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Gum Still Sore After Extraction

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Unread 01-05-2009, 10:32 PM   #1
sandy60
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Default Gum Still Sore After Extraction

I had my 2nd molar extracted 10 days ago. There is no wisdom tooth behind it as it was removed years ago. The extraction hole is fine, no real pain but the outer gum where there also were some stitches is so tender. If I touch it, ouch (I haven't touched it otherwise, I rinse with salt water but I wanted to check which part hurt and it is SO sore). I can see an indentation where the stitches were, little lines. My question is, is this normal, to still be sore and how long does it last? I am older so maybe heal slower?

Another question...although no sign of sinus perforation (like I was afraid of last week and you asked me to see if water seeps into my nose) but my cheek hurts on and off on the bone below my eye and sometimes next to my nose. I am getting worried again and just hope it's just radiating from the whole darn thing and not my sinus. My nose is not running, no blood, no congestion, just pain that comes and goes.
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Unread 01-06-2009, 08:29 PM   #2
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Hi Sandy,

It is normal for the gum area of an extraction site to be sore or tender for a couple of weeks after the procedure to remove the tooth. It is also normal for the face and bony area around the extraction site to be uncomfortable for a couple of weeks as the area is healing.

Sometimes, the gum tissue at the extraction site develops a canker sore from hot, sharp edged or spicy food. Keep in mind that the extraction site is an open wound that is subjected to everything you eat even if you are not eating directly on that area. If that is the case, then salt walter rinses will help heal the gum tissue. It is also imperative to make sure that you brush the first molar (in front of the extraction site) very thoroughly to avoid any plaque from building up along the gumline of that tooth. If plaque accumulates around the gumline of that first molar, it will cause a sore to develop which could spread to the extraction site.

The area along the cheekbone can be tender for a variety of reasons but one that is common is due to trauma with the Zygomatic Major muscle. The Zygomatic Major is a very thick muscle that runs diagonally from the ear, down along the outer edge of the cheekbone to the corners of the mouth. This muscle is referred to as the Smile Muscle. When you have an upper molar extracted, this muscle may be overstretched especially if the patient tightens their facial muscles during the extraction. As the muscle starts to relax and heal, the cheekbone area can feel tender or achey. This condition can last for a few days to a few weeks, but it is temporary.

The nose can be tender from referred pain from the overstretched zygomatic major muscle.

On the other hand, sinus issues or infection can also make both of these areas tender. Usually when there is infection present, the patient doesn't feel very well and may run a fever. Are you feeling ok in general?

If by friday of this week, the gum area is still "very" sore and the area at the side of the nose is "very" sore or you develop swelling or a fever ...... it wouldn't hurt to let the oral surgeon or your general dentist take another look at the area and even take an xray.

Please try not to worry...... your situation does not sound serious but if you are very concerned that something is wrong, it is always best to let the dentist take a look to make sure all is well.

Please keep us posted on how you are healing!

Bryanna ~'.'~








Quote:
Originally Posted by sandy60 View Post
I had my 2nd molar extracted 10 days ago. There is no wisdom tooth behind it as it was removed years ago. The extraction hole is fine, no real pain but the outer gum where there also were some stitches is so tender. If I touch it, ouch (I haven't touched it otherwise, I rinse with salt water but I wanted to check which part hurt and it is SO sore). I can see an indentation where the stitches were, little lines. My question is, is this normal, to still be sore and how long does it last? I am older so maybe heal slower?

Another question...although no sign of sinus perforation (like I was afraid of last week and you asked me to see if water seeps into my nose) but my cheek hurts on and off on the bone below my eye and sometimes next to my nose. I am getting worried again and just hope it's just radiating from the whole darn thing and not my sinus. My nose is not running, no blood, no congestion, just pain that comes and goes.
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Unread 01-06-2009, 11:50 PM   #3
sandy60
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Thank you SO much, Bryanna. I have no fever and feel fine otherwise but I am on amoxicillin 500 for 8 days. I was on penicillin for 5 days after the extraction. What I didn't mention (this is not my week!) is that I developed a periodontal abscess on tooth 11 (root canaled and crowned) and had it traced yesterday by my dentist with a piece of gutta percha and an x-ray. It is very close to the gumline so they suspected that it was periodontal and not a tooth abscess. This happened last year also. The periodontist opened my gum, looked for a crack, found none, attributed it to a pocket, did a guided tissue regeneration and all was well....til Saturday when a big white bump appeared again. It drained on its own on Sunday after rinsing with salt water all day. I called, they phoned in a prescription and I went in yesterday to see what's going on. I am seeing an oral surgeon tomorrow for a consultation. I heard that sometimes they can't see tiny cracks and this can be what causes it. So I am faced with more surgery and they may find nothing again, or extraction if they do find a crack or just feel it's a goner, or leaving it and praying.

I also have to talk to them about a horizontally impacted wisdom tooth (lower, my luck) that has now developed resorption. I am a nervous wreck over all this at the same time. My dentist and the oral surgeon saw the x-ray and both said take another x-ray in a year or two, they didn't seem alarmed. I have an immense fear of this extraction's danger, dry socket, paresthesia and I am petrified. I am almost 60 so wish I had done this when I was young, they saw it and never advised me and I certainly didn't know about this stuff as a younger person. Again, thanks for the advice regarding the extraction site and the great information about the muscle and soreness. I just used 2 mirrors and cleaned the first molar very carefully...there was some food on it and I used a rubber tip to gently swab it off and brushed it very carefully, not touching the extraction site. You're a Godsend and I will let you know the outcome of my consult if that's ok.



Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

It is normal for the gum area of an extraction site to be sore or tender for a couple of weeks after the procedure to remove the tooth. It is also normal for the face and bony area around the extraction site to be uncomfortable for a couple of weeks as the area is healing.

Sometimes, the gum tissue at the extraction site develops a canker sore from hot, sharp edged or spicy food. Keep in mind that the extraction site is an open wound that is subjected to everything you eat even if you are not eating directly on that area. If that is the case, then salt walter rinses will help heal the gum tissue. It is also imperative to make sure that you brush the first molar (in front of the extraction site) very thoroughly to avoid any plaque from building up along the gumline of that tooth. If plaque accumulates around the gumline of that first molar, it will cause a sore to develop which could spread to the extraction site.

The area along the cheekbone can be tender for a variety of reasons but one that is common is due to trauma with the Zygomatic Major muscle. The Zygomatic Major is a very thick muscle that runs diagonally from the ear, down along the outer edge of the cheekbone to the corners of the mouth. This muscle is referred to as the Smile Muscle. When you have an upper molar extracted, this muscle may be overstretched especially if the patient tightens their facial muscles during the extraction. As the muscle starts to relax and heal, the cheekbone area can feel tender or achey. This condition can last for a few days to a few weeks, but it is temporary.

The nose can be tender from referred pain from the overstretched zygomatic major muscle.

On the other hand, sinus issues or infection can also make both of these areas tender. Usually when there is infection present, the patient doesn't feel very well and may run a fever. Are you feeling ok in general?

If by friday of this week, the gum area is still "very" sore and the area at the side of the nose is "very" sore or you develop swelling or a fever ...... it wouldn't hurt to let the oral surgeon or your general dentist take another look at the area and even take an xray.

Please try not to worry...... your situation does not sound serious but if you are very concerned that something is wrong, it is always best to let the dentist take a look to make sure all is well.

Please keep us posted on how you are healing!

Bryanna ~'.'~
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Unread 01-07-2009, 09:08 AM   #4
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Hi Sandy,

Your tooth problem with #11 is very typical with root canaled teeth and it is referred to as a perio/endo infection. Our body has a way of trying to rid itself of irritants and it does so by causing an inflammation to occur. In your case, your tooth is the irritant and the opening of the gum pocket is your body trying to get rid of it. Infectious bacteria set up house in the pocket because it's warm, moist and dark. Irrelevant of how many times your periodontist opens this up, or how many antibiotics you take, you will continue to have an infection because the tooth is not healthy and the body will continue to try to get rid of it. This type of chronic infection will spread to other teeth and other areas under the gum so long as the irritant, the tooth, is present. This is a situation where the tooth should come out sooner than later. Every time it develops a fistula (bump on the gum) more of the bone has become involved as the bacteria has tunneled through the bone trying to let off some pressure. This is not a healthy condition for your overall well being.

I know all the tactics that are used to pinpoint the origin of the infection with the gutta percha and flapping open the gum tissue looking for a crack in the tooth.......... there may or may not be a crack but in this situation it is simply an infected tooth irritating the bone and gum tissue.

Your impacted lower wisdom tooth........ unless you have pain or there is cyst or area of infection on the radiograph, you probably could leave this alone for now. However, you may want to inquire if this tooth is in any way negatively affecting the molar in front of it. Is it pressing up against the molar causing a periodontal pocket? If it is, then you may want to ask how they would proceed with removing it.

I know none of this is pleasant......... far from it!!! I would address tooth #11 ASAP because it can slow down the healing of the other surgery that you had because there is a chronic infection there taxing your immune system.

I know you are very worried and that is understandable. I think if you keep pushing forward dealing with one issue at a time, you will get through this quicker than you imagine and you will be ok!!!

Please continue to keep us in the loop ~'.'~
Bryanna


Quote:
Originally Posted by sandy60 View Post
Thank you SO much, Bryanna. I have no fever and feel fine otherwise but I am on amoxicillin 500 for 8 days. I was on penicillin for 5 days after the extraction. What I didn't mention (this is not my week!) is that I developed a periodontal abscess on tooth 11 (root canaled and crowned) and had it traced yesterday by my dentist with a piece of gutta percha and an x-ray. It is very close to the gumline so they suspected that it was periodontal and not a tooth abscess. This happened last year also. The periodontist opened my gum, looked for a crack, found none, attributed it to a pocket, did a guided tissue regeneration and all was well....til Saturday when a big white bump appeared again. It drained on its own on Sunday after rinsing with salt water all day. I called, they phoned in a prescription and I went in yesterday to see what's going on. I am seeing an oral surgeon tomorrow for a consultation. I heard that sometimes they can't see tiny cracks and this can be what causes it. So I am faced with more surgery and they may find nothing again, or extraction if they do find a crack or just feel it's a goner, or leaving it and praying.

I also have to talk to them about a horizontally impacted wisdom tooth (lower, my luck) that has now developed resorption. I am a nervous wreck over all this at the same time. My dentist and the oral surgeon saw the x-ray and both said take another x-ray in a year or two, they didn't seem alarmed. I have an immense fear of this extraction's danger, dry socket, paresthesia and I am petrified. I am almost 60 so wish I had done this when I was young, they saw it and never advised me and I certainly didn't know about this stuff as a younger person. Again, thanks for the advice regarding the extraction site and the great information about the muscle and soreness. I just used 2 mirrors and cleaned the first molar very carefully...there was some food on it and I used a rubber tip to gently swab it off and brushed it very carefully, not touching the extraction site. You're a Godsend and I will let you know the outcome of my consult if that's ok.
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Unread 01-07-2009, 10:53 AM   #5
sandy60
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Thanks again. I am having the consult today but another question. Is extraction of 11 painful? I have heard that it's the toughest tooth to pull although my dentist said the root doesn't look as long as most. I am asking because even though I have been awake for the last 3 extractions which took about 2 minutes, this scares me and maybe I'd be better off with iv sedation. What has your experience been with your patients? How long does it usually take and do you feel any pain? Another question is can the resorption on the wisdom tooth just stay that way forever and never need to come out? Third questions, what do they give you to temporarily put in the place of a tooth like 11 that shows, while you're healing and have to go outside and not look like a jack-o-lantern :-(

Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

Your tooth problem with #11 is very typical with root canaled teeth and it is referred to as a perio/endo infection. Our body has a way of trying to rid itself of irritants and it does so by causing an inflammation to occur. In your case, your tooth is the irritant and the opening of the gum pocket is your body trying to get rid of it. Infectious bacteria set up house in the pocket because it's warm, moist and dark. Irrelevant of how many times your periodontist opens this up, or how many antibiotics you take, you will continue to have an infection because the tooth is not healthy and the body will continue to try to get rid of it. This type of chronic infection will spread to other teeth and other areas under the gum so long as the irritant, the tooth, is present. This is a situation where the tooth should come out sooner than later. Every time it develops a fistula (bump on the gum) more of the bone has become involved as the bacteria has tunneled through the bone trying to let off some pressure. This is not a healthy condition for your overall well being.

I know all the tactics that are used to pinpoint the origin of the infection with the gutta percha and flapping open the gum tissue looking for a crack in the tooth.......... there may or may not be a crack but in this situation it is simply an infected tooth irritating the bone and gum tissue.

Your impacted lower wisdom tooth........ unless you have pain or there is cyst or area of infection on the radiograph, you probably could leave this alone for now. However, you may want to inquire if this tooth is in any way negatively affecting the molar in front of it. Is it pressing up against the molar causing a periodontal pocket? If it is, then you may want to ask how they would proceed with removing it.

I know none of this is pleasant......... far from it!!! I would address tooth #11 ASAP because it can slow down the healing of the other surgery that you had because there is a chronic infection there taxing your immune system.

I know you are very worried and that is understandable. I think if you keep pushing forward dealing with one issue at a time, you will get through this quicker than you imagine and you will be ok!!!

Please continue to keep us in the loop ~'.'~
Bryanna
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Unread 01-07-2009, 06:57 PM   #6
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Hi Sandy,

The eye teeth or incisors, teeth #11 and 6 can have long roots. However, an oral surgeon or a dentist with alot of oral surgery experience can remove those teeth without a problem. No it should not hurt.

Our eye teeth, 6 and 11, are considered the cornerstone of our upper arch and it is important to replace them temporarily during the healing phase of the extraction and then permanently once the area has healed.

Temporary replacement can be a removable partial denture that either has just that tooth on it or that tooth plus any other missing teeth on the top with exception to the wisdom teeth. Permanent replacement once the area has completely healed could be either another removable partial denture or a dental implant (depending on the health and stability of the bone) or a multi unit fixed bridge.

Your wisdom tooth....... If your wisdom tooth is causing root resorption on your second molar, then it should be removed. This type of resorption will progress and you will eventually end up losing the second molar as well. Is that where the resorption is located??

How did your consult go today?

Bryanna

Quote:
Originally Posted by sandy60 View Post
Thanks again. I am having the consult today but another question. Is extraction of 11 painful? I have heard that it's the toughest tooth to pull although my dentist said the root doesn't look as long as most. I am asking because even though I have been awake for the last 3 extractions which took about 2 minutes, this scares me and maybe I'd be better off with iv sedation. What has your experience been with your patients? How long does it usually take and do you feel any pain? Another question is can the resorption on the wisdom tooth just stay that way forever and never need to come out? Third questions, what do they give you to temporarily put in the place of a tooth like 11 that shows, while you're healing and have to go outside and not look like a jack-o-lantern :-(
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Unread 01-07-2009, 07:26 PM   #7
sandy60
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The wisdom tooth at this point is not interfering with the one in front of it but he is reviewing my cat scan overnight. Here is what happened though with the immediate problem...11 has to come out and I am doing it tomorrow. I am choosing iv sedation because it's just too stressful for me, after just having another tooth extracted. He said he wants to do a bone graft in case I want an implant and even if I don't, he said it's important. Bryanna, I am so scared that this will make things more complicated for me. I just wanted a simple extraction. Our parents and grandparents didn't have grafts done and got bridges...why is this necessary? I am afraid of complications, more pain, I just wanted to keep this simple. Will I have more pain from the graft? I guess I don't want too many details of what can go wrong because I will not be able to sleep but I want to know if grafts can cause more pain. He said he puts a powder in from a bone bank, then collagen, then stitches. I'd need stitches anyway so it doesn't seem like the powder should make it hurt more but I don't know. I am going tomorrow so if you get to this post before then, I'd really appreciate it. Thanks so much as always.


Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

The eye teeth or incisors, teeth #11 and 6 can have long roots. However, an oral surgeon or a dentist with alot of oral surgery experience can remove those teeth without a problem. No it should not hurt.

Our eye teeth, 6 and 11, are considered the cornerstone of our upper arch and it is important to replace them temporarily during the healing phase of the extraction and then permanently once the area has healed.

Temporary replacement can be a removable partial denture that either has just that tooth on it or that tooth plus any other missing teeth on the top with exception to the wisdom teeth. Permanent replacement once the area has completely healed could be either another removable partial denture or a dental implant (depending on the health and stability of the bone) or a multi unit fixed bridge.

Your wisdom tooth....... If your wisdom tooth is causing root resorption on your second molar, then it should be removed. This type of resorption will progress and you will eventually end up losing the second molar as well. Is that where the resorption is located??

How did your consult go today?

Bryanna
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Unread 01-08-2009, 09:02 PM   #8
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Hi Sandy,

I'm sorry I didn't get to your post last night. I assume tooth #11 was extracted today and the dentist put in the graft material?

Generally, the graft material will not cause any additional discomfort. The reason to put the graft in is to help preserve the proper level of bone just in case you decide you want an implant later on. Every time a tooth is removed, at least 50% of the bone never grows back. When bone graft is put in the socket, if the area heals well, then maybe only 10 or 20% of the bone will be lost and the bone that fills in will be very solid. The bone graft is meant to stimulate your own bone to grow in the space and within a few months, the bone graft material has literally become all of your own bone.

Even if you didn't want an implant later on....... it is usually a good idea to do the bone graft as a preventive means of preserving as much bone as possible so the ridge holds it's natural contour and doesn't end up flat.

Years ago bone grafts were seldom used and as a result people who had teeth extracted ended up with little to no bony ridge which will make it impossible to have a comfortable fit if they needed a removable partial or full denture. Without the bone graft, the ridge gets flat and even permanently cemented bridgework will have gaps along the gum line where the teeth are missing due to the bone loss.

Ok.... so how did you do today?? I'm hoping all went well!!

Bryanna



Quote:
Originally Posted by sandy60 View Post
The wisdom tooth at this point is not interfering with the one in front of it but he is reviewing my cat scan overnight. Here is what happened though with the immediate problem...11 has to come out and I am doing it tomorrow. I am choosing iv sedation because it's just too stressful for me, after just having another tooth extracted. He said he wants to do a bone graft in case I want an implant and even if I don't, he said it's important. Bryanna, I am so scared that this will make things more complicated for me. I just wanted a simple extraction. Our parents and grandparents didn't have grafts done and got bridges...why is this necessary? I am afraid of complications, more pain, I just wanted to keep this simple. Will I have more pain from the graft? I guess I don't want too many details of what can go wrong because I will not be able to sleep but I want to know if grafts can cause more pain. He said he puts a powder in from a bone bank, then collagen, then stitches. I'd need stitches anyway so it doesn't seem like the powder should make it hurt more but I don't know. I am going tomorrow so if you get to this post before then, I'd really appreciate it. Thanks so much as always.
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Unread 01-08-2009, 09:32 PM   #9
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Hi Bryanna, I went to my general dentist first who took the impression for the flipper then to the oral surgeon. My dentist said the same thing you did, get the graft now instead of later...while it's open and accessible. So, I got the IV sedation, had no awareness of anything, and it's over. Not that much bleeding, he said there would be less because of the graft. Just stinging now on the palate side. Can't rinse with salt water yet but took some Advil, slept for 2 hours when I got home and glad this is over. Follow up in a week at which time he'll go over the cat scan and his opinion of the wisdom tooth. Thanks so much for seeing me through this!

Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

I'm sorry I didn't get to your post last night. I assume tooth #11 was extracted today and the dentist put in the graft material?

Generally, the graft material will not cause any additional discomfort. The reason to put the graft in is to help preserve the proper level of bone just in case you decide you want an implant later on. Every time a tooth is removed, at least 50% of the bone never grows back. When bone graft is put in the socket, if the area heals well, then maybe only 10 or 20% of the bone will be lost and the bone that fills in will be very solid. The bone graft is meant to stimulate your own bone to grow in the space and within a few months, the bone graft material has literally become all of your own bone.

Even if you didn't want an implant later on....... it is usually a good idea to do the bone graft as a preventive means of preserving as much bone as possible so the ridge holds it's natural contour and doesn't end up flat.

Years ago bone grafts were seldom used and as a result people who had teeth extracted ended up with little to no bony ridge which will make it impossible to have a comfortable fit if they needed a removable partial or full denture. Without the bone graft, the ridge gets flat and even permanently cemented bridgework will have gaps along the gum line where the teeth are missing due to the bone loss.

Ok.... so how did you do today?? I'm hoping all went well!!

Bryanna
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Unread 01-08-2009, 11:37 PM   #10
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Oh Yeh!! I too am glad this is done and you did really good....... you really did!!

The stinging on the palate is normal and it may be like that for a few days but basically the pain should be minimal. You may or may not get a little bruising and some achiness, but that's all normal. As the clot forms and the site starts to heal, you may get some little granules of bone graft material that come out........ don't worry about that, it's all normal!!

Be sure to follow the oral surgeons post op instructions and make sure you drink plenty of water every day to stay hydrated. The last week or so has been tough for you, but you got through it and everything is going to work out ok!!

Check in with us when you can over the weekend to let us know how you are doing. Take care :-))

Bryanna



Quote:
Originally Posted by sandy60 View Post
Hi Bryanna, I went to my general dentist first who took the impression for the flipper then to the oral surgeon. My dentist said the same thing you did, get the graft now instead of later...while it's open and accessible. So, I got the IV sedation, had no awareness of anything, and it's over. Not that much bleeding, he said there would be less because of the graft. Just stinging now on the palate side. Can't rinse with salt water yet but took some Advil, slept for 2 hours when I got home and glad this is over. Follow up in a week at which time he'll go over the cat scan and his opinion of the wisdom tooth. Thanks so much for seeing me through this!
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