Extraction of root canal teeth
 

Hi Bryanna,

Three weeks ago, I had RC tooth #14 extracted and bone grafted due to an abscess eating in the bone, visible on xray. Then, I had to extract #19, which showed nothing on Xray. But after OS extracted it, she saw a deep vertical crack.

So in span of 3 weeks, had to extract 2 RC teeth!

- How long does it take for healing to happen? It's been 4 days and my face is swollen from #19. Is there a difference between hard and soft swelling in the face?

- Also, when I touch my tongue to roof of my mouth, I can the underside of my tongue has these very dark purple, red spots/area. What can those be?

-I am thinking of getting an implant, how long can I wait? OS thinks a year for the top. What if I don't get an implant within a year due to cost? Both #14 and #19 are on top of each other.

Thanks so much! This sight is so useful!

Caligal,

The healing from the extraction of an infected OR root canaled tooth is longer than from an extraction of a non infected tooth. The reason being is that the bone surrounding an infected OR root canaled tooth will also be infected to some degree. To reduce the likelihood of post operative complications and to promote healing a few things need to take place:

1) The surgeon needs to be thorough in removing the tooth in its entirety along with removing all diseased tissue and bone. He needs to be aware and treat if necessary any sinus communication/perforations that are seen or occur during the surgery. Ideally, the bone graft should be placed in healthy, not infected, bone. If the bone has been thoroughly cleaned but there is still evidence or suspicion of infection still present, then it is sometimes best to not place the graft until the site has had time to become healthier.... about 2-3+ weeks post op.

2) The patient should follow the post operative protocol given to them by the surgeon. With the exception of rinsing with any type of chemically laden mouthwash like Listerine as that will cause further irritation and can disrupt the formation of a clot pre disposing the site to develop a dry socket.

3) The patient should not smoke or drink alcohol as long as the gum tissue is open. Any smoking or alcohol will slow down the healing and could easily result in dry socket.

4) The patient should drink water to the equivalent of half their body weight in ounces. Meaning weight 100 lbs = 50 ounces of water per day. The water helps to keep you hydrated and continuously flushes out the bacteria.

5) The patient should eat a sugar free, nutrient dense soft food diet to provide the nutrients, vitamins and minerals needed to heal the bone and gum tissue. If not allergic... all vegetables, fruit, eggs, oatmeal, lean and tender meats (that do not require a lot of chewing), potatoes, and healthy fats like coconut oil, olive oil and organic butter.

6) The patient should brush and floss all of their teeth twice a day to keep the plaque from accumulating anywhere as this sticky substance can cause or contribute to an infection.

In a healthy patient, the healing from an non complicated extraction of a non infected or non root canaled tooth is generally about 2-3 weeks if no post operative complications occur. The gum tissue closes over in about that time frame and the jaw bone takes up to one full year (with or without a graft) to fill in completely.

There is a difference between hard and soft tissue swelling. Soft tissue is associated with inflammation of the tissue, muscles, tendons and ligaments. It is usually soft or spongy to the touch. Hard tissue swelling is when the inflammation is hard and immobile.

The dark spots underneath your tongue may have always been there and you never noticed them? They could be inflamed vessels in response to an irritant or health condition. They have to been seen clinically to evaluate.

Dental implants are intended to be placed in healthy adequate jaw bone no sooner than 4-6 months post op and no later than one year post op the extraction of a tooth.

Bryanna

Thank You Bryanna for such useful advice.

Hello DanyRoden..... You are very welcome!!

Bryanna

1. What does it mean to debride the bone after extraction? If the surgeon doesn't see infection, do they still debride the bone?
2. Do all the OS always remove the periodontal ligament? What happens if its left in there?

After reading these forums, should I ask my OS if they did that? Thanks!

caligal,

I will re post your questions and answer them in bold type. Makes it easier to follow.

<<1. What does it mean to debride the bone after extraction?>>

DEBRIDEMENT OF THE BONE MEANS TO SCRAPE IT CLEAN.
ANYTIME A TOOTH IS EXTRACTED, THE BONY SOCKET THAT THE TOOTH WAS IN NEEDS TO BE SCRAPED CLEAN OF ALL TISSUE REMNANTS AND LOOSE FRAGMENTS OF BONE. IF THIS STEP IS NOT DONE THEN AN INFECTION CAN DEVELOP AND/OR THE SITE MAY NOT HEAL COMPLETELY.

<< If the surgeon doesn't see infection, do they still debride the bone?>>

A THOROUGH DEBRIDEMENT IS SUPPOSE TO BE DONE WITH EVERY TOOTH EXTRACTION IRRELEVANT OF WHETHER THERE IS INFECTION OR NOT.

<<2. Do all the OS always remove the periodontal ligament?>>

THIS IMPORTANT ASPECT OF THE ORAL SURGERY SHOULD NEVER BE SKIPPED OR RUSHED THROUGH. IT IS SUPPOSE TO BE DONE WITH EACH EXTRACTION. UNFORTUNATELY NOT EVERY OS OR DENTIST WILL PERFORM THIS STEP OR PERFORM IT AS THOROUGH AS THEY SHOULD.

<< What happens if its left in there?>>
A BACTERIAL INFECTION CAN OCCUR AS A RESULT OF NOT REMOVING THE NOW NECROTIC TISSUE AND BONE. THIS INFECTION CAN SPREAD BEYOND THIS AREA OF THE MOUTH AND HEALING CAN BE INCOMPLETE.

<<After reading these forums, should I ask my OS if they did that?>>
YOU CAN. HOWEVER, SHE MAY TELL YOU SHE DID EVEN IF SHE DIDN'T BECAUSE THIS STEP IS SUPPOSE TO BE DONE IRRELEVANT OF THE CIRCUMSTANCES.

Do you still have the swelling near #19? Has the area underneath your tongue changed? When is your post operative appointment to see the os?

Bryanna

*** Hi Bryanna,

I still have facial swelling close to 2 weeks later, it's soft facial swelling. I don't have pain or nor a smell but the face is still has some swelling which is noticable. IT DOESN"T SEEM TO BE GOING DOWN. Both #14 and #19 on my left side of the face, so don't know if its #14 or #19 causing the swelling.

At the 1 week post-op, OS said it look fine. What can it be for the facial swelling? My other teeth are fine, don't have cavitiies in the past five years so I feel like I can eliminate the other teeth as the reason. How much time should I wait before getting a 2nd opinion for the swelling? Thanks so much!

I caligal,

Originally you thought the swelling was from tooth #19 which you had extracted around 1/26-1/27. That would mean you are about 10 days post op for #19. Yes?

Soft tissue swelling from a difficult tooth extraction can take a few weeks to go away in some people. If there is no infection and there is nothing slowing down the healing like smoking or a health condition that causes delayed healing, then generally at the 2 week mark it should appear to be subsiding and get noticeably better each day forward.

Bryanna