Concerned about extraction site day 3

[Anne2021]

I have a question for a dentist about extraction sites and what things should look like. There is a white film that is over the clots and suture. I have had six adult (non-wisdom) teeth removed over the last several years. My two lower right molars were removed Wednesday (3/8) - I'm at about 48 hours as I write this. The two lower left molars were removed one at a time in 2019 and just last December (2022) so I remember what the healing looked like and could see them well at the time. The extraction sites look nothing like what I have ever seen before. In the past I would see the hole and the clot in the hole. It just looks really messy and like the clots are higher, almost like they are resting on top of a plateau, not in a hole. There are also stitches, which I've had before, but there is one long suture going longitudinally across the top of the two sites. Is that normal? In the past I have irrigated the lower molars starting with day three at the surgeon's instruction and would gently run the water into the hole. It's like there's no discernible holes. And now this film today has me very concerned. I wondered if it could be the mashed potatoes I had, but the irrigating didn't move any of it. I wasn't going to eat them yesterday, but I was getting very weak last night (I have other health problems) and the yogurt and milk and ice cream weren't enough. So I ate mashed potatoes last night, but wasn't supposed to irrigate until today. Now I'm wondering if the potatoes got in there overnight and are stuck to it all now. I called the oral surgeon's office knowing they close early on Friday and spoke with the assistant. I told her how the clots look and about the white film. The first thing she said was, "That's how it's supposed to look." It never looked like that before, though, with previous extractions. Then she warned me to keep it clean and brush or I will get an infection if plaque forms on it. I said that I am doing the salt water rinses and started irrigating today, but that I wasn't brushing near there due to fear of dislodging the clots and getting dry socket. She said I better brush the gums near there gently or I could get an infection. So maybe it's already infected and that's the white film. The surrounding gum tissue toward where the wisdom tooth used to be years ago and on the cheek side of 30 and 31 is raw and red, like it was traumatized during the process. Even the gum next to the tooth next to them (#29) looks like it got stabbed and/or pulled down. They're closing for the weekend in less than an hour now and she didn't offer for him to take a look at it. In the past they have offered for me to come in to take a look and make sure everything looks good. Does this all sound normal or concerning?

 

[Gordon]

It sounds absolutely fine. You're not at any risk of dry socket this far past the extraction date. Basically if it's not hurting a lot, then it's nothing to worry about

 

[Anne2021]

@Gordon Thank you for your reply. That is reassuring.

 

[Anne2021]

So, it has now been five days since the extraction of 30 and 31. The actual socket sites look better and closer to what I have seen in past extractions now. I still have two things that are concerning me, though. This is strange for me because I have generally healed up well post-extraction without questions or concerns, even as recently as December 2022 when I had #19 removed. So there are two issues I am wondering whether I need to be concerned about or not.

1) The gums next to the cheek side of 30 and 31 are red. It does not seem to be increasing or decreasing, but I can't be sure. Things were quite swollen and tender and it was difficult to pull the cheek away and get a good look the first 2-3 days, but it's been this way at least the last 24 hours.

2) The sensation in part of my cheek and below my lip is odd. It feels cool and different than normal - not cool to the touch, just cool. When I touch it, it's not quite right. The best way to describe it is like when the numbing is wearing off and you get to 85-90% (rough estimate) back to normal and it's almost gone. Yet it still feels like that. I'm actually noticing it more yesterday and today. Yesterday was the first day that it didn't feel like there was a large rock in the side of my face where it was most swollen, but it is still swollen. I don't know if the tenderness and tightness had me distracted from this or what is going on. Now, of course, I'm wondering about nerve damage. I also realized that the only other difference is that I took my last ibuprofen Saturday evening. Could the swelling be compressing a nerve or nerves? I'm restarting the ibuprofen now just in case that is what made the difference. Any thoughts?

 

[Gordon]

Could the swelling be compressing a nerve or nerves?

Certainly possible. Swelling can physically block nerve transmissions.

 

[Anne2021]

@Gordon Well, I called the oral surgeon's office this morning. The woman who answered said that the oral surgeon will want to see me and "map" the area that is affected. She couldn't get me in sooner than three days from now. I'm trying not to panic and concerned about permanent nerve damage.

 

[Gordon]

That would be a good idea, nerves are generally pretty good at bouncing back from this kind of thing.
It's a good thing if you can feel a bit of tingling in the affected area, a bit like when local is wearing off.

 

[Anne2021]

@Gordon Thank you so much for answering. I do feel some tingling, and it does feel like it feels when it is wearing off. It feels like I'm at about 85-90% of it wearing off, but it seems like it's not decreasing anymore with time. I know I have been asking a lot on this post, but it is making me very nervous to wait to get in to see him.

I also am still very concerned about the gums on the cheek side. It just looks raw, almost like the bone is right there and the gum tissue is extremely thin. I can see the little blood vessels and it doesn't look like it's changing. It looks like something just scraped it all along the side and the tissue is gone. I can see the healing process of the sockets, but this area doesn't change. I'm getting concerned that I lost gum tissue on that side during the extraction. If that is gone, how will I wear a partial denture? It looks like there would be almost no cushion between the bone and the denture.

 

[Gordon]

Sorry to be the bearer of bad news. Unfortunately, the nerve recovery process can be a slow one and there's not an awful lot of things one can do to speed things up.
It's not likely to be permanent but it could take months or longer to recover.

I'm not sure what's going on with the gum area, any chance of a photo?

It's pretty early days as far as tissue recovery goes so I wouldn't fret too much about that just now. Gums heal a lot faster than nerves do.

 

[Anne2021]

@Gordon Thank you again for your reply. I think I could tolerate the nerve taking a long time to heal if I could have reasonably solid hope that it eventually would. It's the fear of it being permanent that makes it more difficult. Thank you for the encouragement in that regard. Also, I need a three fillings in the lower right quadrant - 27, 28 and 29, with 27 and 29 far enough long that delay could potentially be a problem, but I'm guessing it's not smart to get more local anesthetic while this is not fully healed, right?

I'm trying to get a decent picture of the gum area, but so far I can't get it to the focus to get a good enough shot where I can even see in the photo what I am trying to ask about. I'll keep trying and post one if I get a better shot.

Thank you so much.

 

[Gordon]

It's not a great idea to get another IDB in the area, but it might be possible to do the work with a different local anaesthetic technique, ask your dentist.

On the other hand, if they feel they need to use an IDB to get it done, then it's the lesser of 2 evils if you needed to have emergency extractions done in the area.

 

[Anne2021]

@Gordon I saw the oral surgeon today. I had reported the altered sensation on the phone on Tuesday and they said to come in today.

While he was first looking inside my mouth at the extraction sites, I asked about the gum tissue and its appearance. He went over some things in general about healing. He teaches one morning a week as part-time faculty at the dental college at the university here, and so when he answers questions, he often goes into a lot of detail like he's teaching, which I like and follow at the time, but not well enough to repeat it. He talked about the blood vessels I mentioned here, and he explained keratinized vs. non-keratinized gum tissue. He was confident that it is healing as it should and that it will be able to support a denture.

We moved on to the altered sensation issue. He tested my ability to feel sensation by poking a few areas inside my mouth and on the outside of my face. I even winced once where he poked inside. Given my level of feeling, he was satisfied that there didn't appear to be serious damage and explained some of the anatomy of the nerves and how the nerve can get nicked from the injection or when it's being extracted - something about the way it pulls away from the socket (and nerve fibers, etc). He encouraged me that it will likely heal with time and suggested 6-8 weeks.

I'm kicking myself though because I had a list of questions, and the other area of concern for me has been that there is still swelling/inflammation in my cheek, as I had mentioned on here. I had asked here before about compression from the swelling contributing to the altered sensation. I completely forgot to bring it up today though I was literally holding a list of my questions in my hand. The cheek is still thicker. I can see it when I open my mouth - I have to pull it back to even see the site of #31. It's not like that on the lower left side (which is missing both molars as well). I can feel it, too, when I wash my face. As I hold the washcloth up against my face, my left side feels normal and my right side feels like I'm cupping a small rounded object in my hand. It's an odd description, but it's the best I can do. I'm getting concerned that the swelling could become chronic. The extractions were nine days ago. Shouldn't swelling have resolved by now if it was going to?

 

[Gordon]

The extractions were nine days ago. Shouldn't swelling have resolved by now if it was going to?

No, it can take a bit longer than that, don't worry overmuch about it.

 

[Anne2021]

@Gordon Okay. Thank you for being here and answering my questions.

 

[Anne2021]

@Gordon I'm back again wondering if things should still be the way they are. Today I'm five weeks out from the extraction of 30 and 31. The top looks good and the inside (tongue side looks good), but the cheek side still has me quite concerned. I still see the blood vessels so prominent through the gum tissue. It looks like bone is just right under a thin layer of gum tissue and is sticking out all bumpy, especially on the area where 30 was. When I eat, if food gets over there between the gums and the cheek up against the bumpy area, it's very sore and causes some pain. It's like there is just no cushion there. It just doesn't look like previous healing (like when 19 was removed in December and healed right up). It doesn't even look the same color. I don't see how I will ever be able to put a partial on it, both due to the bumpiness and almost jutting out of the edges, as well as just how sore it is to even get food near. Is this anywhere near normal at five weeks out? I'm starting to be concerned that they will need to cut it open, shave the bone down and give me a gum graft or something like that because there's almost no gum tissue.

Oh, the nerve issue did get better within about three weeks, I would say, so that part is good.

 

[Gordon]

It can take a while for the bone to remodel. Ironically putting a denture on it will speed it up a bit due to the slight trauma from the denture.
Occasionally you do get a sharp edge of bone that cuts into the gum as it forms over the top, which can need fixing surgically, which isn't as bad as it sounds No grafting is required. But at this early stage I'd just wait a wee while longer.

 

[Anne2021]

@Gordon Thank you for the reply. I'll give it more time. I'm getting eager for the partial denture, and I know my dentist wants to do it after healing. I saw her today about two other teeth and asked her what she thought of the extraction sites. She said they looked good in general, but she said what you did about remodeling and waiting to see, and sometimes needing fixing. I asked about the partial in that event, and she said that we would have to wait for the additional healing time.

I only have 13 and 14 on the upper left back (12 and 15 are gone). 20 and 18 have been gone for more than three years. During that time, 19 provided a place for 13 and 14 to bite down on and vice versa. I lost 19 on December 15, 2022. So, it has been four months since 13 and 14 have not had anything to bite against. 30 and 31 have been gone five weeks. If I have to wait another 6 weeks or so to see what happens there and then maybe start over, it will be a long time for 13 and 14 not to have opposing teeth, and I am concerned about super-eruption. She actually mentioned it as a possibility today, but we didn't go further into it because I had so many other questions. How long can I risk going without a partial on the bottom to meet 13 and 14 or even the teeth on the upper right now that 30 and 31 are gone? Is it possible to get a temporary partial denture of some kind just on the left that I would use just to give 13 and 14 a chance to function while I wait for the healing to get the more permanent partial denture? Nothing fancy, but just enough to keep these teeth from super-erupting?

 

[Gordon]

How long can I risk going without a partial on the bottom to meet 13 and 14 or even the teeth on the upper right now that 30 and 31 are gone?

A year or two. It's not a quick process.

Is it possible to get a temporary partial denture of some kind just on the left that I would use just to give 13 and 14 a chance to function while I wait for the healing to get the more permanent partial denture?

It would be tricky to wear, the denture would be very compromised. Biting on one side only will tend to tip the denture to the biting side, breaking seal and causing it to drop down...
Better just to wait a little bit longer.

 

[Anne2021]

@Gordon Thank you for the answers again. How long would you give it to see if the bone remodels in such a way that I won't need the additional surgery? (I'm currently at 5.5 weeks).

 

[Gordon]

Sorry, there's not really a straight answer to that one. Depends a lot on the patient's physiology and how bad the sharp edges are. If they're really bad, then it's usually better to go in and sort it rather than wait, if you see what I mean?