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Medical Forum / General / General / February 2006

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Tooth extraction - what follows?

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Vierka - 06 Feb 2005 23:27 GMT
Hello,

two days ago I had a tooth extraction of # 46.  There seemed to be no
infection of the tooth at the time of extraction.  The gum on outer
side between the extraction site and the tooth behind is very swolen
and painful as well.  Currently I do not take any prescription pain
killers or antibiotics.  For the pain, I take 600 mg of Ibuprofen
every 8 hours which helps for the first 6 1/2 hours usually.

I was wondering whether this swelling and pain is still normal after 2
days and what actually happens with the empty tooth socket left after
the tooth?  Does the bone space left fill with bone matter or gum
matter?  How does it actually work?  

Thanks for answers!

Vierka
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Posted at: http://www.GroupSrv.com
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Steven Bornfeld - 07 Feb 2005 00:14 GMT
> Hello,
>
[quoted text clipped - 13 lines]
>
> Vierka

    Briefly:
    It would be helpful to know why the tooth was extracted.
    Some swelling post-extraction is normal, depending upon how difficult
the extraction was.  If the tooth was sectioned or any bone removed, I
would certainly expect mild swelling of the cheek next to the extraction
site.  There is also occasionally some bleeding into the tissues which
can lead to a somewhat harder swelling.
    There may be some soreness in the tooth behind the extraction if the
dentist exerted pressure on that tooth during the extraction.  Certainly
if that tooth is significantly sensitive to pressure after a week it
should be looked at.
    Normally in extractions that aren't sutured, the gum heals by secondary
intention: ie, the extraction fills with a clot, and gradually the clot
is infiltrated by granulation tissue and the gum tissue migrates from
the margins of the extraction site and eventually covers over with gum
tissue.  There can be a significant divet in the gum for quite some
time.  Meanwhile, bone gradually grows through the granulation tissue.
It may take up to a year for the bone to heal completely (although the
gum is healed long before).
    You should note that some bone is always lost after extraction--the
alveolar bone the roots of the tooth sit in unique in that it requires
the function of the teeth to maintain itself.  Without the tooth this
alveolar bone is gradually lost.  For this reason some dentists are
grafting extraction sockets now, esp. if there is consideration of
implant placement.

Hope this helps,
Steve

> *---------------------------------*
> Posted at: http://www.GroupSrv.com
[quoted text clipped - 4 lines]
>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        
Sbharris[atsign]ix.netcom.com - 07 Feb 2005 02:40 GMT
>>You should note that some bone is always lost after extraction--the
alveolar bone the roots of the tooth sit in unique in that it requires
the function of the teeth to maintain itself.  Without the tooth this
alveolar bone is gradually lost.  For this reason some dentists are
grafting extraction sockets now, esp. if there is consideration of
implant placement. <<

COMMENT:

Absolutely. If you're even thinking of an implant, have the bone graft
at the same time you have the tooth pulled. The hole's already there
and waiting, and no better time to fill it in.
Steven Bornfeld - 07 Feb 2005 03:03 GMT
>>>You should note that some bone is always lost after extraction--the
>>
[quoted text clipped - 9 lines]
> at the same time you have the tooth pulled. The hole's already there
> and waiting, and no better time to fill it in.

    Well, you should have a reasonable expectation that the increased
alveolar ridge height/width achieved by grafting will be used within a
reasonable period of time, or it will resorb too.
    The oral surgeon who placed my wife's implant surprised me by grafting
an extraction site at the time of extraction--in the presence of a
mid-facial cellulitis.  It worked out just fine.

Steve
Sbharris[atsign]ix.netcom.com - 07 Feb 2005 03:13 GMT
>>The oral surgeon who placed my wife's implant surprised me by grafting
an extraction site at the time of extraction--in the presence of a
mid-facial cellulitis.  It worked out just fine. <<

I had one done that way myself, also with good results. Aparently a
bone graft just doesn't count in the usual way as a foreign object.

SBH
Steven Bornfeld - 07 Feb 2005 03:22 GMT
>>>The oral surgeon who placed my wife's implant surprised me by
>>
[quoted text clipped - 6 lines]
>
> SBH

    They have some way to remove the graft materials' antigenicity.  In my
wife's case, the surgeon used a mixture of demineralized freeze dried
bovine bone and some artificial stuff (hydroxyapatite) mixed together.

Steve
Sbharris[atsign]ix.netcom.com - 08 Feb 2005 05:06 GMT
>>They have some way to remove the graft materials' antigenicity.  In my
wife's case, the surgeon used a mixture of demineralized freeze dried
bovine bone and some artificial stuff (hydroxyapatite) mixed together.
<<

I got sterilized cadaver bone. And being a Tony Hilleman fan, had a
giggle-fit thinking of how Navajos must react to being offered that
option. But was under nitrous, which gives me very odd associational
thinking.

SBH
Steven Bornfeld - 08 Feb 2005 14:56 GMT
> I got sterilized cadaver bone. And being a Tony Hilleman fan, had a
> giggle-fit thinking of how Navajos must react to being offered that
> option. But was under nitrous, which gives me very odd associational
> thinking.
>
> SBH

Yum! :-)

Steve
zwalanga@yahoo.com - 09 Feb 2005 08:36 GMT
> >>They have some way to remove the graft materials' antigenicity.  In
> my
[quoted text clipped - 8 lines]
>
> SBH

Eeeeeeeuuuuuuuuuuuuuu...

I, a 62 year old, have all my own teeth.
steveinFLfl - 11 Feb 2006 14:44 GMT
had a lower right molar extracted feb 2, its now 9 days later and the site
is still sore on the gum.

no dry socket, Ive been eating regular for the past week or so, i sleep ok
but, after waking about 2 hours later the soreness on the gum next to the
extraction site is evident.

its bearable and i take tylenol occasionally, but how long will this area
be sore?
Thomas Jepson - 07 Feb 2005 04:48 GMT
> Hello,
>
[quoted text clipped - 13 lines]
>
> Vierka

You should have been told to gargle with hot, salty water
every few hours to help heal the area and prevent infections.

Why did they pull your tooth?

If the pain persists call your dentist.

Thomas
Mark & Steven Bornfeld DDS - 07 Feb 2005 16:00 GMT
>>Hello,
>>
[quoted text clipped - 22 lines]
>
> Thomas

    Gargling with hot water immediately after extraction is definitely a
bad idea--esp. after a lower molar extraction, because it can dislodge
the blood clot.  This may start it bleeding again, but more commonly
leads to a localized osteitis known as a dry socket, which is no fun at all.
    Rinsing with WARM (not hot) salt water, 1/2 tsp./8oz 24 HOURS AFTER the
extraction is soothing and will dislodge any debris.

Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

JWN DDS - 07 Feb 2005 19:42 GMT
>>>Hello,
>>>
[quoted text clipped - 31 lines]
>
> Steve

I agree with Steve.

jwn dds
Vierka - 07 Feb 2005 15:31 GMT
Thank you for all your help and answers.  

The tooth was extracted because it had root canal done and it broke.
When the root canal was done, another dentist inserted metal post
into one of the roots but it was too large for the canal (as I was
told after by my current dentist) and it fractured one side of the
root.  Couple months after this post and other metal supporting posts
were put in, I bit down on something and the tooth crown (at this time
mostly made of white filling) broke.  I was told that the tooth cannot
be saved (a crown put on it) because the root was not stable and
healthy, etc.  After the tooth was extracted, the dentist told me
that the tooth was actually broken inside as well.

What worries me right now is that the tooth in front of and one behind
the extraction site are very pressure sensitive and painful as well.
I'm hoping that everything is all right with the bone.  The pain is
really not getting any better.

Even though the dentist told me I should think about an implant
because of the "good bone structure", he did not take any measures of
filling the extraction site.

I have been rinsing with warm salty water 4 times a day after 24 hours
on as I was instructed by the dentist.

I also called the dentist yesterday because I was worried about
infection, and he seems to think it's OK and that I might have a dry
socket.  He basically told me to wait whether it gets worse.

It just does not seem all right to me.
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Posted at: http://www.GroupSrv.com
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Mark & Steven Bornfeld DDS - 07 Feb 2005 16:03 GMT
> Thank you for all your help and answers.  
>
[quoted text clipped - 34 lines]
>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        

    You may well have a dry socket developing.  Also, the entire area will
tend to hurt in a case like this, so I wouldn't make too much of the
pressure sensitivity of surrounding teeth yet.
    There are medications that can be placed if you do have a dry socket
which will make it feel much better, and your dentist should agree to
see you.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Vierka - 07 Feb 2005 17:48 GMT
Thanks Steve.

I thought that dry socket usually develops on the third day?  Well the
pain and swelling that I have has really been constant since the first
day of extraction which was Friday.

My regular dentist will check it out on Wed. morning if it doesn't
improve.
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Posted at: http://www.GroupSrv.com
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Mark & Steven Bornfeld DDS - 07 Feb 2005 19:25 GMT
> Thanks Steve.
>
[quoted text clipped - 12 lines]
>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        

    Yes, it usually takes a few days to develop.  Symptoms post-extraction
are all over the map, and yours aren't unusual. Yes, I'd call Wednesday
if there's no improvement.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Vierka - 09 Feb 2005 00:31 GMT
Well, my pain seems to be getting worse - now I have pain beneath my
jaw around lympnodes to the ear, the two teeth around the extraction
site are very sore, and 600 mg of Ibuprofen is not working anymore.
It has been since Friday, so maybe I'm getting resistant to
Ibuprofen?... I don't really know.
I tried 2 tablets of Tylenol 3 yesterday, but that didn't even work as
much as Ibuprofen.  I'd like to know how is it possible that I'm
resistant to this supposedly strong pain killer?  I tried to tell my
dentist that this really doesn't work for me (I had it prescribed
before for tooth ache) but she prescribed it anyway.  I remember my
previous dentist then prescribed Oxycodan which really worked.  Is
there anything bad with Oxycodan that Tylenol 3 is always much more
readily prescribed even though it doesn't really work?

So these are my not so good news.  The good news is that I'm seeing my
regular dentist tomorrow morning, so hopefully she can figure
something out.

Viera
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Posted at: http://www.GroupSrv.com
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Steven Bornfeld - 09 Feb 2005 02:38 GMT
> Well, my pain seems to be getting worse - now I have pain beneath my
> jaw around lympnodes to the ear, the two teeth around the extraction
[quoted text clipped - 13 lines]
> regular dentist tomorrow morning, so hopefully she can figure
> something out.

    I'd guess a dry socket at this stage.  Your dentist should be able to
give you some relief.

Steve

> Viera
> *---------------------------------*
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>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        
Emma Chase VanCott - 09 Feb 2005 03:40 GMT
: Hello,

: two days ago I had a tooth extraction of # 46.  There seemed to be no
: infection of the tooth at the time of extraction.  The gum on outer
: side between the extraction site and the tooth behind is very swolen
: and painful as well.  Currently I do not take any prescription pain
: killers or antibiotics.  For the pain, I take 600 mg of Ibuprofen
: every 8 hours which helps for the first 6 1/2 hours usually.

: I was wondering whether this swelling and pain is still normal after 2
: days and what actually happens with the empty tooth socket left after
: the tooth?  Does the bone space left fill with bone matter or gum
: matter?  How does it actually work?  

Do not swish with water, or drink (suck) with a straw.

This can interfere with the Clot forming and give you a dry socket.

Those are nasty, nasty.

Emma
:)
Vierka - 09 Feb 2005 18:30 GMT
Well, my dentist confirmed that it's a dry socket.
She cleaned it and put the healing gauze inside of the socket which
has awful taste, but as long as that will do the job and heal the
site, I'll be happy.

Thanks for everyone's help.

Vierka
*---------------------------------*
Posted at: http://www.GroupSrv.com
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Mark & Steven Bornfeld DDS - 09 Feb 2005 18:36 GMT
> Well, my dentist confirmed that it's a dry socket.
> She cleaned it and put the healing gauze inside of the socket which
[quoted text clipped - 4 lines]
>
> Vierka

mmm...iodoform!

    The dressing should make you feel comfortable, but it does trap a lot
of dirt and will start smelling if you don't keep it clean.  If it gets
knocked out and you're still in pain, have the dentist replace it.

Best,
Steve

> *---------------------------------*
> Posted at: http://www.GroupSrv.com
[quoted text clipped - 4 lines]
>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Vierka - 09 Feb 2005 21:32 GMT
Thanks Steve!

The filler for the socket definitely makes me feel much better.  I
didn't take pain killers since 6:30 am and now it's 3:35 pm.  There
is no chance I'd last this long yesterday.

How long should the gauze stay inside of the socket?  Is it a
treatment for several days?  
I thought it's just for today...  
The doctor said that it will slowly come out in pieces (which it does)
and that I should not rinse today.  How can I clean it?
When should the socket start healing then?

Vierka
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Posted at: http://www.GroupSrv.com
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Mark & Steven Bornfeld DDS - 09 Feb 2005 22:20 GMT
> Thanks Steve!
>
[quoted text clipped - 8 lines]
> and that I should not rinse today.  How can I clean it?
> When should the socket start healing then?

    The healing is already taking place, although the dry socket delays it
a bit.
    If your dentist said not to rinse, I would leave it alone.  In severe
cases I will have the patient back every couple of days and irrigate it
out myself.  I use iodoform gauze with a dry socket paste.  There may
well be a self-absorbing material around that I don't know about.

Steve

> Vierka
> *---------------------------------*
[quoted text clipped - 5 lines]
>     ** SPEED ** RETENTION ** COMPLETION ** ANONYMITY **
> ----------------------------------------------------------        

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Vierka - 11 Feb 2005 17:36 GMT
Hi,

the extraction site seems to be getting better, but I have a really
large and raw canker sore on the outside gum of the extraction site
and the tooth behind.  I think it was caused when the local
anesthetic needle was injected sideways and then the ends of the
stitches were always on that side.  That's probably how that place
got irritated and the canker sore developed on Monday.  I treat with
a herbal spray for oral sores, but it is not improving.  My lympnodes
are quite sore, so there seems to be a fight going on in there.

Also, how long is the gauze dressing supposed to be inside of the
socket?  The pain has definitely subsided and the socket hole is not
so wide anymore, but I thought it's supposed to fall out on its own
after a day or so?  I now have it there since Wednesday morning.

Thanks.

Vierka
 
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