Extraction issues after a month
 

I'm a 33 y.o. male, non smoker, rarely drink.

I had #19 extracted a month ago. No dry socket or bone chips. Very smooth, quick, and painless. The socket hasn't completely healed over yet. The gum on either side of the hole are pale pink, almost white.

For the last three days I have woken up with #20 and the gum framing the extraction site in pain. Both #20 and #18 are sensitive to cold. It takes 1200mg of Ibuprofen to knock the pain out. Last night the pain woke me out of sleep.

I saw my dentist, who thought my bite may be misaligned. He ground a couple of teeth, and that didn't help.

The only complication has been the development of TMJ disorder. It's slowly getting better.

Questions:
Should the extraction site hurt? There appears to be no infection.
#20 is sensitive to cold and hurts upon waking. Is that normal?
I woke up a couple times last night with my jaw clinched. Could that be the reason for all this sudden pain? Maybe it's inflaming the TMJ as well.

Thank you.

Hi David_Alan,

I am in the dental field and can offer you some help here.
Glad to hear that your extraction went well!

I will re post your questions and answer them in bold type.

<<<Should the extraction site hurt? There appears to be no infection.>>>

WAS TOOTH #19 ROOT CANALED? WAS THERE AN INFECTION AT THE END OF THE ROOT OF #19? SOMETIMES THE BONE HAS SOME DIFFICULTY HEALING WHEN THERE WAS A CHRONIC INFECTION IN THE TOOTH. IT DOES NOT NECESSARILY MEAN THAT THERE IS AN ACUTE INFECTION, IT JUST MEANS IT MAY TAKE LONGER TO HEAL.
SOMETIMES THERE IS RESIDUAL INFECTION THAT WAS NOT REMOVED AT THE TIME OF THE EXTRACTION AND THIS COULD CAUSE THE EXTRACTION SITE TO HURT SOON AFTER THE EXTRACTION OR SEVERAL WEEKS LATER.
DID THE DENTIST TAKE AN X-RAY OF THIS AREA CHECK FOR PATHOLOGY?

<<<#20 is sensitive to cold and hurts upon waking. Is that normal?>>>

IT IS COMMON FOR COLD SENSITIVITY TO DEVELOP ON THE ADJACENT TEETH TO THE EXTRACTED ONE. BECAUSE AS THE GUM HEALS AT THE EXTRACTION SITE THERE WILL BE SOME DEGREE OF RECESSION. THAT MEANS THAT THE ADJACENT TEETH MAY HAVE SOME PARTIAL ROOT EXPOSURE DUE TO THE SHRINKAGE OF THE GUM TISSUE. SOMETIMES THIS SENSITIVITY HEALS ON IT'S OWN, SOMETIMES A COMPOSITE FILLING MATERIAL CAN BE PLACED ALONG THE PORTION OF THE TOOTH THAT IS SENSITIVE. YOU ARE ONLY A MONTH OUT POST OP... SO IT'S BEST TO GIVE THIS A FEW MORE MONTHS OF HEALING TO SEE HOW FAR THE GUM TISSUE RECEDES BEFORE DOING THE FILLING.
ALSO IF EITHER OF THE ADJACENT TEETH HAVE FILLINGS IN THEM OR HAVE CROWNS.... THERE COULD BE SOME DECAY ALONG THE MARGIN OF THE FILLING OR CROWN THAT WAS NOT VISIBLE WHILE THE #19 WAS STILL PRESENT.

<<<I woke up a couple times last night with my jaw clinched. Could that be the reason for all this sudden pain? Maybe it's inflaming the TMJ as well.>>>

THAT IS A TYPICAL SIGN OF A CLENCHING OR GRINDING HABIT... TO WAKE UP WITH YOU JAW CLENCHED. YES, A CLENCHING OR GRINDING HABIT CAN CAUSE VARIOUS TEETH OR VARIOUS AREAS OF THE FACE AND JAW TO HURT... CAN CAUSE THE BITE TO SHIFT ABNORMALLY... CAN CAUSE EXCESSIVE WEAR ON CERTAIN TEETH.... CAN MAKE THE GUMS FEEL SORE. IT IS THE ACTUAL MECHANICAL MOTION OF CLENCHING OR GRINDING THAT PRODUCES THE MOST PROBLEMS. THE INFLAMMATION IS A SECONDARY OCCURRENCE TO THE OTHER.

Bryanna

Thank you for the swift response. Today everything feels much better. Ibuprofen is helping, along with ice on the TMJ & muscles.

All of this tooth trouble is overwhelming, as I have never had dental trouble before. A few fillings, but that's all. No complications.

The root of #19 was not canaled. To my knowledge, there never was infection. I had a pulpectomy about three weeks before extraction. It's a long story, but I was unable to do the full root canal, and I had the extraction done as soon as I could. As it turned out, #19 had several cracks. It was likely that a root canal and crown would not have lasted too long before complications set in. Extraction was inevitable, and it's better to do it while I'm still young-ish (33).
The oral surgeon took a 360 degree x-ray before the extraction. Here it is:

https://sphotos-b-ord.xx.fbcdn.net/h...39568404_n.jpg

I am currently looking for a dentist in Chicago that specializes in occlusion and bite splints.

Hi David_Alan,

Thanks for posting the great xray!!

Tooth #19 evidently had decay or had an injury to the pulp of the tooth....thus the pulpotomy/pulpectomy. The bone looks healthy on this xray so hopefully you had the tooth removed before the bacteria spread to the bone.

Glad you are feeling better. You could also try applying "moist" heat to the TMJ area as that will get the blood flowing which may help reduce and tightness or spasms in the muscle.

Bryanna