I did something to then membrane if it was healing. I read on the Internet that sucking through a straw is a no no. My oral surgeon just said no nose blowing and sneezing and to do so with your mouth open but did not mention a straw. I have taken it upon myself for almost 6 weeks to not use one. Do you think I messed up whatever was healing if it was healing at all ? I look forward to your answer.
Thanks
Nicole

Hi Nicole,

Generally it's ok to drink through a straw, occasionally, 6 weeks after an extraction involving a small sinus perforation. If everything feels the same as it did prior to using that straw, then you're probably ok. I wouldn't worry about it. If you develop symptoms of the perforation being open, then see your dentist. But really, chances are slim that you did any harm.

Ok...... ?
Bryanna

Hi Bryanna,
Wanted to give you an update. Saw the oral surgeon today and he said it looks good and he did a test again. This time no air came out when I blew he said he did not see anything and I do not feel air going up or out the socket. He said that these 95 percent of the time heal on their own but take a while. He wants to see me in 2weeks. At that time he will see how the hole looks.he said it is still red and wants it to be pink. I am not sure what he means by that. The hole is red now but I think it is red before it is pink is that right? It is almost closed is that what he wants to see? Sorry for all the questions. I know this is good news but I am still down cause today it is tender and my tooth two teeth from the site, the one next to the extraction site is not there is still sensitive when I speak. I am not so sure it is even the tooth anymore and it is just coming from the site. Did you ever hear of anything like that? Both the dentist and the oral surgeon said it is referred pain and once the hole has closed the nerves should calm down. I am just having such a hard time being positive. I can't see what is going on like if you cut yourself you can see the wound, I can't see a oaf and I don't understand the nerves in your mouth. I have been dealing with this since august and am just frustrated. Thanks for your ear. I did ask if being 6 weeks is a long time for this to heal and he said no they take time. I have read how some oral surgeons just go in and fix it instead of letting the body try to heal on it's own so I respect him for that

Hi Nicole,

The oral surgeon is right, small sinus perforations usually heal on their own. The dry socket is actually more of an issue than the sinus perf because it takes a long time for the bone to recover from the infection and then fill in properly. The surgical site will close before the bone actually heals. This is normal and not anything to worry about. If a few months or so down the road you develop pain in that area, then it would need to be evaluated with an xray to see the condition of the bone. Otherwise, an xray taken at one of your dental hygiene appointments in a year or so is adequate enough to show how well the bone has healed.

Yes, the tissue will look red before it turns pink. And yes, you could be experiencing referred pain in other areas because nerves basically run in bundles which connect to other bundles of nerves. Hope that picture gives you a better idea of why other areas might be uncomfortable or sensitive. As the bone heals, the inflammation within the bone will subside and the nerves will calm down.

It sounds like things are doing ok.... try not to worry. :)

Bryanna

Bryanna,
You are so sweet and comforting. I thank you so much for your help. I have 2 more questions and than the next time I write will be with the end result of this all. Both dentists oral surgeon and regular said they wanted the tissue pink. They are a little concerned it was still red but the dentist said sometimes it never turns pink and stays that way till it is healed. The oral surgeon did not say this but I got the impression that it is not good it is red and maybe because of the sinus perforation. I could be wrong on that one. What do you think on that? The hole closed more last night and is not that big anymore but I think until it is healed over I will continue to have sensitivity so I will accept that. The other thing is when I speak I feel sinus pressure in the middle not on any side. I just feel stuffy. I am in Ny and the weather here is really bad the last few days. It is raining all the time, very humid and muggy and I feel every sinus issue is contributed to the hole. A nurse told me you don't feel anything with a perforation and many people do not know they have it so she does not think that has to do with the hole and just with my sinuses. What do you think? Bryanna you have been a huge help to me and I will let you know how this ends. Thank you. I am scared because I think that down the road I will have issues but that is just fear. But the dentist who performed the extraction was terminated by the practice because of this situation. I don't think because of the way it was done I think because of the lack of compassion and the dismissal attitude he displayed. But that also makes me think hmmmm?









UOTE=Bryanna;808609]Hi Nicole,

The oral surgeon is right, small sinus perforations usually heal on their own. The dry socket is actually more of an issue than the sinus perf because it takes a long time for the bone to recover from the infection and then fill in properly. The surgical site will close before the bone actually heals. This is normal and not anything to worry about. If a few months or so down the road you develop pain in that area, then it would need to be evaluated with an xray to see the condition of the bone. Otherwise, an xray taken at one of your dental hygiene appointments in a year or so is adequate enough to show how well the bone has healed.

Yes, the tissue will look red before it turns pink. And yes, you could be experiencing referred pain in other areas because nerves basically run in bundles which connect to other bundles of nerves. Hope that picture gives you a better idea of why other areas might be uncomfortable or sensitive. As the bone heals, the inflammation within the bone will subside and the nerves will calm down.

It sounds like things are doing ok.... try not to worry. :)

Bryanna[/QUOTE]

Hi Nicole,

Well thanks for the kind words... I really just want to be of help if I can ;-)

Generally red gum tissue indicates inflammation or bacteria. In your case, it could be that or it could be trauma from all that that little area has been through. I don't think it is related to the sinus perf. It may not change to pink... but I think eventually it will.

Feeling pressure in your sinus when you talk.....perhaps that is inflammation of the sinus cavity from all this damp, humid weather. I'm in NJ and we are dealing with the same crap here. Have you tried taking an OTC decongestant? A supplement that is helpful with sinus issues is called Quercetin. Here is an informative website about what it is..
http://www.quercetinguide.com/
The product that I am most familiar with and recommend to others is made by Jarrow Formulas and it's time released capsule.

I hate to disagree with the nurse, but a sinus perf can be felt if it is causing an airflow from the nose to the mouth that wasn't present prior to the procedure. Some tiny perfs close so quickly that this physical symptom never occurs... in that case, no a person wouldn't be aware of it.

I think you are healing and it is going to take more time than you would like it to. Just be mindful of what you are eating, drinking and be diligent with your oral hygiene while on vacation. Definitely have a fabulous time wherever you are going... hopefully it's warm and sunny.... and let the healing happen ;-))

Please let us know how how you're doing when you get back!
Bryanna



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Hi Bryanna,
I did not go away, I was just not going to write until the site healed because I think I am feeding this by talking about it. I feel a little better today which is great, the site is not so sensitive when I touch it with my tongue so that is good. There are times when I feel pressure when I talk still but that might be because my socket is still red. I don't know. I am so sick of this ordeal that I wish I could crawl in a cave and cry, but I have 2 small kids and I have to force myself to be strong. When I am alone at night that is one thing. My husband is a great guy who is so positive and he feels everything is going to be fine but he is not going through this. I am petrified to go Monday to the oral surgeon. There are a few good things that did come out of this and that is learning to be patient and understanding, exploring my faith, and I lost a ton of weight. I know this has to end eventually that is the body's way but it is getting there that is the battle. I don't want to blame anybody for this I just want it done.. I am really scared that there is a hole in the bone not just a small puncture. I am worrying about everything, and there could be nothing there anymore.. Uggg.. The positive is that I never got a sinus infection yet, no ear pain, facial pain, swelling, liquids out of the nose and I can't suck air up it or down it anymore. Also all day I had a weird taste in your mouth like blood and I have not noticed that for a few days. I hope my posts at least get to help someone else who is going through something like this.
Bryanna, will a dental ct scan show anything and before the oral surgeon goes in if he has to what does he go on do you know? Is it the panoramas he took? I just don't want him going in and finding out it is clothes and I am subjected to more pain.. Thanks for your ear..
Nicole






[/QUOTE]

Hi Nicole,

I understand what you are saying.... completely. I counsel people every day and your fears, questions are very, very common. The only reason that I am able to look at this situation less fearful than you is because I have seen it from the surgical aspect so I am aware of the "unknowns" and the "potentials". To be fair to yourself, you cannot possibly imagine what this site looks like as it is healing because you cannot see it and the complications that you have experienced have left you feeling uncertain and fearful of the worst. From what your recent posts... it sounds to me like it is healing and it's just going to take some time.

I don't see why the oral surgeon would need to go into that site based on what you have described here. At this point, it is best to allow it to continue to heal rather than disturb it. I think that will be the outcome of your visit on monday.

I'm sorry you didn't go away :-(... I hope you can reschedule your trip to another time very soon.

Please try not to worry, you're doing everything right.... it will be ok =)

Bryanna




[/QUOTE]

Hi Bryanna,
So this is the update. I went to the Oral Surgeon for a follow up yesterday. He said it looks better, did the nose blow test and that came out negative. He thinks the sinus communication or OAF is healed. He gave me 3 more weeks. He said that in 3 weeks if the hole is not closed or it is still red then he will have to go in and clean it out. He said there is a chance that a sinus perforation can happen again because he does not know how deep he has to go to clean it and then he shook his hand and said it is a simple procedure if it needs to be done, do not worry about it and we will see in 3 weeks. So I go back the 24th of October. So this is good news, but why do I doubt the answer to the closure of the sinus communication? I think because I feel some pressure but I do not know if it pressure it is like a hard feeling when I say certain consonants and different times not all the time and may not happen for a day. I developed a bone issue on the tip of the gum around the socket. I feel a sharp piece of bone under my gum and it is pointy. He said it might go away and it might not. It is the way the bone healed. He said that he can fix that ( the procedure) but it sounded very painful. He asked if it hurt and i told him no, but it is very annoying and noticeable. If it does not go away it has to be cut and scraped down and that does not sound pleasant. He said he will not do anything until this other issue is fixed and healed up. As long as it does not hurt me, it has to wait. I respect him. He is not quick to jump to anything and you were right about the outcome of the visit.
I am the type of person who needs concrete proof that something is either fixed or is healing and I know you can appreciate that. My original dentist has a i-cat GXCB-500 in his office. Is this a dental ct scan and could this show if the bone has been comprimised and would it show a sinus communication?This seems like a high tech machine so I was going to ask him if he could do it if we could actually see the sinus area and if it was hurt in anyway. Do you know about this?
Also about this bone issue.. Did you know of anyone who ever had this done (the bone being scraped) and if so was it really bad?
Bryanna,
Thanks for your time and your help.
Nicole









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Hi Nicole,

Well, the sinus perf can take a really long time to fully heal. It is good that he is checking again in 3 weeks. Time will tell, that's all you can do right now.

With regard to the bony edge, this is a small splintering of the jawbone during the extraction. Sometimes this takes care of itself, other times it has to be removed and smoothed down. If it is very small, then it's not a horrible procedure.

It sounds to me like the OS is taking a conservative approach and that is good! He want's everything to heal nicely so he's careful not to disturb anything.

The I CAT scan can be diagnostic with regard to the sinuses, however, at this stage it will most likely show a healing perf and since the bone has not yet filled in from the extraction completely... it will show less dense bone than you have in other areas. So unless you are having increasing problems in that area, I would say wait on that scan and see what occurs with the OS in 3 weeks.

Hope you find this helpful ;-)

Bryanna


[/QUOTE]

Bryanna,
Hi Ya How are you? So update is I had the surgical debridement done and when he was in there he poked up with his tool and said the he feels all bone around and that the perf is closed. It has also healed very well, all pink. Sometimes I still wonder if it is open but he told me that I did not need to come back so as I take that as everything is ok. There is no inflammation, no redness, no sensitivity and is very pink and does not hurt when I eat on the extraction so I tak that as it is all good.. FINALLY !!
Well now this happened. After this was all said and done, I made an appt with a new dentist for a check up because the one tooth that stands alone is still sensitive. The morning of the appt my back crown fell off and I was like oh great this is not good. So I had a full mouth of xrays done and the tooth under the crown is fractured. So here comes another extraction and to boot the one next to it needs to come out also because it has an absess but it has been there a while. I knew the tooth would eventually need a root canal but I think i waited to long. I will discuss it again with her on Monday. I also have a tooth on the lower left side (bicuspid) that cracked about 8 months ago and the dentist (old one) filled it and she said that was very bad dentistry. She pretty much told me that all my work (not counting my bridege cuz it is 11 years old) is bad dentistry and that is why it does not last.
I know how you feel about root canals but I made the decision to do it because i can't afford to lose any more teeth and my new dentist told me it needs to be done right to last. Well at first she said i might just need a crown she will not know until she gets in there. Well we started yeaterday and it did need a RC, so she cleaned it and opened it to do it today. I went today and she was awesome. Took her time, very ****, a perfectionist. Took numerous xrays and showed me it when it was done. She got all the canals and the very very top of the tip and she said many dentists and endodontists miss this and that is why they fail. She said it was a beautiful root canal. We did not have time to do the shaving and temporary today that will done Monday. i never had a dentist take their time with me it was always boom boom your out. She said she does a rotary root canal. Many dentist do not do this because the equipment is very expensive she told me. It was by far the best one i have ever had and she was so gentle and patient.
The only issue is that yesterday after the novocaine wore off I still felt very tight and it felt like it was still numb all the way down in the gum but when I touched my face it was not numb. When I mentioned it to her today she had me show her and she said that is the injection site. Is this normal? I never felt this before when I had a root canal.i am a bit swollen but I also had about 9 shots because i could not get numb and during the procedure I needed more novocaine because I started to feel it.
So my question is is that feeling normal and will it go away? and is the swelling from the shots?
Also I am petrified of the extractions and getting a dry socket. My dentist told me that they are not difficult ones and being that the oral surgeon not the dentist is doing it I should be fine. He will stitch it and that will help with the bleeding and it should be fine. There are so many horror stories with dry sockets and even though I had a top one I did not have any pain with it.
Wow this is long. Sorry Bryanna but you helped me through the first time and am looking for your guidance this time also. I just want this facial feeling to go away, I don;t want to be like that forever.
TY
nicole