The 2 Extraction Domino Effect
 

Hello. On Jan. 15, I had teeth #17 & 18 extracted. The molar had fractured under its crown and the other was a horizontally-positioned wisdom tooth; there was some infection brewing between the two teeth as well.

The healing process seemed pretty much uneventful; I wound up with a dry socket, had it packed twice and the oral surgeon commented that things were healing up nicely. However, pain that I had attributed to the dry socket began to increase; after a few days of waiting for it to resolve and taking the prescribed meds for pain, I went back in to see the oral surgeon.

He examined the area and explained that the "tissue wasn't healing correctly" over the extraction area. The only lay person way to describe the tissue was that it was blob-like and it looked as if it was rebelling against what it was expected to do naturally. The surgeon said he needed to open the area, debride it and then take biopsies; due to his busy practice, the first appointment that he could get me in was a full week out.

I counted down each day with anticipation---I was so uncomfortable and in such freaking pain. On the day of the surgery, I looked at the area one last time, and noticed that the area had grown more since the surgeon had examined the tissue a week ago. It was primarily pink with a little pinkish white at the ends.

After the surgery, I didn't have a chance to speak with the doctor about what his impressions were, but the nurse assured me that the biopsies were on their way and that it would take 2 week to get the results. I have a follow-up appointment scheduled with him this Thursday, March 12th to check on the surgery area---the biopsies won't be in until March 10th.

As I sit hère and type this note, I am still in pain. Pain in my mouth, jaw; on the outside of my cheek it's warm to the touch and I do get relief by applying a cold pack. My cheek is yellow in that same area; it looks as if a bruise is in it's healing phase. Part of the pain can be attributed to getting what I think is yet another dry socket, which I will have to have packed tomorrow. I am afraid to admit that the other pain that I feel is similar to what I felt the last time around---prior to noticing that the tissue wasn't healing correctly.

As of tomorrow, I will have taken a total of 25 days worth of the Clindamycin. I
have also been on a high-quality probiotic as well in order to preserve the rest of my system. :) I guess it's safe to assume that the antibiotic isn't kicking whatever it is that's kicking my mouth/tissue/jaw area. I'm allergic to penicillin and bactrim---maybe there is something else that could help eradicate this stuff…germ, bacteria, etc…...

I realize that once the biopsy results arrive, the surgeon will have a clear idea of what is going on with me and we'll develop a plan of attack-----but I am really concerned because I haven't a clue what to think about everything that's been going on. I also fear not getting relief from all of this discomfort…it's hard to find anyone who'll really speak up with a solid, professional opinion and that scares me.

*One other footnote worth sharing. Several days after I had the extractions done, I was scheduled for my regular 6-month cleaning and check-up with my dentist. I explained to her how I was feeling and I described the pain that was creeping in… She picked up one of my x-ray films that they had just taken and pointed to this vertical thing that was very clear. She said "maybe this is your problem." I didn't know what to say because when I normally look at x-rays I don't see much. :) Anyhow, it resembled the lead from inside a #2 pencil---a short little piece for sure. When I explained what my dentist had shown me on an x-ray taken a few days prior to my visit to the oral surgeon, he never said a word, nod his head, or anything. He didn't even look at me. ??? Did I miss something?

I apologize for being so long-winded. Thank you for reading this post. Take care! Laughter

Hi Laughter,

I am in the dental field and can offer you some information here.

You obviously have had some post op complications following the extraction of both teeth which was attempted to be addressed. However, the initial attempt was unsuccessful and then the lag time until the second debridement was not ideal in that you had obviously developed further granulation tissue. The pain must have been awful!

It sounds like this surgeon is awfully busy and may not be spending enough time with you and he really should be explaining the situation better. It is good that he did the biopsy, hopefully he took a specimen for a bacterial culture so that the proper antibiotic can be prescribed.

It is normal for the site to be sore and tender for a few weeks post op. But the actual pain should be less after the 3rd day post op and continue to decrease thereafter. It is normal to have some facial bruising which will go away in a week or so.

Make sure that the surgeon knows the full extent of the location, duration and type of pain you are experiencing. If it seems like he is not taking this too seriously, then perhaps it would be wise to seek an opinion from a different oral surgeon, one that is not associated with the treating surgeon.

Regarding the clindamycin... it is a very powerful antibiotic. It may or may not be the proper antibiotic for this infection. So hopefully the surgeon had a culture done that will determine what antibiotics are best to treat the bacteria. Clindamycin is one of many antibiotics that has the potential to cause an intestinal infection called Clostridium Difficile or C.diff for short. This is a serious infection and can occur even weeks after you stop the drug. It is not a good idea to be on this for any long term unless it is absolutely necessary. Continue on the probiotic ideally indefinitely as you not only need to retain some healthy bacteria in your gut but you need to replenish what is being killed off by the meds.

Just a note about your 6 month dental visit... if the surgical site of the two extractions was still open at that visit, the hygienist should not have cleaned your teeth. That is not something you would have known, but she should have known better. If that were the case, then the cleaning should have been postponed until the sites were closed.

Regarding what the hygienist saw on an xray at your hygiene visit... it sounds like there is either a bony fragment that may have fractured off of the jaw bone during the extractions which means a piece of splintered bone is lodged in there ... and/or the image on the film could have been a piece of tooth that fractured off and was not removed. Either of those things can cause or contribute to improper healing of the extraction sites and infection. The oral surgeon should not have shrugged this off. He should have evaluated it further and spoke to you about it. The fact that he seem to dismiss it, concerns me because he knows the importance of being thorough with his oral surgery and if he left anything behind, he needs to inform you of that and be diligent in taking care of it.

I think you are trying to be nice and go along with whatever is being done. However, I think it would be wise to be a little bit assertive with the oral surgeon and expect some answers about the delay in healing and question what that image was/is on that xray. It is imperative that the surgical sites be clean of all fragments of the teeth and diseased tissue including the periodontal ligaments and any visibly unhealthy bone. Ask him out right... if he did those things. Anything shy of doing those things is not acceptable and can further the infection.

If the oral surgeon does not have that new xray... get a copy and bring it with you when you see him.

Hope this information helps.

Bryanna

Laughter,

Thank you for the kind words :)

I didn't mean to imply that you were being a chicken.... it's okay to be a chicken :) My intention was for you to take a hold of the situation as I felt you were being jerked around a bit.

I am re posting the biopsy report and answering in bold type.

<<"Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious.">>

INTERPRETATION:
AN EXTENDED OR EXPANDED AREA OF THE LOWER JAW BONE AND TOOTH SOCKET IN THE 3RD MOLAR REGION. CONTAINING DEAD CELLS AND A HOLEY APPEARANCE WITH UNDEFINED MARGINS OF THE MEMBRANE COVERING THE BONE. IN OTHER WORDS YOU HAD A TOOTH OR TWO REMOVED, IT WAS A TRAUMATIC EXTRACTION MEANING FORCEFUL AND THE SOCKET WAS NOT DEBRIDED THOROUGHLY.

THIS BIOPSY CONFIRMS INFECTION AND INFLAMMATION REFERRED TO AS OSTEOMYELITIS AND MYOSITIS.

IT ALSO INDICATES THAT YOUR MASSETER MUSCLE, THIS MUSCLE IS USED TO OPEN AND CLOSE YOUR JAW, IS ALSO INFLAMED. THIS COULD BE FROM THE SURGERY, THE INFECTION AND/OR YOU ARE GRINDING YOUR TEETH.

<<It also said "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension.">>

INTERPRETATION:
YOU HAVE SWOLLEN LYMPH NODES SCATTERED ON BOTH SIDE OF YOUR NECK. LARGER ONES ON THE LEFT SIDE WITH 2 OF THEM BEING PREDOMINANTLY LARGER THAN THE OTHERS.

IN OTHER WORDS, YOU HAVE AN INFECTION AND YOUR LYMPHATIC SYSTEM IS TRYING TO DEAL WITH IT. THE INFECTION WAS LIKELY PRESENT LONGER THAN YOU MAY HAD REALIZED PRIOR TO HAVING THOSE TEETH REMOVED. SO THIS WILL TAKE TIME TO SUBSIDE COMPLETELY.

<<The biopsy results were also in and here is what it says:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.>>

EXACTLY, OSTEOMYELITIS MOST LIKELY DUE TO LONG TERM INFECTION AND INFERIOR DEBRIDEMENT OF THE BONY SOCKET WHEN THE TOOTH WAS REMOVED.

THIS IS WHY I CANNOT STRESS ENOUGH TO EVERYONE.... MAKE SURE YOU TELL YOUR ORAL SURGEON TO BE THOROUGH WITH THE DEBRIDEMENT!

<<Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.>>

INTERPRETATION:
LOWER MANDIBLE 2ND AND 3RD MOLAR REGION.
SEVERAL SPECIMENS OF VARIOUS TEXTURE, COLOR AND SIZE WITH SOME BONE ATTACHED TO THEM.

IN OTHER WORDS... DEEP BONE INFECTION WITH BUMPY GRANULATION TISSUE AND INFLAMMATION OUT THE YING YANG!

So you had a severe infection brewing in that area prior to the extractions and even after the extraction due to an incomplete debridement of the bone. The cause of the infection, the teeth, were removed but the site was not able to heal properly because the infected tissue had not been removed. Given the lapse of time before the site was finally debrided, the infection went deeper. Hopefully you are on the mend now. Another thing that disturbs me is that there was no bacterial culture taken according to this biopsy report. Which is just plain irresponsible because that would have determined the proper strain of antibiotic to use. Were there any other reports with this one?

<<Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.>>

FORGET SURGEON #1.... HE COULD HAVE DONE A BETTER JOB. BEING IN A HURRY WHEN PERFORMING ROUTINE ORAL SURGERY IS NOT ACCEPTABLE AS FAR AS I AM CONCERNED. THE HEADACHES, RANDOM ACHES AND PAINS COULD BE DUE TO THE INFLAMMATION FROM THE BONE AND MASSETER MUSCLE. ARE YOU GRINDING YOUR TEETH?? IF SO, I SUGGEST THAT YOU APPLY WARM MOIST HEAT ON THE LEFT SIDE OF YOUR FACE, HEAD AND NECK TO ENCOURAGE BLOOD FLOW AND REDUCE INFLAMMATION. ESPECIALLY BEFORE YOU GO TO SLEEP AT NIGHT.

THE LYMPH NODES CAN REMAIN TENDER FOR SEVERAL WEEKS. THE LYMPHATIC SYSTEM IS DOING ITS JOB OF RIDDING YOUR BODY OF THE TOXINS FROM THE INFECTION. HOWEVER, YOU NEED TO MONITOR THE SEVERITY OF THE TENDERNESS AS TO IF IT IS GETTING BETTER OR NOT. IT SHOULD GRADUALLY IMPROVE UNTIL COMPLETE DISSIPATION. IF IT SEEMS LIKE IT'S NOT IMPROVING OR IT'S GETTING WORSE THEN SEE YOUR ORAL SURGEON #2, NOT OS #1, AND POSSIBLY YOUR PHYSICIAN FOR A WBC AND SED RATE BLOOD TEST.

Hope this info helps. Please keep us posted...

Bryanna

Hello Bryanna,

I appreciate your very helpful response. Yes, I am a chicken---I have the feathers to prove it and I have a pretty impressive “Bock, bock, bock” when it's called for! :)

I understand the concept of being jerked around a bit; I can tell you that based on the things that have taken place, it's clear that someone was in a hurry, took shortcuts and then someone else was assigned to clean up the mess. Your detailed information has made me realize that neither oral surgeon did what was expected of him from a very logical, thorough approach. Maybe they are overbooked; on their way out of town for a month; too booked to have a patient come in right away for a procedure that will relieve them of pain galore (yes, that unhealthy granulated tissue HURT, SQUARED) ; not thinking of and doing everything possible (like taking a bacterial culture during surgery) to assure the best outcome for the patient. But those are the types of unacceptable issues you address and prevent from taking place in your business especially since you're dealing with people's health. Ok, now I'll calm down. :)

From my CT results: "Impression:
An expansile irregular cavity in the left mandible in the socket of left and third mandibular molar with lytic and permeative appearance of the outer cortex and periosteal reaction in view of history of recent procedure this finding is compatible with an intermediate/infectious process like osteomyelitis. Subtle asymmetrical prominence of the left masseter with inflammatory stranding of the overlying soft tissues is also likely related to myositis which could be reactive or infectious." <---for some reason, Surgeon 2 had a problem with that statement while reviewing the CT results. He said “What is could be? Is it either reactive or is it infectious???”

Bryanna breaks it down: INTERPRETATION:
AN EXTENDED OR EXPANDED AREA OF THE LOWER JAW BONE AND TOOTH SOCKET IN THE 3RD MOLAR REGION. CONTAINING DEAD CELLS AND A HOLEY APPEARANCE WITH UNDEFINED MARGINS OF THE MEMBRANE COVERING THE BONE. IN OTHER WORDS YOU HAD A TOOTH OR TWO REMOVED, IT WAS A TRAUMATIC EXTRACTION MEANING FORCEFUL AND THE SOCKET WAS NOT DEBRIDED THOROUGHLY.

THIS BIOPSY CONFIRMS INFECTION AND INFLAMMATION REFERRED TO AS OSTEOMYELITIS AND MYOSITIS.

IT ALSO INDICATES THAT YOUR MASSETER MUSCLE, THIS MUSCLE IS USED TO OPEN AND CLOSE YOUR JAW, IS ALSO INFLAMED. THIS COULD BE FROM THE SURGERY, THE INFECTION AND/OR YOU ARE GRINDING YOUR TEETH. I looked up where the masseter muscle is located and NOW something else finally makes sense. During my one follow up appointment with Surgeon 2, I complained about (what felt like) a big hard bump on the inside of my mouth. It felt as if I had stuffed the inside of my cheek with something solid but I couldn't remove it. That issue was brand new---and most definitely due to the surgery somehow. I've never felt anything like that before or since. Anyhow---the masseter muscle is EXACTLY where the issue is... Surgeon 2 examined the area I was pointing to and said that it was just scar tissue that I had accidentally bitten over a long period of time. Wow. The good news is that it isn't as “tight” as it originally felt.

From my CT results: "Multiple reactive lymph nodes are noted bilaterally scattered throughout the neck, more pronounced on the left. The largest level 1B lymph node measures 1.7 cm in the longest dimension. Another large left 2A lymph node measures 1.8 cm in the longest dimension.">>

Bryanna breaks it down: INTERPRETATION:
YOU HAVE SWOLLEN LYMPH NODES SCATTERED ON BOTH SIDE OF YOUR NECK. LARGER ONES ON THE LEFT SIDE WITH 2 OF THEM BEING PREDOMINANTLY LARGER THAN THE OTHERS.

IN OTHER WORDS, YOU HAVE AN INFECTION AND YOUR LYMPHATIC SYSTEM IS TRYING TO DEAL WITH IT. THE INFECTION WAS LIKELY PRESENT LONGER THAN YOU MAY HAD REALIZED PRIOR TO HAVING THOSE TEETH REMOVED. SO THIS WILL TAKE TIME TO SUBSIDE COMPLETELY. I had an appt. with Surgeon 2 today (3/19). He told me that he wants me to take a copy of the CT results to an ENT and ask him to look at the lymph nodes. He said that he was pretty certain that the ENT wouldn't need to do anything whatsoever, but that it'd be good for me to go to see one (I swear, I'm not making this up. Lol).

From my biopsy results:
Clinical History:
Pre-operative Diagnosis: Granulation tissue. Non-healing socket.>>

Bryanna breaks it down: EXACTLY, OSTEOMYELITIS MOST LIKELY DUE TO LONG TERM INFECTION AND INFERIOR DEBRIDEMENT OF THE BONY SOCKET WHEN THE TOOTH WAS REMOVED.

THIS IS WHY I CANNOT STRESS ENOUGH TO EVERYONE.... MAKE SURE YOU TELL YOUR ORAL SURGEON TO BE THOROUGH WITH THE DEBRIDEMENT!
I have a question; if the debridement process is successful/done right, is it capable of removing all of the osteomyelitis?
Would it have been a good idea for Surgeon 1 to take a bacterial culture during the original extraction procedure? (Honestly, I had never heard of debridement until a month ago; obviously, I had no idea that it was a part of having an extraction done. I really do learn something new all the time...). :)

From my biopsy results: Gross Description:
Source of specimen: area #17 -18. The specimen consists of a 2 x 1.6 x0.4 cm
aggregate of gray-tan soft tissue fragments. There are also seven gray-white fragments, 0.2 to 0.5 cm. The bone fragments are retained.
Diagnosis" Area 17-18: Abscess and subacutely inflamed granulation tissue.>>

Bryanna breaks it down: INTERPRETATION:
LOWER MANDIBLE 2ND AND 3RD MOLAR REGION.
SEVERAL SPECIMENS OF VARIOUS TEXTURE, COLOR AND SIZE WITH SOME BONE ATTACHED TO THEM.

IN OTHER WORDS... DEEP BONE INFECTION WITH BUMPY GRANULATION TISSUE AND INFLAMMATION OUT THE YING YANG!

So you had a severe infection brewing in that area prior to the extractions and even after the extraction due to an incomplete debridement of the bone. The cause of the infection, the teeth, were removed but the site was not able to heal properly because the infected tissue had not been removed. Given the lapse of time before the site was finally debrided, the infection went deeper. Hopefully you are on the mend now. Another thing that disturbs me is that there was no bacterial culture taken according to this biopsy report. Which is just plain irresponsible because that would have determined the proper strain of antibiotic to use. Were there any other reports with this one? No other reports are available. I can only assume from that and the fact that Surgeon 2 has never made a comment regarding a bacterial culture.

<<Fast forward to today. Since my last appt. with Surgeon 2 (Surgeon 1 hasn't returned yet), I have had a bit of pain/discomfort. I am getting headaches focused mostly on the left side (which is where the teeth were extracted); I feel random aches in my jaw/mouth area. The most bothersome is when the lymph nodes in my neck ache---last night they woke me up while I was sleeping. I am assuming that my jaw/nerves/you name it are all trying to get back to normal and it will take a while.>>

FORGET SURGEON #1.... HE COULD HAVE DONE A BETTER JOB. BEING IN A HURRY WHEN PERFORMING ROUTINE ORAL SURGERY IS NOT ACCEPTABLE AS FAR AS I AM CONCERNED. THE HEADACHES, RANDOM ACHES AND PAINS COULD BE DUE TO THE INFLAMMATION FROM THE BONE AND MASSETER MUSCLE. ARE YOU GRINDING YOUR TEETH?? IF SO, I SUGGEST THAT YOU APPLY WARM MOIST HEAT ON THE LEFT SIDE OF YOUR FACE, HEAD AND NECK TO ENCOURAGE BLOOD FLOW AND REDUCE INFLAMMATION. ESPECIALLY BEFORE YOU GO TO SLEEP AT NIGHT. Bryanna, I have never been known to grind my teeth at night. I have no reason to think that I ever have nor has anyone ever told me I did...I have known people who did grind their teeth during the night and it made me about pass out. lol

THE LYMPH NODES CAN REMAIN TENDER FOR SEVERAL WEEKS. THE LYMPHATIC SYSTEM IS DOING ITS JOB OF RIDDING YOUR BODY OF THE TOXINS FROM THE INFECTION. HOWEVER, YOU NEED TO MONITOR THE SEVERITY OF THE TENDERNESS AS TO IF IT IS GETTING BETTER OR NOT. IT SHOULD GRADUALLY IMPROVE UNTIL COMPLETE DISSIPATION. IF IT SEEMS LIKE IT'S NOT IMPROVING OR IT'S GETTING WORSE THEN SEE YOUR ORAL SURGEON #2, NOT OS #1, AND POSSIBLY YOUR PHYSICIAN FOR A WBC AND SED RATE BLOOD TEST. Question; What would each blood test reflect? The WBC would show if there was any infection, right? I will definitely have those tests done at the Internists appointment.

Hope this info helps. Please keep us posted... Bryanna

Based on your advice, I decided to work with Surgeon 2 and forget about Surgeon 1 altogether. My appointment today with Surgeon 2 was scheduled because I wanted to make sure there wasn't any infection taking place and that I wanted to update him on how I've been feeling. We are 2 weeks out from the surgery.

I said that I had a decent amount of pain whenever I ate, sometimes drank and whenever I yawn.
I showed him where my mouth, jaw, side of face and ear aches on occasion and hurts on and off as well. I told him that I have been experiencing frequent headaches which are more intense on the left side of my head.
He asked if any of it woke me up through the night and I told him that the lymph nodes in my neck do.
He examined me for any signs of infection; he said that he saw nothing that would lead him to believe that infection was present. He said that he took a lot of time with me and made sure he got everything out that needed to be removed.
He asked if I was taking anything for the aches and pains. I told him that I take either Tylenol, Motrin or the Norco he prescribed as needed.
He asked for me to be patient. He doesn't want to go back in surgically unless he “knew what he was looking for.” He wasn't going to prescribe antibiotics just in case there might be an issue that isn't visible. He asked for me to give it 2 weeks and to come back in to see him. He said that he hopes by then I will be just fine.
He said if I had trouble between now and then to not hesitate to come in...

He asked me to go see an ENT (I mentioned that in the CT results area above).

He also asked me to see my Internist regarding a non-dental related comment on the CT results.
“Incidental note made of azygous lobe in the right upper lobe of the lung. There is an ill-defined 1.4 cm lymph node in the superior mediastinum in the right paratracheal region.”

That's about everything that I can share at the moment. It goes without saying, but I'm open to any feedback whatsoever.
Thank you again for listening and for helping me to better understand what the heck is going on. :)

~Laughter (Bock, bock, bock)

Hi Laughter,

I've been known to cluck a time or two.... ~:>
I always take fear and apprehension seriously whether it be coming from myself or someone else! I think kindness and competency of those in charge of the situation go a long way with us <<chickens>> :)

Your question about osteomyelitis.... When an infected tooth is extracted there is no guarantee that the bone will be completely healthy once it has healed, especially if the infection was long standing. So it is always best to have a thorough debridement of the bony socket and ideal to do that at the time of the extraction to give the patient the best chance of a positive outcome. It is also ideal to have a culture of the bacteria taken at the time of the extraction so that the proper antibiotic can be prescribed. I only know of a handful of dentists who do that routinely... makes no sense not to, but what can I say :/

I am glad that os #2 is spending some quality time with you. He knows that things were not ideally done initially and since he took your case on he is now obligated to see it through. I agree that you should see your internist for an evaluation of the lymph nodes and I would do that soon. Bring the written results of the CT scan with you and the films also. He will refer you to a specialist if necessary. If the dr does not suggest blood work, then it may behoove you to ask him for it. There are different tests to measure for infection and inflammation in the blood. Just talk to him about doing that as you are concerned about residual infection.

The symptoms that you have on the left side, headaches etc... sound mainly muscular to me. The fact that the tightness is easing up is a good sign! Try the warm moist compresses and see if that makes a difference. Also, you could be grinding or clenching your teeth and not know it. The person that sleeps with you.... could be a sound sleeper and not hear it...?? You mentioned that os#2 thought you had some scar tissue due to a chronic chewing habit in a certain area. If you think about that.......... ...... .... that could be a habit that you do without thinking, like clenching or grinding. As a matter of fact, in order to chew the tissue enough to create scar tissue, you would really be working that masseter muscle which is similar to what happens when you clench or grind your teeth. Make sense??

Keep us posted... and take good care of yourself.
Bryanna

Hello again, Bryanna!

I hope that life has been treating you well. :)

I would like to ask you about the extraction site that I had had debrided and biopsied roughly a month or so ago.

Over the last week, the tissue that's till in the healing process, began to sting. I gingerly peeked to see what was going on, and there appears to be more unhealthy granulated tissue present. It began bleeding so I just left it alone in order to let it heal up. It's roughly 1/3 of the size of the original tissue that had to be removed.

Yesterday, I felt what I thought was a loose piece of skin pressing against the side of my tongue at the extraction site. Once again, I carefully look in to see what the heck is going on, and it's the same area of tissue, but it was filled with pus. Just from the pressure of my opening my mouth, the thing opened up (and of course, that's when I did my infamous spider dance---which I use whenever something freaks me out). :) Since yesterday, it's still doing the same thing and there is also a small amount of blood that surfaces.

Bryanna, can you please explain what is going on---and why it's happening? Is this a common problem after having had the 2nd procedure to remove all the “bad stuff”? Is the presence of pus a sign that my body is trying to get rid of additional infection?

Lastly, I am now hesitant in going back to the same Oral Surgery Center where I had the original procedure with OS 1 and then the follow-up procedure with OS 2. What do you recommend that I do----go to see OS 2 (I will never go to see OS 1 again) or see a new OS who works with a new group of OS's?

As always, I appreciate your help, expertise and time. Thank You!!!

Laughter

Hi Laughter,

I know the "spider dance" well!! I have done that a time or two and not just for stuff pertaining to myself.....!!! Sometimes it makes the patient feel better to dance with them :) Sure wish it made the icky problem disappear though "-"

Okay so you still have some infection brewing there. It could be as simple as something close to the surface of the gum line like a piece of granulation tissue or a bony fragment that has worked its way up. But without a clinical and radio graphic evaluation, you cannot be sure of what it is.

So....... it would be wise to see oral surgeon #2 again. It's okay, I am dancing with you ~'.'~

Hopefully it is just a mild issue and once remedied the site will heal up well. Keep me posted.


Bryanna

Hi again Bryanna,

:) Well, I saw the OS this past Saturday. The panoramic and PT x-rays show that "there is something in there" <----the OS's words, not mine. He agreed that the unhealthy tissue is also back, although it isn't as big as the most recent time that I had to have surgery.

He confirmed the pus and blood factor as well (bleck). Long story short, I have to go in this Saturday (May 9th) to have same surgery again, Bryanna. Is my situation common? How often do patients have this many issues/procedures after having two teeth extracted?

I'm not a happy camper. Cluck,cluck, cluck. ~Laughter

Hi Laughter,

Well this is not really a laughing matter.... :/

I re read your CT results and it is possible that you still have or have recurrent osteomyelitis and perhaps your body keeps making granular tissue because it is confused by the bacteria. New tissue and bone always form after an extraction but when there is bacteria that is irritating the new growth, the new tissue grows lumpy and actually prevents the bone from filling in. That's why it needs to be re surgerized.

This problem is most commonly seen when the extraction site was not debrided thoroughly at the time the tooth was removed. In some cases, the problem goes on for months, even years before it is diagnosed properly.

I must say, your CT scan was hugely helpful in that it gave a clear picture of what was going on. Sometimes the bacteria has really set up house and it can be difficult to eradicate completely. The only thing the surgeon can do is go in again and really clean the site out as best as he can.

I would suggest that you request a biopsy AND culture be taken at the time of this surgery. The biopsy determines the bacteria and cells that are present and the sensitivity culture determines what antibiotic is most appropriate. Truthfully, both of those things are imperative and should be done. So put away the chicken suit and put on the roaster.... !!

I am sorry that you are going through this. We could look back and say... what if the dentist did this or that and what if the initial follow up care had been better. But it won't make the problem go away and it just uses up valuable energy. So try to look forward to getting this taken care of and be (gently) assertive with what you expect to have done. I think this surgeon wants to help you and I feel he would welcome your taking the role of your own advocate.

Be sure to have a soft food diet planned ahead of time so you don't have to think about it when you don't feel like thinking about it :)

Hang in there... and keep us posted.
Bryanna

Hi again Bryanna,

I appreciate you & every bit of advice that you share! :)

A couple of things. One is that I made sure that the OS will do a culture along with the debridement & biopsy this Saturday. Yay! Thank you for reminding me, I would have easily forgotten to have that done.

Regarding the CT results and the osteomyelitis. Before the OS did the first debridement and biopsy, I was in nasty, unbearable pain due to swelling, etc….. Currently, I'm only having a subtle stinging sensation; the only real discomfort I've had was when the OS was examining the area the other day.

My layperson mind wants to ask---can osteomyelitis exist in the body without exhibiting many outward symptoms? I'll be the first to admit that I haven't felt very good lately, but I figured that I was due for an adjustment to my depression meds. lol

As always, thank you for listening. :) ~Laughter

P.S. I'm working on my soft food diet; thank goodness it's only temporary. :)

Hi Laughter,

... And I appreciate your appreciation.. .. ~'.'~

Osteomyelitis can be present with severe, subtle or on/off symptoms. It can become a chronic infection and can also spread from one area of the body to another. Given those issues it can be hard to diagnose definitively if there is no blatant pathology in the area that it is suspected to be in. I know that is not reassuring and I am sorry :/ So it is very wise to have the culture and biopsy done during your oral surgery on saturday to be certain of the bacteria and to be prescribed the proper medication to kill that bacteria. Unfortunately there is still no guarantee that the infection will be cured but it certainly gives you a better shot at it!

The risk of developing osteomyelitis is strongly associated with any severe or long standing tooth or bone infection. I personally feel that all people have the right to be informed of this risk prior to consenting to a root canal. I feel it is just one of the many risks that should be presented and not left unsaid.

Feeling physically lousy is a sign that your immune system is dealing with a lot. I know I sound like a broken record..... but I am a mother and have earned that right.... your diet has a huge impact on how your immune system handles infection and stress. Eating a variety of healthy fresh foods feed the body the nutrients it needs to cope with life. Processed and refined foods deplete the body of nutrients and just add insult to injury. So please go eat an apple and I promise you will feel better.... or maybe I'll just feel better ;)

Do you own a blender or nutri-bullet? Drinking vegetable or fruit smoothies during the healing from oral surgery are excellent choices of nutrition. So are home made soups. Any of that sound appealing to you or do you already comsume those things?

Bryanna

Good morning Bryanna,

I hope that you had a Happy Mother's Day. :)

Thank you for your latest response; my intention was to reply before my surgery on Saturday, but I ran out of time!

Although I didn't eat an apple as you suggested, the neighbor brought over fresh pineapple, cantaloupe, grapes and watermelon that very same day--- how's that for timing? How's that for having great neighbors? ;)

Saturday's surgery is finally over. Instead of sharing long, drawn out conversations with you (the kind that make your forehead hit your keyboard...lol), I want to give you the surgeon's comments.

OS said there were two bone fragments and one root tip that showed up on the radiograph from a week ago.
He also confirmed that he was doing both the biopsy and culture; the culture wasn't necessary because neither the X-rays nor the CT images reflected any existing osteomyelitis. He said the present infection was due to the bone fragments and root tip---and that once he removed them, the infection was also gone.
------------------------------------------------------------------------------------------------
My observation---the OS wasn't in the best of moods; well get in line! Lol

This surgery seems to have caused more swelling and bleeding than the first two. I don't know what the difference is, but I could tell right afterwards that the expected post-operative recovery routine was going to be different this time around. Maybe that's a good sign? ;). Every once in a while, I'll gingerly peek inside my mouth, I have to say that it looks like a complete train wreck. When it comes to my pie hole, Mother Nature sure has her work cut out for her!

I respect the OS's feedback as to whether or not there is existing infection/osteomyelitis, however, I feel SO much better being able to lean on the definitive culture results. Thank you again for the very wise suggestion.

Bryanna, on average, how long does it take to get culture results? If I remember right, the biopsy results took a couple of weeks to arrive.

Why do you think the OS give me a 7-day Rx for Clindamyacin (4 pills a day) if he is certain that there isn't an infection?

One thing I wanted to mention is a few times a day, from my neck up, I am getting really flushed and hot---- I haven't taken my temp during those "episodes", so I don't know if it'd be related or not. Could I all of a sudden be allergic to Clindamyacin? This is my 4th Rx over the last 4-5 months and I haven't had these symptoms before...
I am allergic to penicillin and sulfa.

Ok, time for more ice on this chipmunk cheek. :). As always, Thank You for listening and for your input, Bryanna. ;). ~Laughter

Hi Laughter,

I am glad to see that you can keep your sense of humor in spite of all that is going on!!

So just please clarify for me.... the OS did a biopsy AND culture or he just did the biopsy? I hope he did both. Generally the dentist has the results within 7-10 days. If they are emailed to him, he may have them sooner. For the culture they basically put the bacteria in a Petri dish with different antibiotics to see which is most sensitive. The preliminary report can be as soon as 24-48 hours.

He may have prescribed the antibiotic as a precaution but that still does not really negate the need to do the culture.

So there were root tips retained from the extraction! I'm glad he took them out of there. The surgery he did was pretty extensive as he had to open up a large area and spread the bone apart to retrieve everything. This will take some time to heal.

Regarding the flush feeling, I would suggest that you call the pharmacist and ask if that could be a side effect of the clindamycin. Also, are you taking a probiotic supplement to help replenish the good bacteria that the antibiotic is killing off?

Regarding the use of ice.... basically that should only be applied for the first 24 hours. To apply it now could cause the swelling to become hard and more uncomfortable. It may help to apply moist heat. Not hot, just very warm. You can dampen a wash cloth and put it in the microwave for about 15-20 seconds and then apply that cloth to the outside of your face. Cover that cloth with a dry one to keep the heat in. Leave that on for 15 - 20 minutes and repeat 3 times a day. The moist heat encourages blood to flow and can reduce the inflammation which reduces the swelling.

I sure hope your pie hole starts to feel better soon ~'.'~

Keep in touch with us......

Hi Bryanna,

Yes, I always lean on humor when life becomes a challenge in one way or another---I have always found that laughter is a great stress reliever! Thus the nickname. :)

To answer your question, yes----he did a culture as well as the biopsy. He seemed dismissive while explaining how unnecessary taking a culture would be---but that's ok. Having the results will put my mind (and pie hole) at ease. :)

Yes, I am taking probiotics twice a day; indefinitely. :)

The root tips have come up in previous conversations; the first thought was that OS1 left them there on purpose due to them being too close to my facial nerves. Then the root tip conversation was off the table when all those fragments showed up from the first biopsy.
Prior to the surgery Saturday, the OS reminded me of the risks involved in removing the root tip---to me, if that thing is part of my issue---then let's go ahead and get it out as safely as possible.

I won't know for sure what he was or wasn't able to remove until the follow-up appointment with him this Saturday.

Thank you for the information regarding moist heat for my cheek. I'm a fan of things that offer some level of comfort and relief at the moment. :) Vicodin? Sure. Motrin? Absolutely. Moist heat? Oh yeah. Love from the cats and dogs? Bring it on! :)

I'll be posting an update once I meet with the OS on Saturday.

Thank you, Bryanna!!! ~Laughter

Hello Bryanna,

I hope that you had a great weekend. :)

Well, I had my one week follow-up appointment with the OS on Saturday. Neither the culture or biopsy results were available as of that morning, however the OS explained what he came across during the surgery.

He held up his thumb and forefinger. put less than an inch between the two and said that he removed a root nerve (I believe those were his words---he didn't say tip). He said that it caught him by surprise being that it wasn't visible on my
previous scans (right before the surgery he told me that his plan was to go in to remove a couple of bone fragments and a root tip).
Apparently it was right against the nerve; he said he was "looking right at the nerve" (which is when I started feeling clammy (lol).

He asked a number of other questions regarding pain and numbness, etc… Ever since the original extractions took place (mid-January), I've been having occasional tingly numbness from my left lower lip down to right before my chin area.
I explained to him on Saturday that I noticed a decrease in the tingly/numbness area since this most recent surgery. It's actually shrunk down by at least half, which is great news. :)

On the flip side, I am having pain/discomfort in my mouth. I realize that I am 9 days out from the last surgery, the healing process is going to take quite a while (like you had said), but there is not a moment that goes by that I don't notice
that there's an issue in my pie hole. :) The OS had mentioned that I've got a lot of scar tissue that's accumulated---and that each time he goes in there, more is created. When I look in the mirror, there is the area where my big honking' teeth once resided. :D
It kind of resembles a slot of sorts, running from the back of my existing bottom tooth to the back of my mouth. Then from there up into the side of my cheek is this wad of at least 6 "mini caverns" all which contribute to the painful area that never goes away.
The "lumps" that are formed bother me because they don't feel normal; plus anytime I disrupt them (yawn, try to take a bite, talk) they're really painful, ache, sting, hurt and even feel as if I'm pulling muscles….skin….or I don't know what else!

My question to you Bryanna, is will the above go away and become unnoticeable at some point? If so, great. If not, is there anything I can do to help lessen their overall impact? To be candid, my unspoken concern is that this jazz won't let up entirely and this
would then be my new normal. That would be absolutely impossible.

Side note: It took 3 weeks for new granulated tissue to surface following my second surgery. For that reason, he has me coming back in 3 weeks for another check-up, unless something else warrants an earlier appointment.

As always, Thank You!!!!! Laughter & Her Holey Pie Hole

P.S. I am looking forward to getting the biopsy & culture results ASAP.

Hi Laughter and her holey pie hole ~:-0

Your test results should be in like any day now. If you don't hear from the OS by the end of this week, give them a call.

I just want to say that you have been very fortunate to come upon with OS because he is taken a genuine concern in your case. For him to volunteer what he found during the surgery and to explain it to you.... says a lot about his integrity and his concern for you. So I hope you and your pie hole feel some reassurance that so far, you seem to be in good hands ~:)

Many nerves are microscopic... as those that are inside of the hundreds of tiny canals inside of each tooth. None of which will show up on a scan of any kind unless there is a huge area of gross pathology attached to them. So it's not a surprise for the nerves that he came upon during this debridement to not be visible on the CT scan. My guess is one of two things. One is that the infectious bacteria had formed a cyst(s) that attached itself to this branch or bundle of nerves and when removing the cyst the nerves were intricately connected to it. Or.... was tooth #18 previously root canaled? If so, then the OS may have found necrotic nerve tissue that had been pushed through the root tip of your tooth during the root canal procedure. Another thing that can occur is inflammation from the infection can irritate and inflame surrounding tissue and nerve bundles which can eventually cause these things to take on a new life of their own. I'm sure if you asked him, he would be more specific about his findings. Or you could request the surgical report.

I am very glad that you are experiencing a decrease in the tingling sensations.... yes that is a good sign and hopefully you will have a complete and healthy recovery from all of this.

The descriptive description of your "slots and and mini caverns" can be scar tissue from the multiple surgeries, incisions and various sutured areas. The gum and lower cheek tissue that has been cut can heal lumpy or smooth... depends on the individual. Some people are more prone to developing scar tissue more so than others. Is the OS concerned about these slots and caverns? What does he say about them for the long term? Generally the gum and cheek tissue calm down as the area heals more thoroughly. There has been a lot of traumatic action in that area of your mouth so I would expect it to be a bit lumpy and uncomfortable for awhile.

Some of the symptoms that you have can also be nerve related which hopefully will go away completely. Does the OS have you on any restrictions with food, oral hygiene, yawning... anything? Has he suggested that you exercise your jaw or that you keep it quiet, so to speak :)?

Hello Bryanna & her infinitely helpful dental wisdom, :)

Thank you for the reminder as to when the test results should become available; I'll mark it on my calendar to give them a call. I just hope that I remember to look at my calendar! ;)

I value your feedback regarding my OS. To be honest, he is a very kind, thorough, semi-shy, inquisitive surgeon. He always takes a few moments to think through what might actually be going on with my situation.
His analogy is that its similar to how a person would dissect a puzzle. He mentioned that of his 30-35 years in the OS field, he has had only 1 patient who had to undergo 3 surgeries for the original issue that had brought them to him in the first place.

I feel bad because it seems that he is "cleaning up" OS1's original mess from January. I give him a ton of credit; he's never complained that I wasn't his patient, asked me to go back to OS1, etc.----rather he's stepped up to the plate and is doing his
absolute best. I appreciate him.

To answer your question, yes the molar had been crowned a few years ago. Unfortunately, the tooth fractured under the crown and the dentist discovered the infection between that molar and the horizontally-positioned wisdom tooth. Then it was off to the OS. :)

I'm sure that if I asked the OS about the details of his findings, he'd try to share what he could before I began crossing my eyes. lol You mentioned the surgical report; I've never seen one before but if I were to guess, it's a review of what took place during the surgery.
Maybe even before and after? Man, I feel like such a lay person. :)

Slots & Mini Caverns; sounds like a board game. lol At my appointment, the OS only looked into my mouth. He didn't put on gloves, poke around or anything. He only looked---and said that it looked good. We didn't go into any in-depth discussion regarding pain, restrictions,
exercises, etc.---he did want details regarding the numbness and tingling changes that had taken place. He seemed very curious about those things. I have the distinct feeling that his ultimate goal is to get the area healed up once and for all. That would make two of us! :)

He asked how long it took for the bad tissue to reemerge after the previous debridement and I told him it was 3 weeks. So----he (we) seems to be patiently waiting to see what happens. He did say that if he has to go in again, I'll have even more scar tissue. When he said that,
I think my darn eyes began to cross. ;)

On a side note, the left underside of my tongue started to ache yesterday evening. I hadn't experienced that before now. Also, I am having some pain come around the front of my upper chin and into my lower teeth. That feeling is familiar---I had pain in that area before
I saw the dentist in January. As I'm typing this message, it occurred to me that I ought to keep notes on what I am feeling and where---am I on the right track? It would be helpful to be able to hand my notes to the OS if he wants location details regarding pain and discomfort.

Thank you for listening. Time to let the dogs out. :) Have a great evening and thank you, Bryanna. ~Laughter

Hi Laughter........

Your OS has performed a lot of oral surgery in his lengthy career and no doubt he's had to repair quite a few "mishaps" over the years. I think he's had more than one patient who required 3 or so surgeries to take care of the original problem but he wants you to be optimistic and he's hopeful that this has taken care of the problem. I agree with you, he is trying very hard and being very diligent with your care. His analogy of dissecting a puzzle is so accurate because that is exactly what he has to do when he goes in to clean up the area and it sounds like he has tried to put you back together as best as he can.

You are right..... this surgeon is cleaning up what the other guy left behind as well as the formation of the new mess caused by the original one. But believe me, he has done this countless of times in his career. I feel badly that you have endured such unnecessary dental trauma and infection but I am SO glad that you did not stick with that original dentist!!

The surgical report is the notes dictated or written by the dentist or his assistant. It gives an accurate and detailed synopsis of the pertinent information pertaining to the procedure. It's a part of your records.

I think it is a good idea to make a journal of this entire experience and it would be helpful to include a daily entry as to what new or different symptoms you are experiencing. Include dates and meds starting from the time it first began because not only will it make some things very clear to you but you may need to reference back to what's taken place at some point in the future. So rather than guess ... just journal it all and keep it with other medical papers.

When you see him in a couple of weeks, you can look at your journal (;-) and explain what has taken place since you last saw him. He will then may be able to offer you some helpful or insightful suggestions.

He wants to avoid going in again, believe me. But he knows how important it is for you to heal completely.

I would not be surprised if you experience some odd discomfort, pain, weird sensations as you go along because there is so much repair going on in that pie hole of yours!! I would not dismiss anything that you feel, I would make note of it in that journal you are keeping (;-) and even make note of when you feel these things. Like when you are talking, chewing, sleeping,,,,,, doing nothing. Be mindful if you are clenching or grinding your teeth as either of those things can cause all sorts of pain in various places in the mouth, jaw, head, neck.....

That tight or pulling feeling that you feel when you move your mouth a certain way could be from the way he had to suture the inside cheek tissue. Pay attention to that and make note (!!) as to the severity of that, even note if you are feeling it less and less or only at certain times. All of this is helpful in understanding what is happening and can be useful information at some point down the road. Not necessarily in a bad way, but in a good way!

Thanks for sharing your dental saga with us and for keeping us informed of your progress. Keep on laughing and no matter what, stay focused on the positive!!

~~~~~ ~'.'~~~~~

Hi again Bryanna,

I hope that this post finds you having a pretty nice week. :)

I would like to ask for a bit of your constructive guidance.

My follow-up appt to see the OS is this Saturday. Every time I see him, we
Have a certain amount of time to discuss matters and the appt is over in a heartbeat.

I have several different issues that I want to share with him---and it's important that I explain my symptoms thoroughly.

What I am trying to say is that I am worried about having such a small amount of time to explain the several issues that have taken place since my last visit---along with answering his many detailed questions. I don't want to leave his office feeling that I didn't explain things clearly...or that I left something out by accident because I was in a rush.

What would be the most effective approach on Saturday; to have everything written down in detail for him to review...or to have a basic outline of what's been going on? Either way, he'll have his questions, but for everyone's sake, what would be the best route to take?

I forgot to mention that I begin to stammer & stutter (minus any spitting) in these types of situations; even my pie hole refuses to cooperate and just blurts out sentences that don't quite make sense. Kind of embarrassing to be speaking in tongues in a doctor's office, but it is what it is, right? :)

Thanks for reading this message. I apologize ahead of time....lol.

Take good care, Laughter

Hi Laughter!!

How is your pie hole feeling??

First let me tell you that it is not uncommon for dental patients to stammer and studder their words..... spit, sweat and even physically shake all over when in the dental chair. Those of us on the "other" side of the chair are very use to all of that and can usually decipher the garbled words. With that said.... some dentists will try to make the appointment very short because they know how uncomfortable that patient is and they do not want to make them sit any longer than necessary. So it is best to have all of your concerns, etc. written down so that you can review them with him. Keep in mind that this is your appointment time and your concerns are important. As a matter of fact, you can begin the conversation by saying....<< I have some concerns that I want to ask you about and I even wrote them down so that I don't take up too much of your time.>> This shows the dentist that you are concerned and need his attention. He may ask you to read it to him or he may want to read it himself. So just prepare the notes with the facts and what you feel is pertinent. Make sure that you and the dentist address every item on the list. So bring a pen to jot notes down next to your concerns :)

The best way to come up with a list of things......
Write everything down. Then go over what you wrote and see where you can condense it without leaving out the facts.

When in the chair, do not be concerned about the time. Just focus on going over your concerns and getting a clear response from him. You can cover a lot of stuff in a short amount of time if you are well prepared :P

If there is anything you think I can help you with here, let me know. Or if you need me to explain that further....just holler :-0

Temp

Hi Bryanna,

I hope that you're doing well. I wanted to bug you and update you on
My pie hole saga. 😁.

Saturday I went to see the OS. He made a comment about having removed
A root tip during the last procedure. He examined the area and said that he was happy that it's healing and that it would take another 2-3 months to finish up. When I asked what the culture results were, he said that he didn't do one "because there wasn't any pus present." I am disappointed that he skipped the culture; I just wanted to make sure that there wasn't anything to worry about in my ol' cavern.

I did get a copy of the biopsy results. Here they are:

Clinical History:
Pre-operative diagnosis; Granulation tissue

Gross description:
Source of specimen: area #17
The specimen consists of a 2.2 x 2.2 x 0.3 cm aggregate of tan-gray hard bone,
Tooth and rubbery tissue. The specimen is filtered.

Diagnosis:
Area 17 (after decalcification): sub acutely inflamed granulation tissue, fragments
Of vital and non-vital bone and radicular tooth fragment.

He was glad to look over the list (a very condensed version) that you had suggested (thank you!). It was a luxury for him to have most of his questions answered.

I listed several things, among them being that I'm having occasional tingling on the outside of my cheek; there are varying levels of pain from my lower lip down to my chin (from feeling a little uncomfortable and "bloated (lol), all the way to where the pain gets so bad in the lip/chin area that my bottom teeth ache as well. I told him about the "cramps" under & on the side of my tongue; and I described the deep ache I get down in the surgery site (would that be considered my surgery hole? Lol) all the way down my neck. Come to think of it, my neck hurts where the lymph nodes were acting up earlier on...

The OS said that he wasn't an expert in whatever is going on and he wants me to see a doctor involved in pain management. He said that he would call my Internist, explain what's going on and ask him if he can refer me to the right specialist. End of visit.

OS left a voice message yesterday. Said he was having a hard time getting through to my doctor and that he has not been able to get him on the phone. He also said that he wants me to see a neurologist---and that he wants to see me in a month for follow-up.

I called the OS's office today, made an appointment for a month from now and asked that they leave a message that I had received his message and will call my doctors office on Monday, since they are closed Friday-Sunday.

I'm not sure how all of this will fall into place, but somehow, some way....I will get through to my elusive Internist and follow his lead regarding him speaking with the OS, deciding on a pain management Dr., a Neurologist, all the above....

Bryanna, am I getting close to the finish line with this whole experience? :) Do you have any wisdom/viewpoint that you're willing to share? I am all ears........and all pie hole. ;)

Have a terrific weekend. As always, much appreciation. Laughter

Hi Laughter,

Nice to hear from you and your pie hole ;-0

I'm miffed that he didn't do the culture too. Ugh.... what can I say :/
But thanks for posting the biopsy report!

<<Pre-operative diagnosis; Granulation tissue>>
OKAY, MAKES SENSE.

<Gross description:
Source of specimen: area #17
The specimen consists of a 2.2 x 2.2 x 0.3 cm aggregate of tan-gray hard bone,
Tooth and rubbery tissue. The specimen is filtered. >>

THE BONE TISSUE IS TYPICALLY TAN AND GRAY. OBVIOUSLY THERE WAS A PIECE OF TOOTH REMOVED WHICH WAS PROBABLY WEDGED IN PRETTY DEEP AND HE WAS ABLE TO REACH IT WITH THIS LAST DEBRIDEMENT. RUBBERY TISSUE.... IS CONNECTIVE TISSUE THAT HAS A RUBBER CONSISTENCY AND CAN BE FROM REPEATED SCRAPINGS, INJURY, WEIRD HEALING.

<<Diagnosis:
Area 17 (after decalcification): sub acutely inflamed granulation tissue, fragments
Of vital and non-vital bone and radicular tooth fragment.>>

OKAY, SO YOU HAD INFLAMED TISSUE AND BOTH DEAD AND HEALTHY BONE AND THAT PIECE OF TOOTH. OTHER THAN THE TOOTH FRAGMENT, IT IS TYPICAL TO FIND THE BONE IN THIS CONDITION AFTER TOOTH EXTRACTION AND REPEATED SURGERIES. SO HOPEFULLY THE BONE IS HEALING BETTER NOW THAT THE IRRITANTS ARE REMOVED!!

<< I listed several things, among them being that I'm having occasional tingling on the outside of my cheek; there are varying levels of pain from my lower lip down to my chin (from feeling a little uncomfortable and "bloated (lol), all the way to where the pain gets so bad in the lip/chin area that my bottom teeth ache as well. I told him about the "cramps" under & on the side of my tongue; and I described the deep ache I get down in the surgery site (would that be considered my surgery hole? Lol {{ YES!!}}) all the way down my neck. Come to think of it, my neck hurts where the lymph nodes were acting up earlier on...>>

IS THE AREA NEAR YOUR LYMPH NODE ON YOUR NECK TENDER? SOMETIMES IT CAN TAKE MONTHS FOR THE LYMPHATIC SYSTEM TO CALM DOWN ESPECIALLY WHEN THE IMMUNE SYSTEM HAS HAD TO DEAL WITH REPETITIVE TRAUMAS, MEDICATIONS, ETC.

<< The OS said that he wasn't an expert in whatever is going on and he wants me to see a doctor involved in pain management. He said that he would call my Internist, explain what's going on and ask him if he can refer me to the right specialist. End of visit.>>

THE OS CANNOT BE SURE OF WHAT YOUR CONTINUED SYMPTOMS ARE RELATED TO. HE KNOWS THEY HAVE SOMETHING TO DO WITH THE EXTRACTION OF THE TOOTH, THE REPEATED SURGERIES AND INJECTIONS... BUT HE CANNOT PINPOINT WHICH ONES ARE THE CULPRIT. HE SOUNDS LIKE HE'S HOPEFUL THAT YOU WILL RECOVER COMPLETELY AND PERHAPS SEEING A PAIN SPECIALIST AND YOUR INTERNIST WILL GET YOU THROUGH THE TIME PERIOD BETWEEN NOW AND COMPLETE HEALING. YOU JUST NEED TO BE CAREFUL ABOUT TAKING MEDICATIONS AS THEY CAN BECOME ADDICTIVE AND ARE USUALLY NOT WITHOUT SIDE EFFECTS. BUT IT'S IMPORTANT TO RULE OUT PATHOLOGY IN THE LYMPHATIC SYSTEM AND THEN PERHAPS MASSAGE THERAPY WOULD BE HELPFUL...?? THE TYPE OF CARE THAT YOU WILL RECEIVE FROM PAIN DOCTORS IS REALLY UP TO YOU. MEANING IF YOU WANT TO BE TREATED HOLISTICALLY, WITHOUT MEDS, THEN STATE THAT'S WHAT YOU WANT. OTHERWISE MEDS WILL MOST LIKELY BE THE WAY THEY WILL TREAT YOU.

<< OS left a voice message yesterday. Said he was having a hard time getting through to my doctor and that he has not been able to get him on the phone. He also said that he wants me to see a neurologist---and that he wants to see me in a month for follow-up.>>

YEA, TELL YOU DR TO GET WITH THE PROGRAM !!;) YES, FOLLOW UP WITH THE OS IN ONE MONTH, GOOD. HOPEFULLY BY THEN YOU WILL BE ALL BETTER!

<< I'm not sure how all of this will fall into place, but somehow, some way....I will get through to my elusive Internist and follow his lead regarding him speaking with the OS, deciding on a pain management Dr., a Neurologist, all the above......>>

THINK SERIOUSLY ABOUT NON MEDICATED ROUTES FIRST BECAUSE THE BENEFITS MAY BE LONG SERVING WHEREAS MEDICATIONS ARE NOT. NEUROLOGISTS GENERALLY DO THE MEDICINE ROUTE AS THAT IS USUALLY ALL THEY KNOW. BUT YOU COULD GO FOR THE CONSULT AND SAY... NO MEDS, OTHER OPTIONS.

<< Bryanna, am I getting close to the finish line with this whole experience? :) Do you have any wisdom/viewpoint that you're willing to share? I am all ears........and all pie hole. ;)>>

I WANT TO SAY OPTIMISTICALLY ........ YES!! BUT I REALLY DON'T KNOW. I HAVE SEEN THIS SITUATION MANY TIMES IN VARYING DEGREES AND MOST OF THE TIME THE PATIENT ENDS UP OKAY. BUT IT IS BEST TO CONTINUE TO BE YOUR OWN ADVOCATE AND NOT JUST GO ALONG WITH WHATEVER IS PRESCRIBED. GET ALL YOUR OPTIONS SO YOU CAN DECIDE WHAT IS BEST FOR YOU.

We may have talked about this already, but my mind CRS sometimes. Are you into taking any homeopathy or supplements? Would you be comfortable seeing a massage therapist or biofeedback person?

Thanks for the update... thanks for hanging in there and keeping your humor about everything. I think it's helping you to cope :) I pray you will be just fine in no time and this will all just be a blur of an experience for you.

Hope you and your pie hole have a good weekend...... may the pain be gone........... !!!!

-------------------------------------------------------

Hi Bryanna!

How have you been? A belated Happy Thanksgiving, H’ween, Happy Holidays & Happy New Year!

My pie hole and I wanted to reach out to you to purge several dental-related thoughts & frustrations. I hope you don’t mind…I’ll jump to the present day situation...

It’s been 11 months since the 3rd and final pie hole surgery. I am so thankful to say that the surgery site itself is in great shape; my OS was able to once and for all get that area to heal. YAY!

On the flipside, I haven’t been as fortunate as I’d hoped with the facial nerve(s) healing. I still have issues on the lower left part of my face. From my lip down to under my chin & also on the inside of my mouth (backside of my lip (and space between it and my gums), the gum area and what feels like 2-3 lower teeth). I have constant numbness and tingly sensations in the area from my lower left lip down to under my chin and about an inch or so toward my cheek as well. Couple of quick examples: I can touch the side of my chin and the area beneath my lower lip tingles. When my toothbrush moves around on the left lower inside area of my mouth, I get wave after wave of numbness and tingling. My chin is itchy in one small area most of the time as well.

Worse than the above is the stinging that goes on with my lower left lip. It bothers me on and off, every day; I can’t tell how long it’ll last or what, if anything, causes it to flare up. The damn thing is bothering me right now---it stings from the front of that lip and surrounding area and it extends through to the inside of my mouth. It's accompanied by a burning sensation as well, which really hurts. I’ve described the pain that goes through my lower lip back into my mouth as a burning sensation which radiates right through to the teeth behind that area. Those symptoms also occur daily (or for days at a time) and the amount of time they are on a rampage varies; the symptoms I am having at the moment have lasted for well over 2 days straight.

I’ve given a name to the most evil of all symptoms---the holy muther zing. It’s a sickening, quick feeling of electricity-like zings/zaps that hit the area of my teeth, gums & lip. The zing freaking hurts (thus the name holy muther) and it also makes me feel as if I've bitten down on a piece of aluminum foil!!!! Man…makes my skin crawl!!! The zings happen without warning, lasting less than 10 seconds or so----and they drop into my daily life at east 3 times a day. After all these months of waiting for my nerves to heal and go back to normal, I'm beginning to lose hope that this will get any better...........I don't care where it's located, chronic pain and discomfort suck BIG TIME.

I want to mention that I began seeing an exceptional neurologist (at the request of my OS) to evaluate/treat the nerve issues in my pie hole. She has prescribed a couple of different meds that would theoretically help with the pain; the one med didn’t agree with my system (If I am remembering correctly, it caused intense gastric issues) and the other was a pain medication that I didn’t want to take for any amount of time. It might sound odd, but I had to give that exact same med to my old lab/coon hound dog and his dosage kept increasing over and over as time went on....

Besides the Rx med ideas, the neurologist recommended that I try an over the counter external cream on my face (I can't recall the brand name) when the area flared up. After giving the idea some thought it didn’t make sense to walk around with a tube of cream to apply to my face whenever I was having aches/pain---because it happens so frequently throughout the day and not to mention, the external layer of pain is just the first layer of many that freaking hurt. For a while I used Ambesol (I hope that is the correct name) to apply directly to the front of my teeth and gums located right behind my left lip. It helped numb the area, which helped, but after so much time, I stopped using it. If the issues were going to continue for x-amount of time, I didn't want to be ingesting that stuff day after day (also there was the possibility that these symptoms and damage could be permanent so I was curious about finding another way to cope).

A quick bit of candid background. My neurologist is super but there is sometimes a language barrier between us. I do listen closely to what she is saying and I do believe I understand her but I think she may have trouble understanding me and my "Pennsylvania, WV" expressions. Ex: the last time I went to see her, she asked how the issue with my facial nerves was coming along and I replied “things are holding steady”,meaning that they are the same as they were since my last visit. She seemed very pleased that I was feeling better, etc.---???---but it’s my fault that I didn’t take the time to try and rephrase my answer to her…. In all fairness to her, she wanted to review other issues that have arisen from the CT she had ordered for the facial nerve issues (severe stenosis in my neck), so the discussion regarding the face/mouth pain was only part of my visit. I know, I know, next time I go to an appointment, I will definitely clarify what I meant by that expression and I'll fill her in on any progress (still hoping) or not. She probably thinks that I suck as a patient being that I am not a fan of using Rx meds for pain...

I have developed a few different ways of handling my pie hole issues. One is that I bite down on my lip and space below it---similar to what you might do if you stub your toe---push on it because it hurts. I press my tongue against the inside of the lip area and below. I scratch the infamous itchy chin area when I can't stand it any longer and I try to get through the holy mother zings without making it obvious to those around me. Probably some of the neighbors/friends who I see from time to time think I'm turning into an orangatang; between biting my lip, pushing my tongue against the inside of my lip, scratching my chin and looking like I just chewed on a piece of foil... LOL

What's the old saying about either laughing or crying? Thank you for listening and reading my ramblings. I hope that you and your loved ones are doing great. ~Laughter

A quick P.S. My regular dentist said that she thinks some of my issues stem from the mental nerve.

Nerve injury is a known complication that occurs with molar extraction. Not much can be done once it happens. The healing process can be painfully long or permanent.

Hi Cleo, I appreciate your post. :)

A few questions come to mind---

At what point is nerve damage deemed permanent?

Are there ways to pinpoint which nerve(s) are causing an issue?

If so, are there tests available that could determine the percentage of damage that's taken place?

I'm thinking that if the above things are possible, then perhaps a "customized treatment plan" could be effective in relieving some of the pain & overall discomfort.

Thanks again and have a great day!

Laughter

The area in distress is the only indicator of which nerve is involved.

I just read your other comments here and i saw you were made aware of these risks and told by your OS that the nerve was seen during a 3rd attempted surgery to remove a root tip.

What nerve did they see.. did they say what condition the nerve was in?

Are you under treatment for the cervical stenosis?

Hi there Cleo,

So the symptoms can narrow down which nerve has been aggravated? How is it determined that someone is a candidate to have a procedure done to "fix" the nerve to minimize the daily aches/pains, etc.?

The OS had mentioned to me on a few of my office visits that he himself has facial numbness on one side (can't recall which one). I just assumed it was from having oral surgery---and I can sympathize with him because it feels foreign to have numbness, tingling, etc. in the face. Period. It feels as if you're perpetually recovering from the stuff they numb you with prior to having a cavity filled.

The OS did say at one point that there was a possibility of winding up with facial numbness but that he was going to do everything within his power to prevent that from happening. In an odd, kind of candid way, whenever he'd mention that he had permanent numbness in part of his face---it made me kind of think that he wanted me to realize that other people have the same issue and you wouldn't even know it......kind of like, hey, I have it as well. Again----that's how I felt when he'd bring up his numbness issue---he didn't explain it like that at all.
Regarding the aching, pain, zings, itchiness and so on---he never spoke about any of them as a potential issue. I think that if he had rambled off all those scary long term symptoms---I probably would have felt like running out the freaking door!!! Lol. Anyhow, I can only imagine being super-concerned and even more frightened than I already was because of everything that had been taking place. To be honest...even if he had shared the above, I would have still agreed to undergo additional surgery because what would my other choices be?

To answer your question about the nerve that the OS saw---I have no idea. I didn't think to ask which one it was, etc... I get a bit queasy during any conversation that include the topic of veins, needles, blood, and so on. When he brought up that he had seen my nerve---I had to keep from thinking any further about it. Lol. Even typing the last sentence just made my hands begin to sweat!
Now that you've asked..........I am curious which one he laid eyes on as well. ;). He didn't mention anything else about the nerve, including it's condition.

Regarding the stenosis. I have an order for physical therapy; the neurologist said that she wanted to begin with a basic treatment plan and then go from there, as needed. I'm looking forward to therapy---It'll be great to be able to help my neck area, even if I don't notice a difference. :)

Thanks for reading this post. Have a great day! Laughter.

It's the AREA of abnormal symptoms that dictates which nerve (s) are involved. I've been in a similar situation for several years. You should go back to that OS for a check up on the situation. A neurologist can only medically treat it and that's why you were sent there. I have heard physical therapy may help in certain situations.

A thousand apologies, because I have only quickly perused these posts.
But I did see nerve pain or injury. This is not necessarily for just the original poster, but for anyone who comes upon this or a related topic.
Periodically, I wish to mention that if you feel you were injured by a dental professional (ugh) or any any medical professional, to make sure you document your experience and to make sure you not only seek the opinion of other qualified medical experts such as oral surgeons or neurologists, but also very possibilty a good attorney.I absolutely feel I was damaged by an incompetent dentist.
After a huge delay, I spoke to a few attorneys.
One told me that he didn't want to take the case because cases against dentists were horribly difficult.
Others felt I dropped the ball by waiting too long.
When you are in horrible pain, one tends to think about nothing but getting the pain in CONTROL!
Also, even if there was some sort of mess up and you are suffering bad nerve pain, all hope is not necessarily lost regarding your pain.
It's been approximately 3.5 years since my dental "incident." Lots of doctor appointments, heavy duty pain, heavy duty pain medication, specially formulated medication (which I still take) and so forth.
I'm FINALLY feeling decently. Nope, it's not gone. I have come to accept, it probably will never fully go away.
But, I have pain control and I'm very pleased with this.
I use a compounded cream and it is costly, but I can now spread the script out for five or six weeks instead of four.
And it is extremely rare for me to need strong medication.
I see progress. Yes, 3.5 years was a horridly long time, but I think my nerve has healed to a certain extent. I have other health issues and when this happened, I think I went into shock.
Again, please re -read what I wrote above.
Blessings.

Hope I'm not about to start the same path
 

Wish I read your post before I posted.. Thnk I could be off for the same type of treatment. Having had 6 lower and one upper teeth removed within 3 weeks..all infected I'm thinking the pain and "bits" I can feel trying to pop through my gum could be "bits" that none of the dentists looked at. They all pulled.. Grabbed the gauze.. Told me to bite down for 15 mins and if still bleeding change gauze and should be ok after 30 mins. None washed out, cleaned out or really even looked at gum after they were staring with amazement at how long the roots were on my teeth on the tray. Think I will toddle off to ER and get some more antibiotics and front up at dental surgery Tuesday after the holiday. I always say I would rather have a baby than go to the dentist.. Ive had 5 and only take. Just over 6 hr total..and I get something at the end! Dennyboo