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questions about root canal extraction healing
I have never posted on this forum before but have read some posts here and found that Bryanna is a wealth of knowledge. I am struggling after my recent root canal molar extraction and was hoping to ask some questions for her or other knowledgeable members of this group.
I had a root canal on molar 19 for 2 decades. In the last year I started to get a lot of unexplained dental pain around that tooth. No evidence of anything awry on xray, 3d scan, saw many dentists for opinions. Since I tend to see holistic dentists they pretty much all said that while it looked radiographically fine, being a root canal tooth they are basically ticking time bombs anyway. I did much research and got some energy testing and decided to have it extracted. I had low grade pain in that area for 8 months and it seemed like the right thing to do. I traveled many hours and stayed overnight to see a holistic dentist who did extractions, one of the few in my state. I did not want to just go to any oral surgeon, as I knew it was important to remove the periodontal ligament and clean the socket to prevent cavitations or trapped infection in the bone. The extraction was a little over 3 days ago. I needed an extra shot of numbing and I still did not get totally numb, it was quite uncomfortable but I would bear the extraction. He cut the molar in half to extract each root at a time. He removed the periodontal ligament and used a curette type tool as well as a drill that had water coming out of the side (I think it's a low speed drill?) to remove bone. He talked as he worked which I appreciated and said that there was no sign of infection but there were shards of gutta percha all through the socket. He worked for what seemed like ages. Every time he thought he got it all he would find another one. Finally he said he could not go any deeper or he would cause damage. He placed clots in the socket which he had created using an LPRF machine, and injected homeopathic remedies which I did not fully understand called Sanum. He sewed the top clot to the socket which is his standard procedure to make a healing patch, he called it. I managed to ask if he got all the shards of gutta percha and he said yes. But then I was brought into another room to do payment and never saw him again. I asked his assistant how much bone he took out and she said "more than usual." I was only given one gauze to bite on so I bit on it for about 15-20 minutes but then they wanted me to take post surgical homeopathics. So I had to spit out the gauze. I asked if I needed another and they said no. That was interesting because when I had gotten my wisdoms out I had a huge pack of gauze which I bit on for hours. The office closed and I left to the hotel, which I stayed overnight then went home in the morning. I have many questions following that extraction and I have contacted the dentist a few times but am very very conscious that I do not want to be seen as a bothersome or problematic patient. I ask a lot of questions and some providers do not like that, I found over the years. So I have some more that I am hoping to ask on here. 1.) I usually do not take any pain medicine. For my wisdoms I only took one Motrin and that was the first night of surgery. However this time I simply cannot function without Motrin. I am taking 400mg every 6 hours around the clock, and have done since the night of surgery. I tried twice to go off and I cannot, the pain is too bad. Should it still be this painful over 3 days since the extraction? 2.) I feel very flu like. Very lethargic, hot, muscle aches, slight headache. I have felt like this since the surgery but the feeling of being hot is more intense today. When I take my temp the few times I have gone off the Motrin I do have a low grade fever (between 99.0-99.7). When the Motrin kicks in it reduces the fever so it is hard to tell, on the Motrin I am at like 98.6-99.0. Is this normal 3+ days after surgery to feel flu like or have a low grade fever? Could it be a sign of infection? Being a holistic dentist he does not prescribe antibiotics routinely. 3.) I simply feel that I cannot stand the feeling of my teeth/bite. As soon as the anesthetic wore off I felt panic. The tooth in back of the extraction site feels fine but the tooth in front (#20) feels awful in my mouth. It feels like my tongue is laying on top of the tooth and when I talk or swallow it feels like one of the cusps is slicing the side of it. I can't stop touching this tooth with my tongue and as a result have barely spoken since the surgery, it feels so awful. That tooth specifically was previously a little rotated towards my tongue but it feels now like it's basically impinging on where my tongue should sit. It feels so foreign like a big chewed lump of bubble gum stuck under my tongue. Could this tooth have moved or rotated further during surgery to cause this feeling? Or is it simply my brain having a total freakout because my mouth is missing a tooth? Will I ever get used to this? Should I ask to have that tooth filed down? It is actually the worst part of the whole thing for me, even more than the pain and flu feeling. I am sorry this is so long. I know I might sound very anxious but I truly am. I can honestly say that I never expected feeling like this after, and it has all thrown me for a loop. I thought I would get a root canal tooth out, be uncomfortable but feel really great because it was gone. I was very wrong. So I am pretty anxious. Thank you so much in advance. |
I also want to be clear that I think my extraction was a positive thing and the dentist, even though he was nor an oral surgeon, was very practiced in extracting root canals in a holistic manner. I just feel like I have so many unanswered questions, and being that his office is so far away, it's not like I can pop in there for a follow up. I have no other appointments scheduled with him at this time. My stitches are going to be removed by my general dentist but that isn't for 6 more days....So I am hoping for some guidance and reassurance until then :)
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Hi nukuspot,
Thank you for the kind words :) It sounds like you really did your homework and searched out a qualified dentist to remove your root canaled tooth. General dentists have limited oral surgery education compared to an oral surgeon. However, there are some general dentists who have deliberately continued their education to become skilled dental surgeons. This is not a common practice, but they are out there! It is important to know that although your oral symptoms did not become evident until a year ago, your rc tooth had been infected for 2 decades. Those pieces of gutta percha material scattered in the bone were chronic irritants and bacteria festered around each piece like they were magnets. Your immune system was able to keep the oral symptoms at bay until it could no longer continue to do so. Based on that knowledge and your detailed description of your present symptoms, it is possible that the removal of that tooth and the thorough debridement of the bone has woken your immune system and it's doing it's job to deal with the changes that are occurring. Based on your overall health and the overall health of your immune system, it may or may not be able to deal with this issue on it's own. Meaning you may or may not need antibiotics. That is a judgement call made by the dentist. I am unsure as to why they only gave you one piece of gauze but evidently you did okay without it. Some people tend to overuse the gauze and they end up pulling out the clot. Because he placed the LPRF blood clots (leukocyte platelet rich fibrin centrifuged from your own blood) into the bony socket and tissue he did not want it to be disturbed. These clots are the first step of the healing process as they slowly release growth factors to encourage the formation of new bone. This healing process also stimulates your immune system to send out it's own healing cells. So for some people a low grade fever and some physical symptoms of feeling unwell may be a normal part of this cycle of healing. I will re post your questions and answer in bold type. <<1.) I usually do not take any pain medicine. For my wisdoms I only took one Motrin and that was the first night of surgery. However this time I simply cannot function without Motrin. I am taking 400mg every 6 hours around the clock, and have done since the night of surgery. I tried twice to go off and I cannot, the pain is too bad. >> YOU HAVE A LOT MORE GOING ON WITH THIS SURGERY THAN YOU DID WITH YOUR WISDOM TEETH REMOVAL. YOU HAD A LONG TERM INFECTION THAT HAS NOW BEEN DISTURBED (FOR THE BETTER!) AND THERE IS A LOT OF INFLAMMATORY FACTORS COMING TO THE RESCUE WHICH WILL SIGNAL PAIN CELLS FROM THE BRAIN. ARE YOU TAKING ANY HOMEOPATHICS REMEDIES? <<Should it still be this painful over 3 days since the extraction?>> IT WOULD NOT BE UNUSUAL GIVEN THE CIRCUMSTANCES. THE PAIN SHOULD START TO SUBSIDE AFTER THE 4TH/5TH DAY AND SLOWLY IMPROVE WITH EACH DAY. IF THE PAIN DOES NOT SUBSIDE OR GETS WORSE, THEN CALL THE DENTIST. SHOULD THE PAIN SUBSIDE AND THEN COME BACK, THAT MAY INDICATE A PROBLEM SO CALL THE DENTIST. <<2.) I feel very flu like. Very lethargic, hot, muscle aches, slight headache. I have felt like this since the surgery but the feeling of being hot is more intense today. When I take my temp the few times I have gone off the Motrin I do have a low grade fever (between 99.0-99.7). When the Motrin kicks in it reduces the fever so it is hard to tell, on the Motrin I am at like 98.6-99.0.>> A LOW GRADE FEVER INDICATES THAT THE IMMUNE SYSTEM IS WORKING TO DEAL WITH THE SITUATION. FEELING FLU LIKE, ETC. COULD BE HOW YOUR BODY RESPONDS TO THE STIMULATION OF THE IMMUNE SYSTEM AND IT COULD ALSO BE FROM THE OUT PUT OF CORTISOL WHICH IS A HORMONE RELEASED BY THE ADRENAL GLANDS IN RESPONSE TO STRESS. IF EVERYTHING IS HEALING NORMALLY, THE IMMUNE SYSTEM AND THE ADRENAL GLANDS WILL CALM DOWN. <<3.) I simply feel that I cannot stand the feeling of my teeth/bite. As soon as the anesthetic wore off I felt panic. The tooth in back of the extraction site feels fine but the tooth in front (#20) feels awful in my mouth. It feels like my tongue is laying on top of the tooth and when I talk or swallow it feels like one of the cusps is slicing the side of it. I can't stop touching this tooth with my tongue and as a result have barely spoken since the surgery, it feels so awful. That tooth specifically was previously a little rotated towards my tongue but it feels now like it's basically impinging on where my tongue should sit. It feels so foreign like a big chewed lump of bubble gum stuck under my tongue.>> IT IS NORMAL TO HAVE ODD SENSATIONS WITH YOUR TONGUE AGAINST OTHER TEETH AFTER A TOOTH IS REMOVED. THE TONGUE IS A MUSCLE AND IT IS USE TO BEING IN A CERTAIN RESTING POSITION AGAINST YOUR TEETH. IN SOME PEOPLE THE SLIGHTEST CHANGE IN THE POSITION OF THE TEETH OR WHEN A TOOTH IS REMOVED CAUSES THE TONGUE TO TAKE NOTICE AND NOW IT'S TRYING TO FIND A NEW RESTING POSITION. THIS IS TEMPORARY, IT WILL ADJUST TO THE NEW SURROUNDINGS. IT IS BEST TO TRY AND IGNORE IT AND NOT KEEP TOUCHING IT AS THAT JUST STIMULATES IT ALL THE MORE. YOU MAY ALSO HAVE SOME INFLAMMATION IN THE BONE AROUND THAT TOOTH (NORMAL AFTER AN EXTRACTION) AND IT MAY BE A BIT OUT OF IT'S NORMAL SPOT WHICH YOUR TONGUE IS PICKING UP ON. ONCE THE INFLAMMATION SUBSIDES AND YOUR BODY CALMS DOWN, THINGS WILL SETTLE DOWN. <<Or is it simply my brain having a total freakout because my mouth is missing a tooth?>> IT IS YOUR TONGUE TRYING TO FIGURE OUT WHAT IS MISSING. YOUR BRAIN IS STIMULATING THE TONGUE TO BEHAVE THAT WAY AND IT WILL CALM DOWN WHEN ALL ELSE CALMS DOWN :) <<I can honestly say that I never expected feeling like this after, and it has all thrown me for a loop.>> TRULY THE BEST THING YOU CAN DO IS KEEP YOURSELF HEALTHY THROUGH THIS HEALING PROCESS. THERE WAS NO WAY FOR YOU TO KNOW THAT REMOVING THIS TOOTH WAS GOING TO BE A BIG DEAL TO YOUR IMMUNE SYSTEM. BUT IN THE LONG RUN, YOUR IMMUNE SYSTEM WILL THANK YOU :) Besides the motrin, what else are you taking? What are you rinsing with? |
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Oh! Also one last question that I have been really puzzled about...How did the gutta percha fragments get in the bone in the first place? The dentist said they migrate over time in certain cases but I never had time to ask how or why. The RCT was awfully done. It was done by a family member when I was 15 and had no say in the matter. He was a sloppy general dentist but free so that is where my family took me. It was not even needed, he only did it because I had pain after a deep filling. There was no infection and the tooth was vital. I am still angry about that. I found out during all of this that he also fractured a dental file in my tooth but never told me. It was picked up on xray 8 months ago when I kept having pain and they did multiple xrays of the tooth. It never showed any signs of infection which was commented on as unusual being it has a dental instrument in it. But you can see why I elected to get it removed....I always thought that when it was removed the dentist would see a granuloma or a sign of long term infection but he said he saw nothing to indicate the infection, just many shards of gutta percha very deep in the socket/bone.
That is why I went to a holistic dentist instead of an oral surgeon, because I imagine many oral surgeons would just have popped the tooth out and left the gutta percha shards! I am very glad they are gone but I guess I want to know how they got there in the first place. Is it common with old RCT over time and they all have them or was it yet another part of the bad RCT job done in the first place? |
just an update: Here I am at day 5 and things are exactly the same! Pain not better or worse, just the same as day 3. Which is frustrating. I have tried and am unable to stop taking Motrin. Without Motrin I get frantic because of the pain. On Motrin I still feel pain, it's just less and so I can function.
I called dentist yesterday to ask if this was normal---was not able to speak to dentist (I doubted he would be available) but the assistant who was at my surgery called me back. She said most people are in less pain at day 4 but some have pain 5-7 days. She asked if I thought it was an emergency type pain, I said no but I have no reference, really. The fact that Motrin helps about 50-70% with pain makes me think it's not dry socket....She asked me if I still see the LPRF clots in the socket, they look white. I do but they have shrunk, they are filling up like 2/3 of the socket now. Maybe that's normal? I could not ask her because I could only look after I hung up. I also notice a huge sore (cankersore type?) below the extraction site. It is really swollen and red around it. I think that is where he did the injection for numbing? I also got a mirror and can see two other small sores right on the socket itself. They all look like canker sores (which I am prone to.) I just thought I would be getting better each day by now so it's frustrating and scary. The dentist who took out the tooth is a 3 hour drive so I can't just pop into him to have him look. Even my general dentist is 1.5-2 hours away (I have no holistic dentists in my town). I see my general dentist on Friday to remove the stitches but I am worried that if something is wrong that is still 3 more days. Since I did not get antibiotics, how would I tell if my pain is due to an infection? I am going to try to assume it's normal pain for a cavitation type extraction of a RCT but I admit I am worried. I was like 100% better at day 5 when I had my wisdoms out a few years ago (by a normal OS not a holistic one). Also I still cannot get used to the feeling of the tooth in front of it!!! It still drives me bonkers. I am still on a liquid diet (organic, homemade) but it's so boring. I can't even try to chew it hurts too much on the extraction side and the crazy tooth that is next to the site which feels like 100 times bigger than it used to hurts too, I hit it with a spoon last night and saw stars. |
day 7, pain exactly the same. Saw a local dentist, he said no infection looking areas but he was worried about dry socket. He can't see in hole because the sutures are still and the hole is so deep he cant see to the bottom. He didn't want to mess with it because he wasn't sure what an LPRF procedure would look like and he didn't want to mistake it for dry socket or something.
I drive to my normal dentist in the big city 2 hours north tomorrow for suture removal and post-op. I have NO bad taste or odor at all. Can I have dry socket without it? If it is not dry socket I don't get the pain at all. It is about a 8-9 on a 1/10 pain scale without Motrin, about a 4/5 with 400mg Motrin. Which I can't take forever....Saw my ND, she used a UV healing laser and gave me homeopathics. They did not change it. |
I am just going to keep updating even if I get no replies. LOL.
Day 8. Saw my usual general dentist who is IAOMT holistic one. I felt like he was in a rush from the moment he saw me which drives me crazy about him, otherwise I like him a lot. He removed sutures. Said he thought the socket was OK. He did not think dry socket. Thought pain this much/long was normal. I said the dentist who extracted it did not agree but he didn't really say much after that. He did not think I needed to do anything else and the pain would just go away now that the sutures were out. I am trying SO HARD to not take pain meds but the pain is awful in the ear on the extraction side. Like the worst ear infection ever. Very sharp. My cheekbone also hurts badly. Still cannot eat solid foods, but at least sutures are out. What could this be?? The ear/face near the cheekbone/ear hurt SO much. I am going to have to take Motrin soon or I am going to freak out. Could it be nerve or TMJ? Or could he have been wrong and it is a dry socket because I know they cause ear pain like this? If it is dry socket but undiagnosed so I never get the medicated clove dressings, will it still go away by itself? Anyone welcome to answer me but I am still hoping Bryanna returns :) |
:Wave-Hello: I hear you.
Personally I'd take some Motrin if that brings the pain level down. If you don't want to keep taking that, then try something that's not NSAID. If I was in that much pain I'd probably ask the pharmacist for Panadeine (with the codeine), but that's just me. Having pain in the mouth/ear like that is just awful. I can't help with your other questions but just wanted to post to say that I read it and that I'm sorry you're still in so much pain. I really hope that settles now that the sutures are out. take care there. |
You need a xray and oral surgeon advice!
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what would an xray show? I can ask for one if needed but I would want to know why I was asking....
I have seen two dentists and spoken to the office of the one that did the extraction. No one seems particularly concerned....I don't think I can walk into an random oral surgeon at this point who is unrelated to the whole thing? Thanks for the replies! |
nukuspot,
Your wisdom teeth were much different extractions compared to the removal of this infected molar. Irrelevant of symptoms, this root canaled tooth had been infected for several years which means bacterial changes occurred in the surrounding bone over that course of time. So the healing from this surgery is going to be very different and more complicated than it was with your wisdom teeth. It is obvious that you need to see the dentist who did the oral surgery as he is the only one who knows for certain what he found while doing the surgery and what took place during the surgery. All of the other dentists obviously do not want to get too involved because they do not want to interfere with what has been done and then be blamed for additional complications. You need to follow up with the dentist who did the surgery. Generally the pain from a dry socket does not occur until day 3-4 post op. According to your statements, you have had pain continuously since the surgery. Even if dry socket were suspected, none of the dentists other than the one who did the surgery, is going to want to treat it for the reasons I mentioned above. There is also very good chance that you are having TMJ problems and a very good chance that you are grinding/clenching your teeth... perhaps you just don't realize you are doing it. If that is occurring, then taking anti-inflammatory meds will temporarily subside the pain. But as you continue to clench/grind your teeth, the problem will continue. It becomes a vicious cycle. Taking NSAIDS for an extended period of time is not a good idea because they can cause intestinal bleeding and toxicity issues to certain organs. So although it is convenient to pop a couple advils, it is not without risk of side effects. The pain definitely needs to be managed but at the same time the root cause of the pain needs to be diagnosed because the meds may just be masking the real problem. You need to see the dentist who performed the surgery. Regarding a dental x-ray... it will show if there is abnormal pathology (infection or over growth of scar tissue) occurring in the surgical socket and bone. |
Unfortunately that the the downside of traveling very far to find a IAOMT dentist who does these type of extractions. He is a 3++ hour drive each way, and I don't have the ability to drive for over 6 hours both when I'm in pain but also when I have small children. When we went up for the extraction I had to take my whole family and spend the night.
I probably was not clear about the relationship between the dentist who did my extraction and my general dentist in the big city North of me who I saw yesterday for the suture removal and follow up. They have a relationship where he does the followup and post op for the dentist who did the extraction. The dentist who did the extraction hashis office in a very strange part of the state, so most people get the work from him and the follow up from my normal dentist in the big city. so its not like I'm seeing a random person who doesn't want to get involved. The only random person I saw was my kid's dentist but I just wanted to make sure there wasn't an infection or emergency and he was close. The main pain I am experiencing at the moment is in my ear and cheekbone on the same side as the surgery. Of course the site hurts and also my jaw but the most pain is in my ear and cheekbone. I understand the risks of taking Motrin, I hate it. I discussed it with my ND and she said that the amount I'm using is fine for 2 weeks. I'm even using less than that, as I'm now only taking 400mg before bed and just dealing with pain during the day. Right now as I type this the site feels not too bad but my ear really really hurts. I am wondering if you are right and it could be TMJ. I already have an appliance for TMJ that was given to me a few months ago when I was dealing with the pain before having the tooth out to see if it helps, but I find it very uncomfortable. I subconsciously take it out in my sleep. Perhaps I should try it again and see if it helps the ear pain, hopefully I can keep it in at night. |
Also the pain was worse from day 3-7. It's been slightly better yesterday and today.
It's not that the other dentists would not be comfortable treating dry socket, it's just that my general dentist I saw yesterday said it was healing fine and he didn't see any sign of dry socket. I will call on Monday if the pain is still so bad and ask for an X-ray to check for infection like you suggested. But that would still not be with the dentist who did the extraction. It was pretty clear to me that he was just doing the procedure but I would be doing all follow ups with my general dentist. If it is TMJ what else can I do? Any other ideas other than the appliance at night which I will try? The ear pain is the worst of all the pain. |
Any gutta percha left near the nerve canal would glow on xray.. It's not uncommon for an OS to clean up a mess left behind by a dentist.
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Cleo,
What do you mean? I am confused. The original root canal was done 20 years ago by a family member general dentist when I was a teen. Because of pain in the gum near that tooth starting 8 months ago and also what I know now about root canals in general after reading Price and Mening, I decided to get it extracted. All of the xrays taken (apical xray and 3d galileos) before the extraction showed no sign of infection or anything abnormal except a broken dental file. That alone made me want to get it out. There was no gutta percha visible on the scan or xray. I drove 3.5 hours to a very highly recommended holistic dentist. I was told he was one of the few people in my state that would remove the tooth in a safe manner, that is, removing the periodontal ligament and any infected bone, down to healthy bleeding bone. Both my general dentist and my ND recommended him. They both refer all their patients to him for extractions and cavitation diagnosis/cleaning. He supposedly has people coming from other states for his extractions as well. So yes he is a general dentist but he also does oral surgery and has done for many many years. He was not the cause of the gutta percha in the socket, he found it when he extracted the tooth. He said they were small like "splinters" and that was why they were not visible on xray. I hope that clears any misconception up. I know my story is complicated and easy to get confused! I have been texting with him today (the guy who did the surgery.) I just sent him some photos of the extraction site to review. It's the best I can do in lieu of going up there again. |
nukuspot,
Most dental xrays or scans do not pick up the infectious bacteria in the tiny canals, called dentin tubules, of a root canaled tooth unless that bacteria eroded the tooth enough to be picked up radio graphically. Just because it cannot be seen, does not meant it wasn't there. The symptoms of the gum irritation and pain are indicative of the infection that has proliferated from the root canaled tooth. This is referred to as a perio/endo abscess and is often seen with root canaled teeth. The broken rc file and the slivers of gutta percha were all constant irritants and sources of bacteria to the tooth and the tissue they were embedded in for the entire time that tooth had been root canaled. From a dental perspective, your case is not really complicated meaning it is fairly common to see this exact situation with root canaled teeth. The bite appliance that you have, if it is not comfortable to wear, then don't wear it because it will only cause further irritation to the TMJ. Have your dentist refit the appliance to your new bite. It is common to have bite appliances adjusted from time to time. I understand the professional arrangement between the surgeon and your general dentist. However, no general dentist is going to feel comfortable touching that surgical site irrelevant of dry socket or not, for concern of being blamed for post op complications. The only one who is responsible for treating post op problems is the surgeon who removed the tooth and only he or another oral surgeon should be the one to perform a debridement or further surgery in that same area. This may seem unreasonable to you, but this is generally how these situations are handled. |
I just texted the dentist who did the extraction. I sent him pictures of the extraction site with my phone.
He does not think I need to see him again. He just wanted me to follow up with my Naturopath to see if a virus was affecting the extraction site since I had some canker sores nearby!? So now I don't know what to do. Should I still make an appointment to go see him? That's a long day drive if he just says nothing and sends me home. |
And I totally agree about the root canal having lots of long term issues! When through the pain I am glad I have it and that broken dental file out. I'm just scared because I don't know why I still hurt so much. Smiling with my mouth closed makes it worse, pushing pressure on the gum around the extraction site.
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still in pain. Texted with the dentist who did the extraction all day yesterday. Saw local dentist (dentist who did the extraction knew I was seeing him) who took apical xray of extraction site at my request, nothing abnormal. He examined me again and everything was normal. He said he doesn't know and wonders if neurologic cause. Saw my MD who checked my ears and said they look fine even though the left one feels like it is being stabbed with sharp object. Ear, jaw, facial pain on extraction side is insane. If it is neurological I don't know how I am going to deal with this. The dentist who did the extraction says that he doesn't see any reason that I should drive all the way up to see him, as he wouldn't be able to do any better testing than the local one did. And he also does not know what is causing the pain.
Should I request an empiric trial of antibiotics? I have rarely taken them (twice in the last decade) but I am getting desperate and don't know what to do. It's not like I can just live like this forever. I have no swelling, no fever, extraction site looks good, healing going normally. It's just intense pain stemming from the gum area on the cheek side of the site around the base of my jaw and up to my cheek, ending in the ear where it feels like either the eardrum is going to burst or be stabbed. I think it started so badly over the weekend because I made myself get off the motrin, and the motrin must have been giving whatever is causing it an antiinflammatory effect. Today is day 11 post extraction. |
I got this tooth out because of low grade pain symptoms in my ear, jaw and gum for almost a year. I thought that extracting the root canal tooth would help, and worst case would no nothing. I wasn't 100% sure it was the cause of the original pain but it made the most sense being the gum was sensitive near it and it was a RCT tooth of 20 years of age with a dental file stuck in it! I never thought extraction would make it 1000 times worse. I could live with the pain before. I cannot live with this type of pain the way it is now!
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nukuspot,
There was no question that the tooth was infected as all root canaled teeth are and the gum issue was indicative of the bacteria spreading. So at this point the site looks okay clinically and radio graphically. Motrin calms the pain down... indicating inflammation is present. The pain prior to the extraction was in the ear, etc. So what is the verdict on you having a bruxism habit? Did the dentist say if the endo file had perforated the tooth? Any chance you could post a pre op xray of that tooth? Quote:
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Hi! Thanks for getting back to me. The endo file did not perforate the tooth, thank goodness. That was the first question I asked the dentist who did the extraction. It was stuck in the root. I asked to keep the tooth after extraction (it is cut in half and I *think* I can even see it in one of the halves!) It is really visible on the pre-op xray. I am not sure how to post it but I will try!
The TMJ doctor I was referred to during the last year (I saw no joke, 6 different dentists/specialists) said that it did not look like I had bruxisim but that I might have a night clenching issue. My left TMJ joint clicks and my jaw has a S shape movement when I open. That was why he made the hard plastic nightguard. I think I mentioned it that I find it very uncomfortable, it goes on my top teeth and it's very hard to fall asleep with it in. I always wake in the morning and it is sitting next to my pillow which means I subconiously take it out in the night. I am not sure how long I wear it for. He adjusted it for me and I don't think that it's the fit that I object to, it's the huge lump of hard plastic on my top teeth/palate that leaves no room for my tongue. So I don't really know if it helps or not. I have not worn it since the extraction because I did not want to add to the discomfort. The holistic dentists I have seen didn't put much faith in the TMJ diagnosis, strangely. I will work on figuring out how to post that pre-op picture of #19 with the file! |
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I think it worked! Should I try to get a copy of the apical xray from today to post to compare?
These were taken in Feb. PS--You might pick up on the fact that the tooth in back of the RCT looks like it has a cavity under the filling. Every new dentist I see asks me about that. It is in fact what they tell me is an old fashioned composite which looked radiolucent on Xray, they don't use that type anymore. I think it was done sometime in the early 90s. My usual dentist has been checking it out for years and came to that conclusion that it is not decay, it is the actual filling that looks like that since it hasn't changed shape in the last decade. Just in case it jumped out at you! |
Ps Bryanna,
Totally off the subject but I saw in another thread you live in NJ. My family lives there and my mother keeps telling me there are no holistic dentists she can see. Since you live and possibly work there, maybe you can give me some names to pass to her! |
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Oh! I found some more recent ones! These are from my recent cleaning and checkup in May, about 6 weeks before the extraction. I am sure they look pretty similar but I'll post them anyway.
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Hi nukuspot,
Thanks for posting the xrays! I will answer all of your xray posts in this one post. Clenching.... this habit can literally alter the anatomical alignment of your upper and lower jaw and the pressure that is put upon your teeth and muscles is unbelievable. I found a very informative description of bruxism on this dental site. I am not affiliated with this dentist, have no idea who he is.... just that he wrote an informative piece on this topic. So I'm sharing...... http://www.arizonafamilydental.com/s...inding-bruxism The last molar on your left with the dated composite filling has the root structure of a wisdom tooth. Which is evident when the roots come together in a cone shape. Just curious if it is your wisdom tooth...? Anyway, if that filling is more than 10 years old it may behoove you to have it replaced as all composite restorations break down over time as they wear out from chewing. You can talk to your dentist about that and see what he thinks. The piece of the broken endo file in tooth #19 appears to have perforated the large canal space. Which means that the dentist perforated the canal during the procedure. When that happens, the space the file went into is so tight that he can't back the file out again. So the file breaks off in there. This is a constant irritant and the bacteria is microscopic so it is rarely picked up on an x-ray. Rather than get into that explanation with you because it basically says "oops"... most dentists will just say, a file broke off inside the tooth. There are several issues with the way this rc was done but in the large scheme of things, they are irrelevant. If I remember correctly you said that there were pieces of gutta percha that had to be scraped out of the socket when the tooth was removed. Is that right or was that someone else here....? ;/ I ask because I can see pieces of gutta percha around the mesial root (root on the left) and if they were found in the bone or tissue, then that indicates that the tooth was perforated during the root canal procedure or how else would they have gotten beyond the tooth..?? This tooth was a lot sicker than it appeared radio graphically. Do you have a post op xray of this area that you could share? There are not many holistic or biological dentists in NJ. At least not many who advertise themselves as one. Where in NJ is your mom? Give me a zip code or general idea of the area. |
Thank you for reviewing the xrays!
Yes that was me with the gutta percha fragments. I'm surprised you see them on the xray. No dentist had mentioned them at all, and it want until surgery that they found them. The dentist that did the RCT was a family member and he never told me about the file. I had no idea it was in there until recently. Can you let me know what the other issues with the root canal were? That might help me more easily come to terms with the extraction. With the pain now being worse than the original pain it's hard for me to feel like I did the right thing getting it out. I have to keep telling myself that it was poorly done and needed to come out. I don't have the post op xray yet. I requested it but they didn't email it to me. Once I get it I will post it here. So based on the info, do you think that clenching is causing the pain I am experiencing and it's not a surgery complication? Other than the hard plastic appliance, which I will give another try once I feel healed enough to do so, do you have other suggestions for what I can do? If it happens in sleep I don't have control of it. My mom is at the Jersey Shore! Near Seaside Heights. |
Oops I forgot to answer a few questions. The molar at the back (18) is not my wisdom tooth. That's just my molar. I had the wisdom extracted on that side a few years ago. Is it significant at all the roots look like that or is it just interesting?
I will speak to the dentist about getting that composite redone. I still have two amalgams that I have to put priority on replacing. I have been desperate to get them out for years but my dentist does not want to touch then while I'm breastfeeding. I have been either pregnant or breastfeeding for the last 7 years. As soon as my baby weans I am going to get those finally out of my body, but I'm trying to be patient because I don't want to wean her just for dental work. |
Ok this is REALLY my last question for today, promise!!!
The premolar in front of the extraction site is still very sensitive. I haven't tried to chew on that side due to pain and also the hole still being open from the surgery but sometimes my teeth hit over there when talking or chewing on the other side or I accidentally hit it with a spoon while eating soup. All those are still very very tender. I tapped the teeth in that area with the back of a spoon and it is for sure the one in front (#20) that is hurting. I mentioned this earlier and I also mentioned it to the dentists over the last 12 days since extraction and the common consensus is that sometimes the tooth gets traumatized during extraction of its neighbor but it settles down. Is 12 days a long time for it still to be this sensitive? I'm just so scared that it was damaged in some way. I never ever want to be in the position where I need to get another root canal, but I also don't want to get any more extractions either. I think one of my life's goals from this experience is to just want to keep all the rest of my teeth healthily and pain free as possible. How long is TOO long to still have a sensitive tooth to pressure or chewing after an extraction? At this point even if I wanted to I woujdbt be able to chew on #20. It is better since the extraction for sure, last week just talking hurt it, but it's still not a normal feeling tooth. I still have that weird feeling it's either too big or too close to my tongue too. I asked the dentist yesterday if he could maybe file a bit of it down but he was very reluctant to do that. I guess holistic dentists don't mess with occlusion much because they want to keep all tooth structure intact? |
So So that wasn't the last post. I just discovered that the tooth in front (20) definitely loose! I was playing with it with my tongue and felt it clicking kind of so i looked in magnifying mirror and pushed it with a q tip and it wiggles. I did that to the other teeth near it and they don't move. What do I do?
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here is the xray from yesterday. It is a little off center but he said he can see enough that he is sure there is nothing awry in the socket. I asked if he needed to repeat it to try to get it centered more and he said no. I wish it had included the loose tooth in front rather than the one in back of the extraction, but that was not something I could control. It was painful enough holding that thing in my mouth with all the pain I was in. I hope it was good enough and worth it.
PS off topic but was this a digital or standard xray? Can you tell? It looks like a film, not like the digital xrays I have had in the past. Also that weird upside down A in the corner? I am concerned because I am very conscious of radiation exposure due to the extreme amount of xrays and even a 3d CBCT I have had over the last year since I have been trying to figure out my dental pain. I thought because it was a holistic dentist they would only have digital so I didn't think to ask...AND for the first time in my life they did not cover me with the lead apron while getting the xray. I asked and the assistant said they don't use them anymore unless someone is pregnant. |
Hi nukuspot,
Congrats on all those babies!! And kudos for nursing all of them!! I'm a little scared to ask how many babies you have..... ;) SO how many?? I am floored that you are nursing while going through all of this! How old is this newest baby? I am not a pharmacist but in doing a quick google search if it were me I would definitely cut back on the amount of motrin to only 600 mgs a day. There is no definitive answer as to whether or not NSAIDS are safe during pregnancy or breastfeeding. The meds are certainly more readily absorbed by the placenta than they are via the breast. But please use great caution when taking it. It is also probably best to not feed your baby for at least an hour or more after you've taken an NSAID. Okay so I looked at your xrays again, the pre op ones. Your upper left second pre molar, #13, was lined up to bite against #19 and 20. Now that 19 is gone it is hitting into #20 only. Which means 20 is now taking all the pressure of the bite from #13 whereas before it was shared between 19 and 20. If you are clenching, and I think you may be..... this could be why #20 feels so sensitive and surely why it has become loose. Look at the bitewing xray photo #2015 267 JPG. Notice where the cusp of #13 is hitting into #20. It's hitting on the distal (back) cusp of #20 where you have a good sized filling. This situation needs to be addressed or #20 is going to end up in trouble. The dentist may not be able to relieve this by adjusting your bite because it is tooth against tooth and there is really no where to alleviate it because these teeth need each other to bite against. So it is most likely the clenching that has to be brought under control in order to save #20. Can you visit the tmj dentist again for an adjustment on the appliance? I know the hard plastic ones are bulky and feel like a mouthful of plastic. I would talk to him about an alternative to what you have because something needs to be done. Did you read the info I gave about bruxism? Clenching is generally a stress habit.... not that you are under any stress.... !!!!! I know your day is wrapped around your children, as it should be,... but you're going to need to fit in mommy time to take care of this. There are relaxation exercises you can do, even meditation is helpful. Perhaps your dentist knows of a local massage therapist or other who can work with you on this. Quote:
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nukospot,
I don't like this xray, sorry. But it is only part diagnostic and what good is that... really?? The way to tell if it is a digital or not.... when the xray was taken did the image come up on the computer screen? If so, then it is digital. The little @ in the corner is just the marking on the end of the sensor. Nothing to be concerned about. HOWEVER, never let any one take a dental xray without putting the lead shield including the lead thyroid collar on you. Yes, digital xrays are minimum radiation and much safer than most other forms of radiography. But they still give off radiation and because we are exposed to radiation in various ways throughout our day, we need all the protection we can get when deliberately radiating ourselves. The assistant is only thinking about the radiation from that one xray and not giving any thought to what we are all exposed to every single day. Radiation poisoning occurs from an accumulation of radiation. So with each exposure throughout our lives we get what is called a cumulative amount. Sounds like the assistant needs to become better informed as she is zapping people all day no doubt! Quote:
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Thank you!!! That was so so helpful. The TMJ dentist is up in the big city so it's hard for me to go see him. Plus that guard he made me was about 1000 dollars and I know my insurance won't cover another one this soon. I wonder if all the issues I've been having were from clenching! And maybe I didn't even need the extraction????
I am going to try to wear that bulky hard plastic one again. I am just going to try to get used to it. I didn't give it much of a chance before, I was dismissive that I could not do it, but now I think I have to if that is what is going on. I just drank a vegetable juice and with the straw I bit very lightly on all my teeth. #20 feels so weird. Other than being tender and slightly mobile it also feels almost like a pins and needles feeling when I bite on it. I called my dentist and left a message, he just got the receptionist to call back and say that I need to give it a "few weeks" to see if it settles down and tightens up before he will see me about it. I think he is reluctant to adjust the bite but I might have to be persistent I think? As far as the babies...Well...I just have two. I'm a VERY extended breastfeeder. Ha! I nurse until they want to stop. With my first it was around 3. My second might be going a bit longer :) Good news is that I forced myself to not take any more Motrin. Today is day 3. I'm just working on the pain mentally. Once I feel recovered enough I could try intra oral massage again. I tried that in the past and had a good experience and two bad ones. You have made me cautiously hopeful that maybe it's not a surgical complication after all. I have not work my appliance in weeks. How do you suggest I sterilize it before using it? Since my extraction site isn't closed yet I just want to be careful. Should I soak it in diluted hydrogen peroxide first? I know I had a lot of other questions. No rush but hopefully if you had a chance you could get to them. I wish I could pay you for your help. You have been more helpful to me than anyone I've ever "met" online. Thank you!!! |
Oh we cross posted. When you said you didn't like the xray was it because it was off center or because you saw something weird in it?
It had a film which she took out and brought somewhere and then later it was on the computer screen next to me. What does that mean? |
Holistic dentist for Nukospot's mom
Nukospot,
Okay so she lives in south jersey. There are a few down there, but no one I would personally recommend. Would she be willing to travel to King of Prussia, PA? It would be almost 2 hours from her. But the dentist I am thinking of has an office across the parking lot from the King of Prussia Mall which has like 350 stores!! People travel all over the country to see this dentist. Let me know. |
You have been SO helpful. I can't thank you enough. I told my mom about this forum, she is on here right now across the country reading this.
I imagine that you cannot post specific dentist's names on here so could you PM it to me or could I just search on the IAOMT website to find one in King of Prussia and that would be who you were talking about? If wearing this night guard would help the pain go away, make my tooth next to the extraction site feel normal and stop it from being loose, or even help one of these issues, it would be the most amazing thing ever. I am going to try my hardest to get used to wearing it. I just made a massage appointment with the one therapist who did intra-oral massage in the past who I liked and didn't cause pain like the other ones did. I also am going do try acupuncture again. I am really hoping this is the answer. My main question is below in bold: My final question (for now) is do you think that I have messed up that tooth #20 permanently? I have been dealing with the pain for almost a year. Originally the pain was mainly in the gum between #19/20 (as well as my jaw and ear on that side, and above near #15 which I now think might have been my TMJ joint.) Being that #19 was a RCT tooth it took all the blame in my mind which was why I got it extracted. Now that it's out but the pain is worse and #20 feels so sensitive and not in the right position in my mouth, I can only imagine that if you are correct, the same forces that caused the pain before, which was my clenching at night, are still at play but now that #19 is gone, #20 is taking the whole force. If I could figure out how to post a photo from my phone, I can show you that #20 even looks different from my other teeth. My other teeth are all straight-ish but #20 is rotated with the cusps towards my tongue, almost like it is lying down. I have mentioned that all year to everyone I have seen and they never said that I could be moving it, they just said "teeth drift lingually over time as you age." But why it was JUST that one tooth seems really suspicious! If I take the pressure off the tooth now by all the things I read in that article you posted and start wearing my night guard faithfully and get massage, will that tooth every go back to normal, or will it just arrest any further damage? Will the tooth ever "stand back up" in my mouth and move back to a normal position and get less sensitive and stop being loose? Or will it just stop it from getting worse? |
Hi nukuspot and mom ;)
First let me say I commend you on nursing your babies until "they" are done nursing. I did the same and personally think that's how nature intended it. I will PM you the name of the dentist is KOP. He is well worth the trip! AND the mall is awesome! I am going to re-post your questions and answer you in BOLD type. <<My final question (for now) is do you think that I have messed up that tooth #20 permanently?>> I HOPE NOT. THE XRAYS SHOW A BIT OF IRRITATION ALONG THE PERIODONTAL LIGAMENT AND SOME BONE LOSS. BOTH OF WHICH WILL OCCUR IF YOU ARE GNAWING INTO THIS TOOTH. BUT IT APPEARS TO BE VERY MUCH ALIVE AND I DON'T SEE ANY SIGNS OF A FRACTURE IN IT. << I have been dealing with the pain for almost a year. Originally the pain was mainly in the gum between #19/20 (as well as my jaw and ear on that side, and above near #15 which I now think might have been my TMJ joint.)>> THE MESIAL ROOT OF #19, WHICH IS THE LEFT ROOT CLOSEST TO #20, WAS IN BAD SHAPE. THERE IS A LARGE VOID IN THE CENTER AREA OF THE CROWN PORTION OF THAT TOOTH WHICH MOST LIKELY WAS SURROUNDED BY DECAY. THE MESIAL ROOT APPEARS TO HAVE BEEN ONLY PARTIALLY INSTRUMENTED DURING THE RC PROCEDURE AND IT WAS NOT EVEN FILLED PROPERLY. THE GUTTA PERCHA IS SCATTERED ABOUT IN THE MID SECTION OF THAT ROOT WHICH CAN INDICATE A PERFORATION SOMEPLACE ALONG THE ROOT SURFACE. SO #19 WAS A BACTERIAL MESS. WHEN THE BACTERIA IN A ROOT CANALED TOOTH PROLIFERATES BEYOND THE TOOTH, IT ENTERS THE GUM TISSUE AND THE BONE. THE TYPICAL RESULT OF THIS PROLIFERATION IS OFTEN PAIN, TENDERNESS, SENSITIVITY IN THE GUM AND BONE LOSS ALL ON THE "ADJACENT TOOTH". SO THAT COULD BE PART OF WHAT HAS HAPPENED TO TOOTH #20. ESPECIALLY SINCE THE MESIAL ROOT ON 19 (CLOSEST TO #20) WAS THE MOST DISEASED OF THE TWO ROOTS. ADD TO THIS A CLENCHING HABIT AND I THINK ITS PRETTY REASONABLE TO SAY... POOR #20! << Being that #19 was a RCT tooth it took all the blame in my mind which was why I got it extracted.>> TOOTH #19 WAS THE CULPRIT AND IF YOU HAD NOT HAD IT REMOVED, TOOTH #20 WOULD DEFINITELY BE IN DEEPER JEOPARDY DUE TO THE PROLIFERATION OF THE BACTERIA FROM THE MESIAL ROOT OF #19. << Now that it's out but the pain is worse and #20 feels so sensitive and not in the right position in my mouth, I can only imagine that if you are correct, the same forces that caused the pain before, which was my clenching at night, are still at play but now that #19 is gone, #20 is taking the whole force.>> THE PAIN WAS MOST LIKELY CAUSED BY TWO THINGS. ONE, THE BACTERIAL INFECTION AND INFLAMMATION LIVING IN TOOTH #19. TWO, THE PROLIFERATION OF THE BACTERIA AND INFLAMMATION GOING FROM 19 TO 20. THIS CHRONIC CONDITION LEAVES 20 IN A VULNERABLE STATE.... ADD THE CLENCHING HABIT THAT YOU HAVE HAD FOR SOME TIME ALONG WITH THE CURRENT SITUATION OF HAVING NO NEIGHBOR TOOTH TO TAKE UP SOME OF THE FORCES OF YOUR CLENCHING, #20 IS NOT A HAPPY CAMPER. << If I could figure out how to post a photo from my phone, I can show you that #20 even looks different from my other teeth. My other teeth are all straight-ish but #20 is rotated with the cusps towards my tongue, almost like it is lying down. I have mentioned that all year to everyone I have seen and they never said that I could be moving it, they just said "teeth drift lingually over time as you age." But why it was JUST that one tooth seems really suspicious! >> WAS TOOTH #20 ALWAYS A BIT ROTATED OR DID THIS JUST HAPPEN OR WORSEN SINCE YOU BEGAN TO HAVE SYMPTOMS IN THAT AREA A YEAR AGO? << If I take the pressure off the tooth now by all the things I read in that article you posted and start wearing my night guard faithfully and get massage, will that tooth every go back to normal, or will it just arrest any further damage?>> THE SOONER YOU TAKE THE PRESSURE OFF, THE BETTER. THERE IS NO WAY TO KNOW IF #20 IS GOING TO COMPLETELY RECOVER OR NOT BECAUSE IT HAS BEEN THROUGH A LOT, UNBEKNOWN TO YOU UNTIL NOW. I THINK FINDING WAYS TO DE STRESS AND CLENCH LESS ARE KEY NOT ONLY FOR THIS TOOTH BUT FOR YOUR OVERALL HEALTH. <<Will the tooth ever "stand back up" in my mouth and move back to a normal position and get less sensitive and stop being loose? Or will it just stop it from getting worse?>> IF YOUR CLENCHING IS CAUSING THIS TOOTH TO ROTATE OUT OF ITS NORMAL POSITION AND YOU STOP CLENCHING, IT MAY MOVE BACK A LITTLE BIT BUT PROBABLY NOT BACK COMPLETELY AS THE BONE HAS ADJUSTED TO THE NEW POSITION OF THE TOOTH. THE GOAL IS TO RELIEVE THIS TOOTH FROM UNNECESSARY PRESSURE ASAP TO GIVE THE LIGAMENT AND NERVES A CHANCE TO RECOVER. HOPEFULLY THAT WILL OCCUR AND WHEN IT DOES, THE TOOTH WILL BECOME HEALTHIER AND WILL NO LONGER FEEL ODD TO YOU BECAUSE THE PAIN AND SENSATIONS WILL BE GONE. SO EVEN IF IT WERE TO STAY AT THAT ANGLE, IT WILL BE LESS NOTICEABLE BECAUSE NOTHING WILL BE DRAWING YOUR ATTENTION TO IT. BTW....after reading your description of how the post op xray was taken, etc. it may or may not be a digital one. You should ask if it was or not when you make it clear that you expect to be covered with a lead shield for all future xrays!! |
Yes the rotation of 20 was just in the last year. I first noticed it last winter which was right around the time the symptoms started. At first it was "just" a chronic earache with no known cause starting last fall. In January of this year I went to a dentist (just a local one, not my usual holistic one) for an eval on the suggestion of my ENT to see if a dental cause was part of the earache. Directly after that exam (which involved cold testing of all my teeth on my left side of my mouth and a vigorously done assessment of my TMJ--the dentist at the time said she didn't see any sign that anything oral could cause the ear pain but that was the pivotal "straw that broke the camel's" back, and I had pain between 19/20 in my gum and up behind 15 where my wisdom tooth had been ever since.
I first noticed that 20 was rotated but no other tooth was about a month later but I was told it was just in my head and it must have always been that way, and I was just focusing on my mouth now because of pain. Now puzzle pieces are coming together in my mystery, thanks to you. I still don't know what caused the earache and then all the other pain so suddenly after that exam, but now at least I do know that 20 rotating was not in my head. It was real. Thank you. I am scared that I will not be able to manage the clenching and I'm going to cause more harm to 20. I am going to try my best with every tool I can think of. Even if removing 19 wasn't the magic answer to my pain that I had expected, I think it's opening the door to helping me further solve the mystery. And you are a big part of that help Bryanna! I am extremely grateful to you. Ps I'm a bit disturbed if they don't use digital xray! I would imagine all holistic dentists would want to minimize radiation as much as they can. Since he is my children's new dentist (my usual dentist in the big city doesn't see pediatrics) I want to make sure they will get the least radiation. We will always request a shield from now on, regardless. |
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