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Medical Forum / General / Dentistry / September 2006

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extraction follow-up - bone sticking out from gum - s.m.d.

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Bill Gates(Email to me without 'this is not spam' in the subject is directed straight to the trash unread by automatic filters.) - 01 Aug 2006 18:57 GMT
I had my 4 wisdom teeth extracted.

Getting approval from MDC (Guardian - Managed Dental Care of
California) for the extractions took months and required 6 formal
complaints and an appeal, and many phone calls, and that's not counting
the work that the doctor's office had to do. The surgeon has a great
bedside manner and I think he did a good job.  It cost just under a
thousand dollars so far, and I have to go back for further work, and
pay for it:  The extractions caused the bone on the inner ridge of my
lower jaw just by the extraction site to become exposed - after
surgery, it had a hair-thin covering of gum, but that soon eroded and
now the bare bone is sticking out, and I fear the same thing is
happening on the other side.  Apparently, taking care of this
complication is an extra cost! -around $200.  I had picked up a flyer
beforehand for a product that is inserted into the hole left by the
tooth that (according to the flyer) is slowly replaced (by the body) by
bone, leading to a stronger jaw and less bone erosion.  I meant to ask
for it, but the approval process was so tortuous, I failed to do so at
the right time.  I wish I had, as I bet it would have sped the healing
(I still have holes I have to labouriously keep clean, over a month
later!) and perhaps even prevented this problem by not making the
now-exposed bone so prominent. But hindsight is always easier than
foresight...  The professional opinions I got were all pro-extraction,
but the lay opinions were not.  I figured that the DMO wouldn't cover
the extraction if it wasn't advisable (the insurance issues were about
who would do which procedures and what costs would be covered(7140 vs
7220 vs 7210...GP vs Surgeon), not about whether the teeth required
extraction. In the end, 2 7210's and 2 7240's both by the surgeon/oral
surgery specialist, were done)

The surgeon said I could just leave it, and it would slough away
naturally, and called it an exostosis, though based on the wikipedia
page on it, that doesn't make sense; I don't recall that it's new bone
growth.  I did some further research and it seems more like alveoplasty
- 7310 "Conservative contouring of the [in ths case lower] jaw bone
especially after extraction of teeth" . It hurts, it's sharp, and I
imagine that it's at some sort of elevated infection risk, but I have
no idea if that's a major issue or not. I'm not on antibiotics or
anything.  I saw the surgeon again 2 weeks after the extraction, and
the bone was bothering me and we discussed it.  It got a bit better and
then exposed completely.

Just found it as I was reviewing this message: After reading
http://www.fortworthoralsurgery.com/pages/alveoplasty.htm I REALLY wish
I'd had the socket filled!!  Is it too late?  It's been just over a
month. Anyone have experience with the stuff? (Thanks, W,S&R!)

Anyway, I'm most interested in opinions on whether there's a high risk
of infection when bone is exposed, and what the surgery would be like
(and what's likely if I do nothing), and general advice and patient
experiences.

-RBG (Email to me without 'this is not spam' in the subject is directed
straight to the trash unread by automatic filters.) Posting here
because the replacement forum isn't run competentty.
Joel344 - 04 Aug 2006 13:45 GMT
Leave it alone ... it'll heal

--
Joel34
adamscool - 31 Aug 2006 06:01 GMT
I went  to a free dental clinic because bone was sticking out in my
lower right jaw.They said I needed an oral surgeon.I went to one and he
extracted my back wisdom tooth in my lower right jaw.The area got
infected and he went in and scraped the jawbone.Then my lower lip went
numb,burning and itching with my right chin going numb.The pain was
constant for three months! The dentist said I would "have to live with
it".What an a.shole thing to say to a patient.I looked on the internet
and found that I had trigeminal paresthesia or neuralgia.The dentist
knows exactly what he did and tried to weasel out out it.I couldn't sue
the sucker,but I filed a complaint with the dental board of
examiners.Now on the lower right side of my jaw the bone is coming
through the gums.It is jagged,and hard as steel,and it is rubbing
against my tongue.I feel like a teething infant.I don't need all these
dental problems at 55.I believe I'll buy a dremal tool and get a
de-burring tool and take some pain killers and carefully grind the bone
down!I'll try not to traumatize the gums while I'm doing it.I'll save 6
or 7 hundred dollars for 10 minutes of work.I'll keep you posted on my
success on this matter.
C.J. Thomas - 31 Aug 2006 12:27 GMT
Try to find another oral surgeon to drill away the irritating bone.  Who
knows what type of bugs you will be introducing if you use your own dremal
tool.  The bone following an extraction can remodel for the next 6 months.

Your nerve damage will hopefully get better over time.  Unfortunately, with
third molar extractions, there is a risk of damage to some of the nerves in
your mouth, which should have been explained to you when you signed the
informed consent with the oral surgeon.  Did you have to give your written
consent before the extraction?

I had a patient that I needed to perform a root amputation on this time last
year.  Upon flapping the gingival tissue, I located the mental nerve; I
didn't cut it; however, I irritated it (inadvertently).  The patient
reported a sense of numbness over the next month or so; however, slowly,
normal sensation came back.  I don't think you have trigeminal neuralgia.
This is usually associated with a trigger point on the face somewhere.

Hope you start to feel better soon...

> I went  to a free dental clinic because bone was sticking out in my
> lower right jaw.They said I needed an oral surgeon.I went to one and he
[quoted text clipped - 14 lines]
> or 7 hundred dollars for 10 minutes of work.I'll keep you posted on my
> success on this matter.
Alexander Vasserman DDS - 02 Sep 2006 07:59 GMT
This sort of thing sometimes happens. The bone needs to be smoothed
down it should not take any longer than 10 min including numbing time.
If I do the extractions, I usually take care of these complications
without additional charge to the patient since it is easy to miss a
sharp edge of bone.
I think it is costing you extra because you have Guardian insurance and
youare probably getting a large discount elsewhere in your treatment.

> Try to find another oral surgeon to drill away the irritating bone.  Who
> knows what type of bugs you will be introducing if you use your own dremal
[quoted text clipped - 33 lines]
> > or 7 hundred dollars for 10 minutes of work.I'll keep you posted on my
> > success on this matter.
 
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