gum pufiness 6 weeks after a root canaled tooth extraction
 

I couldn't get the pre root canal x ray from my old dentist. I talked to one dentist who saw the x rays with white spot and he said yes it could be rc material but that wouldn't cause a problem, and if there is no apparent sign of infection, to let the nature heal the extraction. I just saw my OS ( the jerk, because I couldn't get appointment with somebody else for 3 weeks ) when I asked about that white spot, he said yes, that's rc material, but that's not a problem at all. He said to either open it up, or wait a couple of weeks more. I'm afraid I will wait and end up having it open up anyway, but I'm afraid to have that re opening done. It's still a little red inside the socket, he took a panoramic x ray, he doesn't see anything on it, but said the x rays doesn't pick up everything.

nyuszisie,

The statement made by the dentist about the rc material not causing any problem is just unrealistic. Hopefully it won't cause a problem but no one can affirmatively tell you it won't. My concern, which should be your dentists concern as well, is the possible relation between your sinuses and the rc material. Any chance you could post the panoramic xray?

here is my x ray, the person who I talk to was very nice, first she said she needs to ask a dr.'s permission, but then she said " I'm sending it to you ".

nyuszisie,

Thanks for posting the panoramic xray. From this radiographic view the rc material is in communication with or laying in front of your sinuses. Your extracted tooth was in the same position. I've asked you before if the dentist who extracted this tooth checked for a sinus communication at the time of the extraction. I believe you said that was not done...??

It also looks like the periodontal ligament was not entirely removed during the oral surgery. So now it makes sense why the rc material was not removed a that time as the site was not thoroughly debrided. Both of these things, the rc material and the ligament remnants could become problematic or it may not become anything significant to worry about. No one can predict that outcome.

You may have already mentioned this someplace....... but are you in the process of having more dental work done? Do you have pain in other areas of your mouth?

The OS didn't check for sinus communication, never even mentioned anything about that being a possibility, and like I wrote before I'm very frustrated and angry because he didn't cleaned the extraction site, and I'm afraid that is why I still have this on and off pain and the puffiness. I'm not having any other dental work done for right now, I will have to go back to this same OS to have the site re opened and cleaned. I asked him if he is going to send anything to pathology, he said yes if there is something suspicious, and I of course mentioned the antibiotic allergy, he didn't quite answer me.

Is there a chance that the OS will not remove enough stuff from the socket , I mean the ligament and the infected bone he should have removed at the time of the extraction ? He said it takes 15-20 minutes with local anesthesia. Of course I'm so scared it's still not going to be OK, and I'm scared this second time I'm going to develop a dry socket. Birth controll pills make me more prone to them ?

nyuszisie,

So the oral surgeon acknowledged that the site should be surgically debrided? If so, then he suspects that there is a problem there. Otherwise, he would not have agreed to doing that. If the surgeon feels that he was thorough during the extraction and feels the post op x-ray shows proper healing then he would not want to go in and do the debridement.

Regarding the sample of tissue for pathology.... it is not a question of seeing something suspicious in the socket. The bacteria that could be a problem may be microscopic. It makes perfect sense for you to know what bacteria is lurking in there and what antibiotic will take care of it.

Don't be hesitant to tell him you want him to send specimens of the tissue and bone that he removes during the debridement to the lab for diagnosis of the bacteria and a sensitivity culture done to determine what antibiotics are best suited for it. Tell him to have the lab bill you directly. Your insurance may or may not cover it. I believe based on my professional experience that this test can be extremely helpful. But it is up to you if want to do it or not.

nyuszisie,

There is always that chance that he will not be as thorough as he should be. After all he wasn't thorough the first time around. This is why if you insist on him sending the material out to the lab... he will know that you are serious about getting this done right.

There is a chance you will develop a dry socket. Tell him you are concerned about that and want to do everything possible to avoid it.

Birth control pills..... if you are prescribed an antibiotic, then your BCP may not be effective while you are on the antibiotic. Yes, BCP can also elevate the risk of developing a dry socket so it may be best to schedule the oral surgery for the week that you are not on them. But preferably not the first two days of your menses.

I had the extraction the day before my menses ( that was the week I was on sugar pills ) and I didn't develop a dry socket, I don't know if that helped or not. I asked him about dry socket if he re opens the site, and honestly he was looking at me like I fell from Mars , but they never even mentioned dry socket to me not before and not after the extraction, not the dr. not the nurse, and there is not even a word about dry socket on their post op instructions they gave me before I left the office. I learned about it from the internet. Of course I want to have done everything what is in my best interest, even if I have to pay for it, I'm just afraid he will do whatever he thinks he wants to do, and he won't listen to me what I have to say. He acts like he doesn't have any idea why I still have a problem, x rays look good, the site looks good ( except the little redness in the socket ) , and he acts like he is doing me a favor re-opening the site. Because he even said " how I know the pain is from the tooth / extraction site, you had pain before the extraction ". I made appointment with another OS, unfortunately that appointment is in almost 3 weeks, and I don't know if I should wait that long, and besides I don't know anything about that dr. either. They put me on call list, so if an appointment comes available sooner they will call. I didn't make the appointment with this jerk yet. And this puffiness is still worse as the day goes by, gums are tender, but I didn't have pain in almost a week now.

You said you are not going to tell me about the procedure ( re-opening and cleaning the extraction site ) because maybe I won't need it. Now that it's only a matter of scheduling it, please tell me what should I expect. :confused: