Extraction and Smoking

[MSCherokee]

Yes, I know, I shouldn't smoke...nevertheless, I do, about a half pack a day. ;) Brief background - I have RRMS, TMJ and periodontal disease (told it was caused by a combination of MS meds and genetics).

I had a root canal in lower molar 21 years ago. Had an infection under the tooth a couple of months ago. My dentist gave me antibiotics and said I could either have a repeat root canal or extraction. He said if it were his tooth, he'd have an extraction. I was leaning towards a second root canal but when I went back for a cleaning, my dentist said he took a closer look at the x-ray and recommended extraction only. So lucky me, I go in the day after Valentine's Day.

I am no stranger to having extractions/oral surgery. I had four permanent teeth pulled as a child due to overcrowding and had my impacted wisdom teeth surgically removed, which was an extremely painful experience that left me virtually unable to open my mouth or eat for well over a week.

I've read several of the extraction posts and recommendations and I already have my arnica on its way. I guess my main concern is keeping the pain - either from the extraction itself or my TMJ - to an absolute bare minimum and trying to avoid dry socket at all costs.

Any helpful hints/suggestions? I am almost positive the dentist won't prescribe pain meds. If he does, it will be hydrocodone which makes me barf every time so I refuse to take it. :mad:

[TooTired]

Hi MSCherokee,
OUCH! I have had several teeth extracted and the wisdom teeth were the absolute worst. The very first one I had the same problem you did with even opening my mouth. They were the only molars that caused that problem, howeer, teeth further forward didn't.

I also have the same barfing problem with anything with codeine in it. Darvocet is not as effective, but works well for me and doesn't cause that awful nausea. Might want to ask about it?

Wish you the best. Let us know how it goes?

[Bryanna]

Hi Ms Cherokee,

Extraction of the wisdom teeth can cause limited opening for a week or so because the jaw has to be opened wider than normal to gain access to these teeth. This stretching of the jaw muscles causes a temporary spasm to occur and once the mouth is closed, the muscle cramps up. Inflammation from thst type of surgery will also cause limited opening of the jaw as well.

Your lower molar that is being extracted next week could cause some TMJ discomfort post operatively. Mainly because there will be some pressure on the lower jaw during the procedure and this can cause some facial ligaments and muscles to cramp up which causes inflammation in the joint area. Sometimes pressure on the lower jaw can temporarily displace the TMJ, which again sets up for some inflammation and cramping of the ligaments.

The best thing to do is prepare yourself ahead of time for the oral surgery. This includes the arnica, as you have already done, soft nutritious foods for at least a week or so post operatively, salt for warm water rinsing, vitamin C, B complex and a good mutli vitamin to help keep the immune system healthy.

Pre operatively, between now and then, choose a cd that makes you feel relaxed. Play it once a day so your body gets accustomed to relaxing to it. Play that cd during the procedure. Most dental offices have cd players with headphones, if you don't have your own. This technique works really well especially if you prepare yourself ahead of time.

Perhaps most importantly....... stop smoking. I know this is not what you want to hear, but smoking is the one sure thing that can cause a dry socket to occur and prevent proper complete healing of the socket. I have seen this scenerio countless times, it is very hard to treat, it is painful and it is totally avoidable.

Pain meds...... don't take anything that makes you vomit. I have patients that do great on the arnica if they use it several times a day along with warm salt water rinsing. Do both for several days post operatively. It is important to be able to eat afterwards so any meds that you take for pain, even advil or motrin, will not bother your stomach. Again, smoking will diminish the effect of homeopathy and most OTC pain meds.

Please let us know how you do!

Bryanna



Yes, I know, I shouldn't smoke...nevertheless, I do, about a half pack a day. ;) Brief background - I have RRMS, TMJ and periodontal disease (told it was caused by a combination of MS meds and genetics).

I had a root canal in lower molar 21 years ago. Had an infection under the tooth a couple of months ago. My dentist gave me antibiotics and said I could either have a repeat root canal or extraction. He said if it were his tooth, he'd have an extraction. I was leaning towards a second root canal but when I went back for a cleaning, my dentist said he took a closer look at the x-ray and recommended extraction only. So lucky me, I go in the day after Valentine's Day.

I am no stranger to having extractions/oral surgery. I had four permanent teeth pulled as a child due to overcrowding and had my impacted wisdom teeth surgically removed, which was an extremely painful experience that left me virtually unable to open my mouth or eat for well over a week.

I've read several of the extraction posts and recommendations and I already have my arnica on its way. I guess my main concern is keeping the pain - either from the extraction itself or my TMJ - to an absolute bare minimum and trying to avoid dry socket at all costs.

Any helpful hints/suggestions? I am almost positive the dentist won't prescribe pain meds. If he does, it will be hydrocodone which makes me barf every time so I refuse to take it. :mad:

[MSCherokee]

Thanks TooTired and Bryanna!

If the dentist does decide to prescribe pain meds, I'll ask him about Darvocet. I did have to take that years ago when I cracked my tailbone and I remember it helped with the pain but really messed with my emotions. I think I'd rather cry than vomit though any day!

As far as the smoking goes, I am going to give it another try this year. Last year I was very close to quitting when my mom passed away, then I started smoking full force again, about a pack a day. I am slowly weaning myself off. I still have nicotine lozenges left from my last quit attempt. I'm wondering if they would be a little easier on the extraction site, provided I kept them on the opposite side of my mouth. BTW I didn't realize that smoking would diminish the effects of meds - very interesting!

I love the CD suggestion - now I have to figure out which one - hmm, decisions, decisions.

And thanks much for the heads up that this extraction may cause a flare up of the TMJ. I asked my dentist about it but he acted like this was going to be a cake walk and shouldn't effect the TMJ. LOL, I know my own body well enough to know that virtually nothing is a cake walk.

[Bryanna]

Hi MsCherokee,

The nicotine lozengers are not a good idea after the extraction. For one reason, any form of drawing in of the cheek muscles, either on a cigarette, a straw or lozenger will disrupt the formation of the clot. Once the clot is disturbed, the surgerized socket becomes infected and the bone becomes dry.... resulting in a dry socket. Secondly, the chemicals in the lozenger will get in the extraction site just like they do from dragging on a cigarette. Some people try to cover up the socket with a piece of gauze whenever they smoke, but they find out within a day or two that it didn't prevent the dry socket from occuring.

You had mentioned that you also had periodontal disease. This condition alone can cause some complications during post op healing because of the chronic infection from the disease. Think of your immune system already dealing with the perio condition and now you have oral surgery to remove an infected tooth. Even in a non smoker, this is expecting alot of your immune system.

Your tooth may come out <easier> compared to one that was not periodontally involved because it may have less bone holding it in the jaw. However, the surgical site should still be taken care of the same way, irrelevant of the ease or difficulty of the extraction.

I know to give up smoking is very difficult........ but only you can do it once you've made up your mind ~'.'~

Please let us know how things go!
Bryanna





Thanks TooTired and Bryanna!

If the dentist does decide to prescribe pain meds, I'll ask him about Darvocet. I did have to take that years ago when I cracked my tailbone and I remember it helped with the pain but really messed with my emotions. I think I'd rather cry than vomit though any day!

As far as the smoking goes, I am going to give it another try this year. Last year I was very close to quitting when my mom passed away, then I started smoking full force again, about a pack a day. I am slowly weaning myself off. I still have nicotine lozenges left from my last quit attempt. I'm wondering if they would be a little easier on the extraction site, provided I kept them on the opposite side of my mouth. BTW I didn't realize that smoking would diminish the effects of meds - very interesting!

I love the CD suggestion - now I have to figure out which one - hmm, decisions, decisions.

And thanks much for the heads up that this extraction may cause a flare up of the TMJ. I asked my dentist about it but he acted like this was going to be a cake walk and shouldn't effect the TMJ. LOL, I know my own body well enough to know that virtually nothing is a cake walk.

[JOE1]

Yes, I know, I shouldn't smoke...nevertheless, I do, about a half pack a day. ;) Brief background - I have RRMS, TMJ and periodontal disease (told it was caused by a combination of MS meds and genetics).

I had a root canal in lower molar 21 years ago. Had an infection under the tooth a couple of months ago. My dentist gave me antibiotics and said I could either have a repeat root canal or extraction. He said if it were his tooth, he'd have an extraction. I was leaning towards a second root canal but when I went back for a cleaning, my dentist said he took a closer look at the x-ray and recommended extraction only. So lucky me, I go in the day after Valentine's Day.
I hope this shows up. Can't figure out where to type a reply.
I have practiced Dental Hygiene for 30 years.
I would not worry about a dry socket. This is not a wisdom tooth, and dry sockets are not ususally a problem in other areas.
I agree with your DDS. If the tooth has already had a root canal, then blows up years later, don't dump anymore time and money into it.
I think you will be surprised how fast you heal up. Gentle rinsing. Try not to dislodge the clot. If the dentist places a suture over the extraction hole, all the better. not usually necessary, tho.
Most ext's don't require RX paid relief. usually controlled with Motrin, etc. But if you need it, be the sqyeaky wheel and GET IT. Don't let anyone tell you you don't hurt when you do, and don't take a prescription that you know you can't use. There are alot of options to keep you comfy, but usually, just getting the problem tooth OUT, starts the pain relief. Good Luck. I bet you do well! JOE1:
I am no stranger to having extractions/oral surgery. I had four permanent teeth pulled as a child due to overcrowding and had my impacted wisdom teeth surgically removed, which was an extremely painful experience that left me virtually unable to open my mouth or eat for well over a week.

I've read several of the extraction posts and recommendations and I already have my arnica on its way. I guess my main concern is keeping the pain - either from the extraction itself or my TMJ - to an absolute bare minimum and trying to avoid dry socket at all costs.

Any helpful hints/suggestions? I am almost positive the dentist won't prescribe pain meds. If he does, it will be hydrocodone which makes me barf every time so I refuse to take it. :mad:

I hope this shows up. Can't figure out where to type a reply.
I have practiced Dental Hygiene for 30 years.
I would not worry about a dry socket. This is not a wisdom tooth, and dry sockets are not ususally a problem in other areas.
I agree with your DDS. If the tooth has already had a root canal, then blows up years later, don't dump anymore time and money into it.
I think you will be surprised how fast you heal up. Gentle rinsing. Try not to dislodge the clot. If the dentist places a suture over the extraction hole, all the better. not usually necessary, tho.
Most ext's don't require RX paid relief. usually controlled with Motrin, etc. But if you need it, be the sqyeaky wheel and GET IT. Don't let anyone tell you you don't hurt when you do, and don't take a prescription that you know you can't use. There are alot of options to keep you comfy, but usually, just getting the problem tooth OUT, starts the pain relief. Good Luck. I bet you do well! JOE1:

[RachelBrainF]

I agree with Joe.
I am also another Hygienist who has practiced for 30 years.

Only rinse if it is suggested by your dentist. Usually a post op recovery sheet is given to a client.

Sine this is a fully erupted tooth it sounds like a simple extraction.
If it is simple and uncomplicated...any potential TMJ issues should be negligible.
The more relaxed you allow yourself to be..the less fear...and less discomfort during and after.
Let us know how you make out.

[Bryanna]

Hi Joe,

Pardon my interjection here, but don't you think that it is important for this person to take her smoking habit seriously to avoid surgical complications? By telling her not to worry about it, is like tellng her to go ahead, smoke, you'll be fine.

I respect your lengthy career in dental hygiene, but how much oral surgery have you actually seen? I've been chair-siding oral surgery for 30 yrs and have seen countless cases of alveolar osteitis from various tooth extractions, not just wisdom teeth.

Smoking........alcohol consumption....... poor post operative care....... radiation therapy....... any autoimmune disease....... these are the big contributory factors in getting this nasty, painful, condition. I have also seen people whose extraction sites have NEVER healed after a dry socket because they went back to smoking before the bony area had time to heal completely, which can take several months or more depending on the overall health of the person. When exploratory surgery is done on these cases, the bone is like mush, it's black, it's smells awful and it is severely necrotic. The oral tissue may appear to look like it had closed over, but it's open enough to get a fine paper point way up inside the necrotic socket which means that bacteria is getting in there also.

With all due respect Joe, my intention here is not to contradict your post. This person deserves to be informed of the complications that can occur if she smokes after her oral surgery. From her original post, it sounds like she already has other chronic health and dental issues going on..... a dry socket is the last thing she needs right now.

I too hope she does super well!!

Bryanna




I hope this shows up. Can't figure out where to type a reply.
I have practiced Dental Hygiene for 30 years.
I would not worry about a dry socket. This is not a wisdom tooth, and dry sockets are not ususally a problem in other areas.
I agree with your DDS. If the tooth has already had a root canal, then blows up years later, don't dump anymore time and money into it.
I think you will be surprised how fast you heal up. Gentle rinsing. Try not to dislodge the clot. If the dentist places a suture over the extraction hole, all the better. not usually necessary, tho.
Most ext's don't require RX paid relief. usually controlled with Motrin, etc. But if you need it, be the sqyeaky wheel and GET IT. Don't let anyone tell you you don't hurt when you do, and don't take a prescription that you know you can't use. There are alot of options to keep you comfy, but usually, just getting the problem tooth OUT, starts the pain relief. Good Luck. I bet you do well! JOE1:

[Bryanna]

Hi Rachel,

Again, as I posted to Joe..... I respect your lengthy career in oral hygiene, but how many extractions have you seen?

Fully erupted teeth don't make an extraction simple. Periodontally involved teeth tend to have bunches of necrotic granulomatous tissue embedded in the socket. The bone is often necrotic also, especially if the tooth has been root canaled. Both of these conditions can complicate any extraction. The fact that her tooth is loose maybe in her favor allowing an easier removal of the tooth itself. But the area is still infected and will need thorough debridement.

Salt water rinses beginning 24 hours post operatively is absolutely essential for healing of the oral tissue and it keeps the socket from becoming embedded with food debris. I have never witnessed an extraction, not even a deciduous tooth, where the dentist did not recommend warm salt water rinsing.

At least we agree on your last statement...<The more relaxed you allow yourself to be..the less fear...and less discomfort during and after.> AMEN to that!

Bryanna








I agree with Joe.
I am also another Hygienist who has practiced for 30 years.

Only rinse if it is suggested by your dentist. Usually a post op recovery sheet is given to a client.

Sine this is a fully erupted tooth it sounds like a simple extraction.
If it is simple and uncomplicated...any potential TMJ issues should be negligible.
The more relaxed you allow yourself to be..the less fear...and less discomfort during and after.
Let us know how you make out.

[Chemar]

my dentist was very emphatic about the salt rinses being essential beginning 24 hrs after the extraction and, altho I do not smoke, I was told and the after care instruction sheet had in bold letters to avoid smoking as the suction could dislodge the clot and cause problems. The aftercare booklet also had information on the salt rinses and why they make all the difference in rapid and problem free healing.

thanks again Bryanna for so freely sharing your knowledge and experience here.
Your help got me through that complex series of extractions I had to have and I healed very quickly and completely :)

[MSCherokee]

Yes, I appreciate any and all help and suggestions - I need all the help I can get! :wink:

Frankly, my dentist knows of all my health issues and is very well aware that I smoke so it rather P's me off that he didn't warn me strongly against smoking after extraction. A part of me wants to put this extraction off indefinitely and concentrate on quitting smoking first. <sigh> It's not like my tooth is bothering me right now. If I were to quit smoking cold turkey, well, that would be quite a nasty scene that will be avoided at all costs. I wished to hell every day that I had never picked up the habit but I did. DH used to harp on me about it, but he has never had an addiction to anything in his life so he has no clue. LOL

Anyhow, I have decided to compromise. I am going to bum a couple of nicotine patches off someone and hopefully this will get me through the roughest couple of days. So, I'm going to keep my appointment and just get it overwith and hope for the best! :D

[Chemar]

good for you. MSCherokee!:winner_first_h4h:

the hardest part is making the final decision to just go do it.You are past that post!!

keep us posted and hope those patches help ya thru with the nicotine ok.
I am an ex smoker (25 years ex now...phew!!) so I do know the problem with that habit.
who knows, maybe the patch period will help u cut down or get to quit point.

oh yes, those little arnica pillules (most health stores have them) really helped me with pain and healing after the extractions too.

all the best
Cheri

[Bryanna]

Hi Ms Cherokee,

Most dentists (and hygienists) that I personally know, will not assertively tell their patients to stop smoking. To be blatantly honest with you...... Sometimes we feel that it's not worth our time because we sense that the patient is not going to comply anyway. Then other times, it is because we don't want the patient to put off the surgery because they haven't stopped smoking. However, neither of these reasons is meant to diminish the severity of what the post operative complications can be with someone who smokes.

Because of my education and my lengthy background in chair side assisting, I am also a patient counselor. This means that it is my responsibility to educate the patient on the relationship between their oral and systemic health and I take that role on very seriously ........because I care, I really care about the patient.

Just some FYI...... I too was a smoker. My mother smoked when she was pregnant with me which predisposed me to a nicotine addiction. I smoked for about 15 years starting at a very <young> age. I had a second molar extracted when I was 18 years old and I did not listen to my dentist warn me about smoking. Guess what......... I ended up with a dry socket! It was one of the most painful experiences that I can remember! So, I do understand how difficult this whole thing is for you.

It is not wise to put the extraction off for 2 main reasons....... One, the tooth is infected and the infection will progress. Two, unless you are truly motivated, you will not stop smoking and you could then end up in a dental emergency situation which just complicates the everything.

The nicotine patches may be helpful and they will not cause any direct irritation of the surgerized area. Hopefully you can stay on them long enough for the site to heal.

I think your surgery is going to go ok and just remember to take good care of yourself afterwards ~'.'~

Keep us posted!
Bryanna


Yes, I appreciate any and all help and suggestions - I need all the help I can get! :wink:

Frankly, my dentist knows of all my health issues and is very well aware that I smoke so it rather P's me off that he didn't warn me strongly against smoking after extraction. A part of me wants to put this extraction off indefinitely and concentrate on quitting smoking first. <sigh> It's not like my tooth is bothering me right now. If I were to quit smoking cold turkey, well, that would be quite a nasty scene that will be avoided at all costs. I wished to hell every day that I had never picked up the habit but I did. DH used to harp on me about it, but he has never had an addiction to anything in his life so he has no clue. LOL

Anyhow, I have decided to compromise. I am going to bum a couple of nicotine patches off someone and hopefully this will get me through the roughest couple of days. So, I'm going to keep my appointment and just get it overwith and hope for the best! :D

[Bryanna]

Hi Cheri,

Thanks so much for speaking up here! I was feeling like I had stepped on some toes and that is SO NOT what I wanted to do.

Your positive experience with your dental surgery is so enlightening to others!! I am SO glad that you are doing well!! Give yourself a pat on the back for staying courageous throughout the process and for taking such good care of yourself postoperatively!!!

Bryanna ~'.'~




my dentist was very emphatic about the salt rinses being essential beginning 24 hrs after the extraction and, altho I do not smoke, I was told and the after care instruction sheet had in bold letters to avoid smoking as the suction could dislodge the clot and cause problems. The aftercare booklet also had information on the salt rinses and why they make all the difference in rapid and problem free healing.

thanks again Bryanna for so freely sharing your knowledge and experience here.
Your help got me through that complex series of extractions I had to have and I healed very quickly and completely :)