Gum after extraction
 

Hi Bryanna, I had tooth 2 extracted 4 weeks ago, as you know. It doesn't hurt anymore and the lumpiness is going away. It looks fine except the inner part, the hole, is not the color of the gum, pink...it still looks partially reddened. I get my stitches out tomorrow from the other extraction (tooth 11, different oral surgeon). I had my follow up for the first tooth and he said it looks fine, but that was 3 weeks ago. Surgeon #2 said maybe a piece of bone is trying to come out but I don't see anything. How would they know, an x-ray? He said no, so I don't know. Is it normal for it to still be a little red (no blood or anything)? No infection because I have taken antibiotics and there is no soreness in that area anymore. The thought of going back to the first oral surgeon who extracted #2 for further intervention is freaking me out. Do some people just have this redness then it goes away? Thanks.

Hi sandy,

The redness in tooth # 2 site could be a small bone spur that is trying to make it's way out and it's irritating the edge of the gum tissue. Sometimes it will show on an xray, but not always. Sometimes the spur is so incredibly tiny but it's just enough to irritate the tissue. If it is a tiny bone spur in the tissue, then it only takes seconds to remove it and it's not anything to get concerned about.

The redness could also be from eating on it. I know you are trying to avoid that area, but food gets over there anyway.

I'm sure the surgeon will take a look at it when he removes the sutures from the site of #11. Let us know what he says!

Bryanna

Thanks! One question, if it doesn't show on the x-ray, what do they do? Make an incision and look? The thought of this scares me, more surgery? More worrying about a dry socket? Can that happen if they are near the bone again? What I mean is do they just cut your gum open because of a suspicion of a tiny spur? Would it be right underneath the surface? Do they have to stitch you again after this? Lots of questions but I am not good with this stuff :-(

Hi sandy,

If a bone spur is wedged in the gum tissue, it is usually superficial and can be easily removed without making an incision. If the bone spur is attached to bone, then a small incision is made to get access to the spur. Do not be concerned about a dry socket. There is no chance of that happening when removing a bone spur unless the entire surgical area has to be opened and debrided..... which is rarely if ever done.

So what did the surgeon say at your post op yesterday?

Bryanna

Hi Bryanna, thanks for asking. He said 11 is healing well. I got the flipper today and I just got home. I tried it on (it is a hard acrylic that goes all the way around to the back right) and I can't form words properly. I am going to see how that goes, practice talking...I see a lot on the net telling you how to practice. This isn't a permanent solution but at least I don't look like a jack-o-lantern anymore. Will I ever sound normal..how long does it usually take to talk like we did before?

Hi sandy,

Great to hear that #11 site is healing well. Did the OS comment on the #2 site at all?

Getting use to a removable partial denture, or flipper in your case, can be a bit tricky. It should be worn for several hours at a time throughout the day. Your cheek muscles, your tongue, your palate, and the areas that are missing teeth have to adapt to something being there and this takes time. If you leave it out too often, then you will never get acclamated to wearing it and it will always have that stiff, awkward, pinching feeling. Once your mouth adapts to it, the bulkiness will go away and speaking and eating will be easier.

It is important to wear it enough to see where you may develop sore spots so your dentist can make the proper adjustments. If you only wear it once and awhile, the dentist cannot tell where it needs to be adjusted and he could end up ruining the fit completely.

I suggest to patients to put it in after breakfast in the morning and then don't take it out again until lunchtime. After lunch put it back in until dinner. After dinner put it back in until you go to bed. Leave it out while you sleep.

After about a week or two of that, then try eating one meal with it. Gradually work your way up to eating every meal with it. But always leave it out while you sleep so your oral tissue gets a rest. The mouth is a perfect place to develop a fungal infection so it is important to let the oral tissue breathe (not covered) while you sleep.

I find that this regimend works well for most people because it can become very frustrating if you try to make the partial work all at once rather than giving yourself time to break it in.

Also, make sure that you thoroughly brush your partial denture when you take it out of your mouth and before you put it in after it's been sitting for awhile. This also helps to lessen the chance of developing a fungal infection.

Bryanna ~'.'~

Both the OS and my regular dentist said that 2 may need to be cleaned out but I may be a slow healer so leave it alone for now. It is still reddish. I have yet another question. The tooth on the flipper is higher than the gum by about a millimeter. It may look like the old tooth when the impression was taken but now it looks pointy on top and way too big. As you know, I had a bone graft so still healing. My dentist said the gum will recede and the flipper will fit better but I thought with the gum graft, the gum will get bigger and be even lower. I asked if the tooth can be filed down in the lab and he said no. It looks so big...nobody will look at the top of my gum but after paying so much for this, shouldn't it loook better? It matches exactly but looks kind of at an angle, just not meeting the gum correctly. Will my gum in fact recede and go back to its original shape which is more arched, un which case the tooth will fit better? I am so unclear on this. Thank you so much for the tips. I can't speak normally and it feels like it is squeezing my teeth, so uncomfortable. I'll do what you and my dentist said though. I don't see how I will ever get used to this, feels like a mountain in my mouth :-(

Hi sandy,

With regard to tooth #2 area.... in about 3 months, have an xray taken of that area to determine how the bone looks and if there is any sign of a bone spur. The bone takes months to fill in and unless you are having pain there, it is just too early to tell if there is something that needs attention.

With regard to #11 .... the dental lab cannot fabricate a tooth on a partial to resemble (exactly) what the other teeth look like. The fake tooth may indeed look too long compared to the other ones but the gum in that area will shrink somewhat as the extraction site heals. According to your posts, you didn't have a gum graft, you had a bone graft. These are two completely different things. The bone graft has only minimal effect on the shape of the gum as it is really meant to fill in the bony socket and encourage your own bone to fill in as completely as possible. The more bone that fills in, the lower the gum will heal along the gumline leaving it with a more natural appearance. However, months down the road your permanent implant crown may be slightly "longer in the tooth" than your adjacent teeth. Without the graft material, you would have lost at minimum 50% of your bone level at that site once the area healed. This would have resulted in a caved in appearance of the bony ridge and a very high arc along the gumline. So the graft will help to minimize that "arc" in the gumline but not eliminate it completely.

If you feel that the fake tooth is causing too much pressure along the gum in the site of #11 then one of two things may be happening. One is the flipper may not be seating all the way down and needs to be adjusted or the tooth is too long and it needs to be filed down a little bit. Adjustmens can be made to the tooth or any other part of the flipper without ruining the integrity of the appliance. Sometimes just the minimalist adjustment does the trick!

The flipper will feel like a mouthful until you get use to it. But the pressure feeling should lessen with each day of wearing it. If you find that any tooth or area becomes very achey or painful, then the flipper definitely needs an adjustment.

As far as talking with it, again your muscles have to get use to it being there. Your tongue is not use to sharing the palate when you speak or eat but if it fits well, your tongue will adapt to it being there.

I know this is hard..... and it seems like it's just never ending!! I wish there were any easier way......... ~'.'~... hang in there!!

Bryanna

Hi Bryanna, when you say the more the bone fills in, the lower the gum will be, I want the gum to be higher. The other eye tooth is higher and they matched in appearance when the impression was made. Maybe this is what you meant since you said it will recede. The gum now looks boxy and does not have the moon shape arch on top...and the fake tooth does so points over the gum a millimeter above. One thing also is that my palate is still sore and the area is yellowish from the bone powder still there. The flipper is very irritating so I am hesitant to wear it, I would like to wait a few more days until there's less pain, more healing. No rush, I guess as long as I don't care esthetically.

My dentist told me that the tooth cannot be filed. The funny thing is that when I tilt it, the tooth fits in beautifully but then the flipper isn't tight in my mouth (the wire hanging!) so I can't wear it that way! I just wish it looked right from the beginning. I hope the gum starts taking the arch shape, does it know to do that by itself? I am sorry to bug you with all this, I just am really thrown by this experience, the cost, the other problems they see, may need more extractions on old root canaled teeth...it just is all happening at once. But if you can answer the first question about the shape, I'd appreciate it. Is it normal for it not to fit the shape of the tooth when the patient first gets it? I am sure it WAS the shape of the original tooth but now it looks like a big buck tooth. One more thing, do they ever remake these if the patient just doesn't feel right, even giving it a chance? I mean legally, are they supposed to for no fee? I also don't see why he said it can't be shaven...I know they can adjust something but what, if not the shape? I am so lost with this!

Hi sandy,

You have been through alot in just a short amount of time and you have a ways to go yet before you are in the clear and just on maintenance visits. But honestly, you are doing great in taking care of yourself and following post op instructions!

You mentioned that you have other dental work to be done. My suggestion is to not move forward with any permanent restorations until you have a complete diagnosis of all of your dental needs. If you are going to have more teeth removed, then you may have replacement options that could be less costly overall instead of doing one area at a time.

With regard to the bone grafting...... when this is done, your natural bone fills in more completely thus the gum area only shrinks back to where that bone levels off. When no bone graft is placed, the gum tissue can shrink to the point of appearing flat because the bone becomes flat and the gum tissue hugs it tight.

You may have recession on your other eye tooth and you may have had it on #11 as well. This would make the gum look higher than it really should be. Healthy gum tissue is never pointy.... it is rounded along the contour of where the tooth meets the gum. Chances are, the gum area in the #11 site will not match #6 (the other canine) because there will be no recession in the #11 site.

From your description of the flipper and the way it fits..... it sounds to me like it needs to be adjusted and may not be fitting very well. Aside from #11 looking different than #6....... the flipper should snap into place and not be poking you in the gum uncomfortably. A little pressure on that gum is ok and it acutally will serve to set the gum with a slight indentation as it heals which is what you want it to do. But more than a little pressure means it needs adjustment. And yes, the tooth can most defintitely be shaved down a bit if necessary.

I don't know why your gum is still sore on the palate nor do I know why you have a yellowish area. The bone graft is not placed in tissue, therefore it is not visible in color through gum tissue. The graft is placed inside the same bony socket that held the tooth in your jawbone so the graft material is encased in bone. Did your surgeon say anything about the yellow color??

If your flipper is not fitting properly and the dentist cannot make the proper adjustments without ruining the integrity of it, then yes, he should make you a new one at no charge to you. Dental Labs make mistakes all the time but more importantly if your impression was not exactly right, then the lab fabricated it to what the impression was and it could be that the appliance is not fitting properly in your bite.

It is important to wear the flipper so the gum area heals with a certain arc to it if you plan on having an implant sometime in the future. But if it is totally uncomfortable, see your dentist about adjusting it. He may get a bit annoyed but that's his problem......... it needs to fit properly and you may unfortunately have to make a stink about it!

Bryanna ~'.'~

The yellowish stuff is the same that was there from day 1 which you said will fall out in little pieces and not to be alarmed. It has but there is still a little left in the socket. Less each day and the OS said it would be another few weeks before I see pink gum again. My regular dentist looked at it and said this is normal and today I saw my periodontist today about something else and she said it would take a few more weeks. The palate still hurts, I guess I am a slow healer. The other extraction site is less red. The team I go to want me to not panic and just do one thing at a time but it just seems like everything is falling apart. Old root canals that have some pathology that may need redoing, another darn gum swelling today on tooth 18 that had to be curretted and may mean opening up to look at a cracked root and perhaps another extraction. I am really stressed as this hasn't happened in years when I was not so worried about things. I was about 32 when most of my RCs and crowns were done.

Thank you for telling me I am handling this well because I feel like this is permeating my life and I am extremely distressed and that's why i keep writing. I may get an endo consultation because what you say is true...why get a bridge or even this flipper when another tooth may have to come out and it won't be useful anymore. The money...this has killed me. I live in a metropolitan area where dental work is really expensive. I have time before I decide on an implant ot fixed bridge for #11 so by then, I should have the total picture. Thanks so much again.

Hi Sandy,

One comment that you made that I would like to remark on. Here is what you wrote...... <<I may get an endo consultation because what you say is true...why get a bridge or even this flipper when another tooth may have to come out and it won't be useful anymore.>>

I must clarify my opinion of which I have stated here and elsewhere many times. IMO, it is never, never a good idea to get a root canal nor is it wise to retreat a tooth with a root canal. ALL root canaled teeth are infected because the microscopic canals are not accessible, they cannot be cleaned out. Therefore the root canaled tooth will always harbor infectious bacteria irrelevant of how well a root canal procedure is performed. In addition to this anatomical fact, a persons immune system plays a big role in how this infected tooth will affect their overall health.

If you have a removable partial denture, teeth can usually be added to it without having to make a whole new one. The idea when making a partial denture for a patient who still has some questionable teeth is to make it so it can accomodate additional teeth as the questionable ones are removed. This is all part of the "long term" treatment planning that I spoke to you about earlier when I suggested that you get a diagnosis of what all your dental problems are before you get any further dental restorations or bridges done.

The flipper that you currently have may or may not be adaptable to adding teeth because it may have been fabricated to just accomodate #11 and #2. This is another reason why it is important for patients to have a complete diagnosis of their dental problems so they don't waste money on doing bits and pieces of dentistry only to find out that it could have been done alot less expensively in the long run.

Permanently cemented bridges cannot accomodate any additional loss of teeth. They would have to be remade entirely.

From what you are now describing....... it sounds like you have ongoing periodontal disease and old root canaled teeth. As you are finging out, this combination will eventually end up in tooth loss. This is due to the infectious nature of the periodontal disease and the infected root canaled teeth. One condition feeds off of the other and there is no way to get rid of one if the other one is still present. Again, I think you are experiencing this exact scenerio at this time as you are dealing with one swelling after another in areas of root canaled teeth. Curretting the area of these infected swollen gum pockets is typically done in conventional dentistry, but it is basically a waste of money and there is no long term benefit to doing this procedure. The pocket will become overloaded again because the infection is coming from the tooth. The oral problem with this constant reccurance is the bone level deteriorates more and more every time. The sytemic problem with these infections is the bacteria not only lives under the gum tissue, it travels through your bloodstream. This is why I repeat myself here and elsewhere for people to seriously consider removing their infected teeth............

I am giving you the information straight....... not holding back and not pulling any punches. I know it is not what you want to hear and I know it is overwhelming. I wish I knew of a better way to say it all. But you deserve to be told the truth and you deserve to know what your dental issues are so you can make an informed decision as to what is in your best interest and not keep pouring more and more money into dentistry that will not only be short lived, but will also have negative affects on your overall well being.

You need a diagnosis of all of your dental issues and you need treatment options both short and long term AND then you decide which path you are most comfortable taking. Your dental team "probably" wants to do what they think will make you happy...... so you have to make yourself clear if you are willing to continue on this path of patching up here and there and redoing dentistry here and there...... or you prefer to get your mouth healthy by getting rid of the infections in a shorter amount of time.

Please don't let this information upset you. You are trying to do the right thing, you just need to know what the problems are so you can make a plan to deal with them.

We're always here..........~'.'~

Bryanna