Tooth #20, or should I say, Socket #20...

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John - 30 Nov 2007 18:30 GMT

As you all know, it was extracted 23 days ago. Well, it still hurts
on and off, though not as bad as it did before extraction. The socket
looks ok to me, no sign of any infection or swelling or oozing. A
week post extraction, the DDS said it looked great and to come back in
7 weeks to be evaluated for an implant.

Now, is it that unusual for an empty socket to still be hurting 3
weeks post extraction?

If so, what could possibly be the explanation for the pain?

After complete healing, there should be nothing filling the socket but
bone, correct?

Any remaining periodontal ligament post extraction should have gone
away, correct?

If it's still hurting in 5 more weeks, what then?

The DDS was disinclined to give me an implant if there is still any
pain, but I figure, if it's going to hurt no matter what, I might as
well have an implant rather than a bridge, to maintain jaw bone mass
and not grind down two perfectly good adjacent teeth.

John.

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Steven Bornfeld - 30 Nov 2007 18:42 GMT

> As you all know, it was extracted 23 days ago. Well, it still hurts
> on and off, though not as bad as it did before extraction. The socket
[quoted text clipped - 4 lines]
> Now, is it that unusual for an empty socket to still be hurting 3
> weeks post extraction?

Not unusual to have some residual soreness.

> If so, what could possibly be the explanation for the pain?

Slow healing of dry socket, bony sequestration.

> After complete healing, there should be nothing filling the socket but
> bone, correct?

It takes many months for the socket to fill with bone. However, the
gum heals over more quickly and the pain should gradually disappear.

> Any remaining periodontal ligament post extraction should have gone
> away, correct?

Pretty much. They used to teach curetting of the socket to remove any
ligament, but I don't think anyone teaches this anymore. The idea of
the curetting was that some epithelial cells in the ligament could
potentially form a cyst. But this has been largely discredited AFAIK.

> If it's still hurting in 5 more weeks, what then?

Depends on the trend--if it's improving even slowly give it more time.
If you see increased redness, any drainage, or increased pain, by all
means have it looked at.

> The DDS was disinclined to give me an implant if there is still any
> pain, but I figure, if it's going to hurt no matter what, I might as
> well have an implant rather than a bridge, to maintain jaw bone mass
> and not grind down two perfectly good adjacent teeth.

If the pain remains it may be necessary to re-enter the site to look
for what's causing the pain. Your surgeon will not likely place a
fixture if there is any reasonable expectation that there is something
wrong, like an infective process. However, if the area is opened for
examination and possible debridement it may be advisable to put some
graft material in to preserve the ridge.

Steve

> John.

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John - 30 Nov 2007 22:19 GMT

On Nov 30, 1:42 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:
...

> > The DDS was disinclined to give me an implant if there is still any
> > pain, but I figure, if it's going to hurt no matter what, I might as
[quoted text clipped - 9 lines]
>
> Steve

Thanks for the excellent details!

John.

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