Lower left molar extraction.

[Gordon]

I also wondered if it could be oral thrush due to the amount of antibiotics I’ve had but apart from the swelling/puffiness, I can’t see the telltale white patches you would expect to see with thrush.

Very unlikely to be Candida, the symptoms are wrong.
If it was a pretty "violent" extraction then 2 weeks is not that long for healing to occur, I suspect it just needs more time. Do you still have some Difflam? That might help speed up the healing a bit.

If your cheek is still sore then postponing the filling might not be a bad idea.

A photo would be handy if you want a better answer.

 

[Niki87]

Went back to dentist, he said gum is still inflamed likely due to infection the tissue closing over something, he has given me further antibiotics and said may need to cut into it if doesn’t heal - I will be travelling in 10 days so he wanted to try antibiotics first - I am so scared and sore, will this heal?

I’m still trying to get a decent photo that is useful to you. Will post pic if I manage. But its basically still raw in the middle.

 

[Niki87]

I’m also supposed to be getting fillings done in two days, not sure if I should postpone till this has settled, it may be too much for my mouth to handle? Then there’s the worry of leaving the cavities longer - this is so stressful. I cannot work at the moment as it is too painful to talk!

 

[Niki87]

 

[Niki87]

This is prob best pic I can get, the tooth behind is getting so much plaque build up as it’s difficult to clean it as so sore to get brush anywhere near it, just using a soft brush at moment - not been able to go back to my ekectric yet. All my teeth feel so sensitive it’s like having a pneumatic drill in my mouth. Using flouride mouthwash aswell. It will be 3 weeks on Thursday, at what point would you look at asking an oral surgeon for opinion? If it was feeling ok I wouldn’t be so worried, but it’s not ….

 

[Gordon]

It looks like there's a sharp edge of bone there that's cutting into the mucosa as it tries to heal over it. Any dentist should be able to fix that for you fairly simply, it doesn't need an OS.

 

[Niki87]

Is that the tiny white dot in the middle, I took this photo yesterday, it was the clearest one - I can’t see it today, will it eventually work itself out if can’t get hold of it, nothing showed up on X-ray but guess if it’s just a tiny sliver it wouldn’t show would it, what about the overall healing though? It will be 3 weeks on weds?

 

[Niki87]

I suppose there could be more aswell ….? If the tissue closes over bony spicules will they resort - or do they have to find a way out and it won’t heal until they do? Thanks again Gordon, you have a good eye, I missed that

 

[Gordon]

Spicules either work their way out or get resorbed if the gum manages to close over them. 3 weeks isn't really that long a time scale, given the amount of trauma associated with that extraction.

 

[Niki87]

Thanks Gordon, I need to ask your opinion. As you will know I’ve sought different opinions about my surrounding teeth. I think I need to focus on the extraction healing and I can’t cope with more dental work - at least not in the next couple of weeks. The dentist I saw today spent a lot of time with me and both the teeth that are either side of the extraction are mobile - one in particular and does hurt when the tooth above hits it in a certain way as they now hit differently. This is one that another dentist wants to do a small filling on.

Q1. The dentist said it’s a time thing as to whether it will heal and firm up, said it’s not easy to predict what will happen to a tooth that has had trauma? Is this correct? And would it be advisable to wait to give it time to settle? (He by the way could not see a cavity on X-ray or on the tooth). My fear is drilling into a tooth that is already upset may just finish it off, especially if it something that can wait a bit.

Q2 there is a small cavity on the upper left, this time he could feel it with probe, but again says nothing to see on X-ray. Small hole in old amalgam though, which will need doing eventually but is not an urgent given my current situation. Whereas previous dentist said there was a shadow that suggested deep decay, so I,ve had two now say can’t see anything on X-ray and one that said the opposite. The dentist who said possibly deep decay didn’t spot anything wrong with the filling itself. How do I know which to believe? The one with the cavity that was evident on clinical examination obviously will need doing but will a couple more weeks change the situation significantly?

Q3 The dentist today did the X-rays same way as others, little plastic thing in mouth, but he left the room and came back with two small films and put them on white background, they do get put on the computer system though. Are these X-rays less reliable than the digital straight to computer ones? or no difference? The same?

I apologise for the nature of these questions and I am only asking for your opinion as you have a wealth of knowledge and am sure you have come across many of these questions.

It’s hard to know what to do. I’m having such a hard time dealing with this extraction that I don’t want to rush into doing things all at once because I am in a panic situation.

The appt with the dentist that wants to do the fillings felt quite rushed and they seem to focus a lot more on the cosmetic side of things, although they do general dentistry aswell. It was a more swanky office with large tvs with calming images on them and tranquil music but didn’t actually make me feel any less anxious.

Sorry long post.

 

[Gordon]

Q1. The dentist said it’s a time thing as to whether it will heal and firm up, said it’s not easy to predict what will happen to a tooth that has had trauma? Is this correct? And would it be advisable to wait to give it time to settle? (He by the way could not see a cavity on X-ray or on the tooth). My fear is drilling into a tooth that is already upset may just finish it off, especially if it something that can wait a bit.

Yes, response to trauma is a bit of a lottery. It seems to relate to how wide the apex is at the end of the root, which allows more or less blood into the pulp, but it's not a 100% certainty.
If it's a small cavity, then I'd leave it, if it was a bigger one with a risk to the pulp already, then I'd get on and fix it.

Q2 there is a small cavity on the upper left, this time he could feel it with probe, but again says nothing to see on X-ray. Small hole in old amalgam though, which will need doing eventually but is not an urgent given my current situation. Whereas previous dentist said there was a shadow that suggested deep decay, so I,ve had two now say can’t see anything on X-ray and one that said the opposite. The dentist who said possibly deep decay didn’t spot anything wrong with the filling itself. How do I know which to believe? The one with the cavity that was evident on clinical examination obviously will need doing but will a couple more weeks change the situation significantly?

Give 2 dentists a single patient and you'll get 3 different treatment plans
Diagnosis is more of an art than a science to be honest, x-rays don't show everything either. If he can get a probe to "stick" in the hole, then there's some decay present. You won't know for sure how much till you get physically into the tooth.
Given that nothing is showing on the x-ray then it's likely fine to leave it for a while.

Q3 The dentist today did the X-rays same way as others, little plastic thing in mouth, but he left the room and came back with two small films and put them on white background, they do get put on the computer system though. Are these X-rays less reliable than the digital straight to computer ones? or no difference? The same?

No difference. Sounds like this time he used film rather than digital?

 

[Niki87]

Yes like old school X-rays, the others have all been ones that have gone straight onto the computer. Doesn’t seem to be many dentists that use film anymore, I suppose digital is just quicker.

 

[Niki87]

Gordon, obviously you have vast experience in dentistry, have you ever come across a situation where you have had to provide a patient with a letter for insurance, such as advising against travelling? Just interested to know if you’ve ever come across this while practising?

I am going on holiday next week, it has been planned for a long time and will be a long haul (9hr flight) we are only planning on relaxing so won’t be travelling around doing activities etc. I’m hoping if I can relax a bit it will help my continued healing. I will be taking antibiotics and painkillers.

I have scheduled the two fillings for as soon as I get back. So, in 3 weeks time. The dentist said it’s fine to wait till I get back, but obviously I’m worried with everything that’s going on.

I have read horror stories about flying with any cavities etc. But I guess people fly all the time with cavities they don’t even know about yet. what would you have told your patients if this question came up?

With your experience I would imagine you have been asked similar questions before and would just appreciate your views.
Many thanks as always

 

[Gordon]

I've had to do the opposite for serving soldiers and sailors, i.e. certify that they didn't have any ongoing dental issues that would cause problems for them on deployment
Never had to tell anyone not to travel.

The only very slight risk related to travelling and dental issues is kind of theoretical, basically if you have an ongoing acute abscess, the slight reduction in air pressure when flying could (in theory at least!) cause the abscess to increase in size and possibly lead to pain/swelling.

A sort of variation on that is with deep sea divers, as they come back up tiny amounts of air trapped between (amalgam) fillings and teeth can expand and cause pain. I've literally seen that once before (but I didn't treat many deep sea divers!). Had to dig out all his amalgams and replace with bonded composite/glass ionomer fillings instead. Note we're not talking about snorkelling in the Bahamas here, just the serious deep sea stuff involving depressurising and so on

So go and enjoy your holiday

 

[Niki87]

Thanks Gordon, I really am not sure what to do at the moment, my mouth is so sore again, if you look inside my cheeks it’s full of ‘dents’ and is red. It actually feels like my mouth is on fire!

Mostly on that side, when I bring my back teeth together, the upper second molar almost disappears into the flesh so you can see it’s constantly catching. It is at an angle like / in towards the cheek, the outside edge sits over the bottom molar, so the back edge of the tooth sits inside the lower molar. I used to have this issue with my wisdoms until they were removed then it was such relief, my cheek was normal again.

It would take years I imagine to move this tooth into correct position, if that would even be achievable. Although I absolutely hate the thought of another extraction, what other option is there? Can you extract a tooth for that reason? It’s not a virgin tooth, it already has an old amalgam and needs another filling/refilling (as above) I can’t live like this forever.

I am so depressed about this, im seriously worried about my future, my job as it’s so hard to speak without soreness. I’m genuinely scared.

Have you come across this problem before?

 

[Gordon]

Could smooth the outer cusps off a bit, so they're not digging into your cheek so much. You really need to talk it over with your dentist who can see exactly what's going on there.

 

[Niki87]

You don’t fancy coming out of retirement then? I’d travel to Scotland to see you!

 

[Gordon]

I've not touched a patient for 6 years now, going on 7... you really don't want me anywhere near your teeth

 

[Niki87]

@Gordon aww shame

 

[Niki87]

@Gordon Hi again, please look at the photo below, this is 6 week mark, extraction site still hasnt looked any different in last 3 weeks.

I paid to see an oral surgeon privately, he said he doesn’t know why it is slow to heal but feels it is healing. Nothing showing on OPG X-ray apart from a shadow between where tge roots where and the back tooth and he said he didn’t know what that was and could be an artefact. I have not seen it on any of my other X-rays done at the dentist.

I asked about debridement and he said he would not do at the moment as it could ‘open a can of worms’ I asked what he meant but he didn’t eleborate. He said he would have done that at about 2 weeks but at that stage it’s still early and you’re going back to your dentist who say give it time etc.

My questions are:
1) why would you not debride? Is it reasonable to wait it out, and if it still looks the same in another month, what should I do? Seek another opinion?.

2) please look at the tooth behind, this is now looking quite badly stained, and if you look above the white mark, there are little ‘pitted’ spots that feel rough - they weren’t there before either, or maybe they were but now they are stained they show up more, what could that be? They feel rough to the touch and worried about this tooth now. X-rays few weeks ago didn’t show much but it looks to have changed appearance on the outside.