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Gum Still Sore After Extraction

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Unread 01-09-2009, 12:06 AM   #11
sandy60
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Bryanna, my post-op instructions are for extractions, nothing specific about a graft so I looked online and it said don't look at the graft site because pulling the lip can cause harm. I did look briefly, not knowing this (won't again) but see a little piece of bone. Is this my bone or a granule that they put in? I'm glad you mentioned it because I got scared that it's exposed bone and had fantasies of dry socket. Do the granules look like tooth color? Will it fall out on its own? You don't think it's my own bone, do you? The way they described it, they extracted the tooth, put in bone powder, then a piece of collagen, then sewed it. I don't see black stitches, I was too nervous to even ask if they're self-dissolving or not. This hurts more than last week's extraction.

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Originally Posted by Bryanna View Post
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
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Unread 01-09-2009, 11:37 AM   #12
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Hi Sandy,

The post op instructions pertain to all extractions including those where there has been a bone graft placed. Gentle salt water rinsing starting 24 hours from the time of the extraction is recommended just like you did after the last extraction. GENTLE is the key here for about 3 days and then you can rinse more aggressively as the time goes on.

It's ok to look at it, you did not disturb it. This area of the mouth can be a little more tender for the first few days compared to a molar area because of where it is and how much movement is done every time you speak, etc. But it has nothing to do with the grafting. The integration of the bone graft material starts almost immediately as it becomes one with your blood clot which encourages your own bone to regenerate. The graft is still in a non solid state but the collagen material and the sutures will hold everything in place as it solidifies.

The sutures that are used are either black or white. The white ones can be a little hard to see as they are soaked in blood. But in a day or two they become more visible. Do you have a post op appointment for suture removal?

The granules of bone graft can look like time pieces of white bone. There is usually alot of graft material put in the socket underneath the collagen, more than is necessary to allow for some to leak out during the healing phase.

I recommend to our patients to take Arnica pellets homeopathically for swelling and pain. It really does work great and can be used along with other meds.

I think you will be ok!! Keep in touch and always feel free to ask any questions :-))

Bryanna



Quote:
Originally Posted by sandy60 View Post
Bryanna, my post-op instructions are for extractions, nothing specific about a graft so I looked online and it said don't look at the graft site because pulling the lip can cause harm. I did look briefly, not knowing this (won't again) but see a little piece of bone. Is this my bone or a granule that they put in? I'm glad you mentioned it because I got scared that it's exposed bone and had fantasies of dry socket. Do the granules look like tooth color? Will it fall out on its own? You don't think it's my own bone, do you? The way they described it, they extracted the tooth, put in bone powder, then a piece of collagen, then sewed it. I don't see black stitches, I was too nervous to even ask if they're self-dissolving or not. This hurts more than last week's extraction.
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Unread 01-09-2009, 04:30 PM   #13
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Bryanna, my hard palate behind the tooth is so sore, it looks so mangled. I am sure there was no mistakes by the surgeon, it just happened from the cutting and instruments. I called but the office is closed for the day, didn't want to bother him (got the service). Is there anything I can put on it topically or best to leave it alone? I wouldn't do it so please don't feel responsible, I would check with him first but can orajel hurt the area? Salt water doesn't help. I am at the point where I may take the percocet. Advil and Tylenol aren't helping much (although it might be a lot worse if I hadn't taken them). It feels at moments like someone is poking me with a hot sticl, burning. Is this common? I know the palate is very sensitive...I didn't have this much pain on the outer gum with the extraction 2 weeks ago of tooth 2..it hurt but this is more lancing. So painkillers even work for this type of pain? I do have a tiny piece of bone (really tiny) sticking out of actual site, could be the graft particle, so I am not really worried about that, just want to get rid of this pain and it's the weekend, oral surgeons not in. How long does it take to stop burning, usually?


Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

The post op instructions pertain to all extractions including those where there has been a bone graft placed. Gentle salt water rinsing starting 24 hours from the time of the extraction is recommended just like you did after the last extraction. GENTLE is the key here for about 3 days and then you can rinse more aggressively as the time goes on.

It's ok to look at it, you did not disturb it. This area of the mouth can be a little more tender for the first few days compared to a molar area because of where it is and how much movement is done every time you speak, etc. But it has nothing to do with the grafting. The integration of the bone graft material starts almost immediately as it becomes one with your blood clot which encourages your own bone to regenerate. The graft is still in a non solid state but the collagen material and the sutures will hold everything in place as it solidifies.

The sutures that are used are either black or white. The white ones can be a little hard to see as they are soaked in blood. But in a day or two they become more visible. Do you have a post op appointment for suture removal?

The granules of bone graft can look like time pieces of white bone. There is usually alot of graft material put in the socket underneath the collagen, more than is necessary to allow for some to leak out during the healing phase.

I recommend to our patients to take Arnica pellets homeopathically for swelling and pain. It really does work great and can be used along with other meds.

I think you will be ok!! Keep in touch and always feel free to ask any questions :-))

Bryanna
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Unread 01-09-2009, 06:03 PM   #14
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I am sorry, I didn't see your last reply when I asked about the bone. I am still a little out of it. I took the percocet and waiting for it to work. Every now and then, the whole area pulsates. I'm on amoxicillin for days now so it wouldn't be an infection (although there was one there with the abscess). The palate is really what's hurting the most, not the extraction site. I can deal with this as long as I know it's not dry socket. Between filling in the socket with bone and it being an upper canine tooth, this is rare, right? Maybe I shouldn't ask because if you say yes, I would freak out :-(

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Originally Posted by sandy60 View Post
Bryanna, my hard palate behind the tooth is so sore, it looks so mangled. I am sure there was no mistakes by the surgeon, it just happened from the cutting and instruments. I called but the office is closed for the day, didn't want to bother him (got the service). Is there anything I can put on it topically or best to leave it alone? I wouldn't do it so please don't feel responsible, I would check with him first but can orajel hurt the area? Salt water doesn't help. I am at the point where I may take the percocet. Advil and Tylenol aren't helping much (although it might be a lot worse if I hadn't taken them). It feels at moments like someone is poking me with a hot sticl, burning. Is this common? I know the palate is very sensitive...I didn't have this much pain on the outer gum with the extraction 2 weeks ago of tooth 2..it hurt but this is more lancing. So painkillers even work for this type of pain? I do have a tiny piece of bone (really tiny) sticking out of actual site, could be the graft particle, so I am not really worried about that, just want to get rid of this pain and it's the weekend, oral surgeons not in. How long does it take to stop burning, usually?
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Unread 01-09-2009, 08:45 PM   #15
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Hi Sandy,

Sorry for my delay in replying.....

What you are describing does not sound like a dry socket. Do not put anything on the area or the palate near the surgical wound especially oragel. Only rinse with warm salt water, that's it.

The stinging is probably from the palatal injections. The area behind the tooth on the hard palate is probably inflammed because he may have made an incision there and that could also be why it looks mangled. The inflammation will go down within a day or two, just keep rinsing with the warm salt water.

Everything you've posted so far sounds normal for this time frame of healing. Yes, pain killers will work to suppress this type of pain. By Monday, the area should probably feel alot better with only mild discomfort if everything continues to go well. I think for now, it sounds like it's ok!!

Try not to worry....... it's going to be ok :-))

Bryanna







Quote:
Originally Posted by sandy60 View Post
I am sorry, I didn't see your last reply when I asked about the bone. I am still a little out of it. I took the percocet and waiting for it to work. Every now and then, the whole area pulsates. I'm on amoxicillin for days now so it wouldn't be an infection (although there was one there with the abscess). The palate is really what's hurting the most, not the extraction site. I can deal with this as long as I know it's not dry socket. Between filling in the socket with bone and it being an upper canine tooth, this is rare, right? Maybe I shouldn't ask because if you say yes, I would freak out :-(
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Unread 01-09-2009, 09:11 PM   #16
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Thanks again. The area that's all messed up looking is right behind the socket, about 1/2" inch worth. Is that where they inject you? I have had palate injections before but they seem more in the center or betwen the tooth and the center. I was asleep so don't know and even if I am awake, hard to know. One question is, they put a collagen membrane over the graft...did they stitch that? How does it stay on if not? I don't even know if I got stitches but see incision lines behind the tooth and in front of it. I forgot to ask if I got stitches, which (as you can tell, lol) is not like me...I was just so nervous that I froze up and didn't say much. Thanks for the orajel tip, I won't use anything. I am using the salt water. It burns but I know it's good in the long run. Even with the Percocet, it still hurts but tolerable. This is like a pizza burn times 100, it's a very delicate area. I am rambling here but if you could answer the questions above, I'd really appreciate it and no need to apologize about the delay, I am SO appreciative that you are taking the time to do this at all. It means so much to us folks on the other side of the chair!

Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

Sorry for my delay in replying.....

What you are describing does not sound like a dry socket. Do not put anything on the area or the palate near the surgical wound especially oragel. Only rinse with warm salt water, that's it.

The stinging is probably from the palatal injections. The area behind the tooth on the hard palate is probably inflammed because he may have made an incision there and that could also be why it looks mangled. The inflammation will go down within a day or two, just keep rinsing with the warm salt water.

Everything you've posted so far sounds normal for this time frame of healing. Yes, pain killers will work to suppress this type of pain. By Monday, the area should probably feel alot better with only mild discomfort if everything continues to go well. I think for now, it sounds like it's ok!!

Try not to worry....... it's going to be ok :-))

Bryanna
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Unread 01-09-2009, 11:18 PM   #17
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Hi Sandy,

From your description it sounds like he may have made incisions in the front and back of the tooth and flapped the gum tissue back off of the bone a little. Sometimes this is done to get a better visual look at the area when there is a possibility that the bone surrounding the infected tooth has deteriorated from the infection. It is important that the surgeon keep as much healthy bone intact as possible and at the same time remove all of the infected bone so the area heals well. Flapping back the gum tissue gives the surgeon a clear view of all of that.

The injections of local anesthetic to remove #11 are given in several areas and some of those are different areas on the palate.

The collagen membrane resembles a small piece of white tissue. The graft material is packed into the socket and then the membrane is placed snuggly over the graft and the gum tissue is sutured closed or nearly closed. The bone graft and the membrane instantly fill with blood and the body starts to send healing cells to the area as the blood clot forms holding all of this together. The graft and membrane become one very quickly so don't worry about it coming out or anything.

There is definitely stitches. Sometimes they are the dissolving kind and sometimes they are not. It is important that you have a follow up appointment with the oral surgeon within the next 2 weeks. Then it is also important to have an xray taken of that area in about 3 months and then again in 6 months to see how the graft material is healing.

The salt water should not really burn. Perhaps you are using too much salt and/or the water is too hot?? The water should only be warm and just add a pinch of salt and see if that makes a difference. Rinse very gently 3-4 times a day but no more than that for about the first week.

If you need the percocet, take it. Especially at night because you need to get adeqate rest.

It is good that you are mindful of taking care of yourself during this time and your concerns are totally understandable. I really think from what you have described, that you are doing ok!!

Keep in touch ~'.'~

Bryanna



Quote:
Originally Posted by sandy60 View Post
Thanks again. The area that's all messed up looking is right behind the socket, about 1/2" inch worth. Is that where they inject you? I have had palate injections before but they seem more in the center or betwen the tooth and the center. I was asleep so don't know and even if I am awake, hard to know. One question is, they put a collagen membrane over the graft...did they stitch that? How does it stay on if not? I don't even know if I got stitches but see incision lines behind the tooth and in front of it. I forgot to ask if I got stitches, which (as you can tell, lol) is not like me...I was just so nervous that I froze up and didn't say much. Thanks for the orajel tip, I won't use anything. I am using the salt water. It burns but I know it's good in the long run. Even with the Percocet, it still hurts but tolerable. This is like a pizza burn times 100, it's a very delicate area. I am rambling here but if you could answer the questions above, I'd really appreciate it and no need to apologize about the delay, I am SO appreciative that you are taking the time to do this at all. It means so much to us folks on the other side of the chair!
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Unread 01-11-2009, 08:41 AM   #18
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Hi, I have a few more questions. The abscess where tooth 11 still looks like it is there, I see yellowish circle with red ring. There was a crust around it that fell off but today it looks like it did originally. I pressed it, not to drain it but out of curiosity (gently) and it still hurts. I am still on amoxicillin. The surgeon told me when the tooth is out, the abscess will go away. Any feedback on that would be appreciated.

Also, where tooth 2 was extracted, it looks lumpy. Both the second surgeon (I went to someone else the 2nd time who I know better) and my own dentist said it looks lumpy but sometimes it heals that way. One said maybe they can smooth it out. Argh, what do they do? It's just been 2 weeks so doesn't the bone have to grow in? Don't they have to give it more time? I feel very weird (no pain there) but my cheek hits the empty space and it feels strange and at times like I am biting my cheek. I have the ist molar out on the other side but it never felt weird because the support of the last tooth is there. Have you heard this complaint before? Do most people get used to it or do they get an implant?

Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

From your description it sounds like he may have made incisions in the front and back of the tooth and flapped the gum tissue back off of the bone a little. Sometimes this is done to get a better visual look at the area when there is a possibility that the bone surrounding the infected tooth has deteriorated from the infection. It is important that the surgeon keep as much healthy bone intact as possible and at the same time remove all of the infected bone so the area heals well. Flapping back the gum tissue gives the surgeon a clear view of all of that.

The injections of local anesthetic to remove #11 are given in several areas and some of those are different areas on the palate.

The collagen membrane resembles a small piece of white tissue. The graft material is packed into the socket and then the membrane is placed snuggly over the graft and the gum tissue is sutured closed or nearly closed. The bone graft and the membrane instantly fill with blood and the body starts to send healing cells to the area as the blood clot forms holding all of this together. The graft and membrane become one very quickly so don't worry about it coming out or anything.

There is definitely stitches. Sometimes they are the dissolving kind and sometimes they are not. It is important that you have a follow up appointment with the oral surgeon within the next 2 weeks. Then it is also important to have an xray taken of that area in about 3 months and then again in 6 months to see how the graft material is healing.

The salt water should not really burn. Perhaps you are using too much salt and/or the water is too hot?? The water should only be warm and just add a pinch of salt and see if that makes a difference. Rinse very gently 3-4 times a day but no more than that for about the first week.

If you need the percocet, take it. Especially at night because you need to get adeqate rest.

It is good that you are mindful of taking care of yourself during this time and your concerns are totally understandable. I really think from what you have described, that you are doing ok!!

Keep in touch ~'.'~

Bryanna
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Unread 01-11-2009, 03:01 PM   #19
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Hi Sandy,

The "abcessed" area that you are speaking of at the site of #11....... is it on the cheek side and along the bumpy, bony ridge or is it above that bony ridge area? Did that area actually develop a scab??

The original source of the abcess came from the infected root canaled tooth. As the infection spread from the tooth to the jawbone, the abcess occured. The steps in clearing up an abcess begin with removing the source, which was the tooth, then remove the abcessed bone and tissue inside the socket, irrigate thoroughly with saline, close up the wound and put the patient on antibiotics. I would assume that your surgeon did all of those steps before placing the bone graft material, collagen and sutures. That is the standard procedure in a case such as yours. Sometimes, the area is too infected to place the graft material at the time of the extraction, but the surgeon should be familiar with that issue because that is actually part of his training in this type of procedure. If the graft is placed in infected bone, the area will not heal and the graft would need to be removed. This is one good reason all surgeries like yours should be followed up within 2 weeks from the extraction.

I am not surprised that the area is sore to the touch, that is very normal and expected. The yellowish circle with red ring could be a canker sore. These can develop near or around extraction sites from the trauma of the instruments, etc during the surgery. They tend to be the sorest about the 3rd to 4th day after the extraction and then continually feel better and fade away from the 5th day on. They can last up to 21 days in all. The other thing is, that area of bone above #11 site is bony and the skin could appear yellowish with some red color because the tissue is thin there and the bone is close to it. If you notice pus or a foul odor coming from that area, then you should see your dentist early this week. Or if you develop a fistula, it is raised and looks like a pimple on the gum, then see the surgeon asap.

Amoxicillin is routinely prescribed for oral infections but sometimes the bacteria is not sensitive to it and the antibiotic needs to be changed.

I would expect #2 area to look a little lumpy at this stage of healing. The tissue has not completely filled in yet and the bone has definitely not healed in yet. It has several more months to go before it's considered solid again.
It is way too early to determine if anything should or could be done to address the lumpy tissue there. Most people get very used to that tooth being gone and never replace it. I think you need to give it some more time.

So many things to think about but you are taking good care of yourself through this phase and if anything unusual pops up, I think you will be aware of it. If ever in doubt, schedule a quick appointment with the dentist or surgeon to be sure........ ~'.'~

Keep in touch....... enjoy the rest of the weekend!

Bryanna


Quote:
Originally Posted by sandy60 View Post
Hi, I have a few more questions. The abscess where tooth 11 still looks like it is there, I see yellowish circle with red ring. There was a crust around it that fell off but today it looks like it did originally. I pressed it, not to drain it but out of curiosity (gently) and it still hurts. I am still on amoxicillin. The surgeon told me when the tooth is out, the abscess will go away. Any feedback on that would be appreciated.

Also, where tooth 2 was extracted, it looks lumpy. Both the second surgeon (I went to someone else the 2nd time who I know better) and my own dentist said it looks lumpy but sometimes it heals that way. One said maybe they can smooth it out. Argh, what do they do? It's just been 2 weeks so doesn't the bone have to grow in? Don't they have to give it more time? I feel very weird (no pain there) but my cheek hits the empty space and it feels strange and at times like I am biting my cheek. I have the ist molar out on the other side but it never felt weird because the support of the last tooth is there. Have you heard this complaint before? Do most people get used to it or do they get an implant?
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Unread 01-11-2009, 03:45 PM   #20
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Hi Bryanna. The fistula/abscess was 1/8" of an inch above the gum line of tooth 11. It isn't a canker sore; it's the same spot that was there before, yellow (pus underneath) surrounded by a red ring. It wasn't exactly a scab, just a thin crust that fell off yesterday over that small area. It went down in swelling and actually now just looks like white dead tissue sloughing off. I was asleep but I am sure the surgeon did all you said. He is the most well known oral surgeon in my city and has been practicing for 30 years. I am still on amoxicillin for another 6 days. he added to the prescription that I already had to be sure that it's eradicated.

I am seeing him on Thursday for the follow-up. I am more uncomfortable now in the area of tooth 2 but don't plan on an implant for that tooth. It just feels so annoying that my cheek is going into the space. I looked at the inside of it and it has scratches, has bled (I didn't see it) but it being caught between the teeth. Is there something other than an implant that could be put there?

This is all too much at one time. By the way, I am also missing 30 and 29 for the past 3 years and never replaced them. I know I will have to address that issue eventually but for now....argh is all I can say, I feel old and depressed and now my cheek looks sunken in, my face looks too thin. Thanks in advance for your reply.

Quote:
Originally Posted by Bryanna View Post
Hi Sandy,

The "abcessed" area that you are speaking of at the site of #11....... is it on the cheek side and along the bumpy, bony ridge or is it above that bony ridge area? Did that area actually develop a scab??

The original source of the abcess came from the infected root canaled tooth. As the infection spread from the tooth to the jawbone, the abcess occured. The steps in clearing up an abcess begin with removing the source, which was the tooth, then remove the abcessed bone and tissue inside the socket, irrigate thoroughly with saline, close up the wound and put the patient on antibiotics. I would assume that your surgeon did all of those steps before placing the bone graft material, collagen and sutures. That is the standard procedure in a case such as yours. Sometimes, the area is too infected to place the graft material at the time of the extraction, but the surgeon should be familiar with that issue because that is actually part of his training in this type of procedure. If the graft is placed in infected bone, the area will not heal and the graft would need to be removed. This is one good reason all surgeries like yours should be followed up within 2 weeks from the extraction.

I am not surprised that the area is sore to the touch, that is very normal and expected. The yellowish circle with red ring could be a canker sore. These can develop near or around extraction sites from the trauma of the instruments, etc during the surgery. They tend to be the sorest about the 3rd to 4th day after the extraction and then continually feel better and fade away from the 5th day on. They can last up to 21 days in all. The other thing is, that area of bone above #11 site is bony and the skin could appear yellowish with some red color because the tissue is thin there and the bone is close to it. If you notice pus or a foul odor coming from that area, then you should see your dentist early this week. Or if you develop a fistula, it is raised and looks like a pimple on the gum, then see the surgeon asap.

Amoxicillin is routinely prescribed for oral infections but sometimes the bacteria is not sensitive to it and the antibiotic needs to be changed.

I would expect #2 area to look a little lumpy at this stage of healing. The tissue has not completely filled in yet and the bone has definitely not healed in yet. It has several more months to go before it's considered solid again.
It is way too early to determine if anything should or could be done to address the lumpy tissue there. Most people get very used to that tooth being gone and never replace it. I think you need to give it some more time.

So many things to think about but you are taking good care of yourself through this phase and if anything unusual pops up, I think you will be aware of it. If ever in doubt, schedule a quick appointment with the dentist or surgeon to be sure........ ~'.'~

Keep in touch....... enjoy the rest of the weekend!

Bryanna
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