Lower left molar extraction.

[Gordon]

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?.

You'd be opening it up and basically starting the healing process all over again afterwards. Probably for no actual benefit.

The other tooth, looks like some areas of hypominerised enamel, they'll be rough and pick up staining easily. CAn't say if they're decayed without physically examining them, but it's not likely. They'd have been mostly covered by the tooth in front so you'd not have noticed them before.

 

[Niki87]

Thanks Gordon, do you think this still has a chance to heal? So worried about it.

I am getting the upper filling done today so will ask about the tooth at the back again. I’m concerned as the surface is rough it’s now going to be more prone to decay.

I hope you don’t mind my asking, I’ve read a few of your replies in other posts where you mention about your wife being missing her first molars and also having had her wisdom teeth out, so presumably she has the second molars on their own at the back? Has she had any issues with this? Can a molar survive with no immediate neighbours so to speak? I appreciate everyone’s situation is different. I think you mentioned her upper ones moved a bit but the lower stayed where they were?

I feel like I’m in damage limitation mode now and just trying to preserve what I’ve got, I’m only in my mid 40’s.

I am upset that in over 10 years my original dentist never did any updated bite wings or any X-rays at all as I can’t help but think if the problems with the tooth that ended up being extracted had been picked up earlier and he had listened when I told him several times at checkups that the tooth still bothered me, It wouldn’t have come to this, my whole bite is off now and it feels like my mouth has been ruined by this. It seems to be common practice that bite wings at least be taken every 2-3 years to help pick up on early changes?

Thanks again for your time and input Gordon.

 

[Gordon]

I’ve read a few of your replies in other posts where you mention about your wife being missing her first molars and also having had her wisdom teeth out, so presumably she has the second molars on their own at the back? Has she had any issues with this? Can a molar survive with no immediate neighbours so to speak? I appreciate everyone’s situation is different. I think you mentioned her upper ones moved a bit but the lower stayed where they were?

Yes that's right. No, she's had no problems with them at all. If anything having no immediate neighbours is a bit of a positive, gives much better access for cleaning around the tooth for instance.

 

[Niki87]

@Gordon I’m back again, I got a cancellation for my NHS appointment with oral maxillofacial surgeons. Dr I saw today was trying to find where pain is coming from I my socket - 8weeks + now. I have attached a pic, I don’t know if you can make out the bony ‘bobble’ on the lip side of the socket, just underneath the pre-molar. He kept touching there and it was so painful, he said it’s a sharp bony prominence which can happen when the buccal bone breaks etc, he is saying that it should gradually remodel itself (it’s not poking through the gum) does this sound right? And how long can that take? Is that what normally happens? And what do I do if it doesn’t. Feel so deflated at the moment as nothing seems to be going in right direction with this socket healing

 

[Gordon]

does this sound right?

Yes

And how long can that take?

Varies a lot, depends on a load of different factors, so I couldn't even guess.

Is that what normally happens? And what do I do if it doesn’t.

Occasionally. If it carries on then the only remedy is to lift a flap of gum and physically smooth the bone down.
It doesn't come to that very often though, I've personally only done it once in my entire career and there were other factors at play there.

 

[Niki87]

@Gordon thanks, hopefully it will smooth off a bit on its own given some time, as I wouldn’t want to cut into the gum, it is reassuring to hear you only had to do that once.
Im assuming some buccal bone loss is relatively common with some extractions?

 

[Gordon]

Yes, sometimes a big chunk of bone comes out attached to the tooth roots, there's nothing you can do to prevent it and you've no idea it'll happen until it does.

 

[Niki87]

@Gordon I wanted to ask, how quickly can other teeth start moving following extraction? I may be imagining things but the lower molars on the opposite side to my extracted molar seem to be tilting more inwards, I’m sure they must have been anyway but seems more pronounced, I have quite a small mouth so don’t have a lot of spare space, is there anything that can be done to prevent this getting worse? Do molars tend to tilt inwards more as you get older? (I’m 48), thanks as always

 

[Gordon]

Pretty slow, even with orthodontic forces acting on them 1mm a month is about as fast as you can move teeth.
It's unlikely that they'll tip far inwards, you've got a big muscular floppy thing in the middle of your mouth that tends to keep them upright

 

[Niki87]

@Gordon see I thought that as my tongue is always pushed up against my teeth, so you would think that would push them the other way? But then I suppose you have your cheek on the other side aswell doing doing the same…

 

[Gordon]

But then I suppose you have your cheek on the other side aswell doing doing the same…

Exactly. The teeth sit inside a sort of Neutral Zone (Got to get in a Trek reference ), between the tongue on one side and lips/cheek muscles on the other.
It's amazing how we chew, the tongue pushes food onto the teeth from the inside and the buccinator muscles in the cheeks push it back the other way.

I had Bell's Palsy once many years ago and it was amazing how food piled up between my teeth and my cheek when my buccinator muscle on that side stopped working.

 

[Niki87]

@Gordon Wow, yes you don’t realise how everything works together, until something doesn’t! And probably why you notice changes to your mouth so much.

You may remembe4 me being concerned about the second molar behind the extracted one due to hypo-mineralisation (pic is above somewhere). Well I had a hygiene visit today (first proper one in awhile as they avoided the extraction area last time. She was having a poke around and did say afterwards that she was careful around it as it did feel ‘softer’ there and she didn’t want to cause any problems. There are little ‘pits’ which aren’t as ovbvious visually now I’ve had a clean but you can still feel them as rough spots.
She said at least we know about it, whereas before it wouldn’t have been seen as it would have been covered my other tooth and more likely decay would have set in. She said to basically watch it and the dentist is aware aswell.

Im wondering though - when you have an area of ‘softened’ enamel, is it destined for a filling/restoration at some point? Can it re-harden at all, thereby halting any decay/stopping it from progressing through the enamel? (I use duraphat). Did mention the fluoride stuff you can paint on but as I’m using the duraphat they said to stick with that for now.

Just wondering if there’s anything else I can do, apart from what I’m doing?, watching my diet, maintaining good cleaning/flossing, only really drink plain water, nothing acidic (do like a cold glass of milk tho - hope that’s still allowed?, it has calcium lol). I guess it’s good that I do have better access to clean that area now so if there is a problem it can hopefully be dealt with earlier.

Thanks Gordon.

 

[Gordon]

Can it re-harden at all, thereby halting any decay/stopping it from progressing through the enamel? (I use duraphat). Did mention the fluoride stuff you can paint on but as I’m using the duraphat they said to stick with that for now.

Yes, it absolutely can and does remineralise. Try physically massaging a little tiny smear of the Duraphat into the area if you can access it with a finger tip.

In terms of diet, it's just a case of moderation, it's not really the amount of carbohydrate in the diet that's the problem, it's the frequency... sipping on a coke for 2-3 hrs does far more damage than just guzzling a couple of cans in quick succession for example.

Wow, yes you don’t realise how everything works together, until something doesn’t! And probably why you notice changes to your mouth so much.

Humans can distinguish between the equivalent of 2 hairs thickness when biting down into them. i.e. if you bite into something 2 hairs thick and 1 hair thick, you could tell the difference, it's amazing we can get away with fillings and crowns at all to be honest.

 

[Niki87]

Yes, it absolutely can and does remineralise. Try physically massaging a little tiny smear of the Duraphat into the area if you can access it with a finger tip.

In terms of diet, it's just a case of moderation, it's not really the amount of carbohydrate in the diet that's the problem, it's the frequency... sipping on a coke for 2-3 hrs does far more damage than just guzzling a couple of cans in quick succession for example.


Humans can distinguish between the equivalent of 2 hairs thickness when biting down into them. i.e. if you bite into something 2 hairs thick and 1 hair thick, you could tell the difference, it's amazing we can get away with fillings and crowns at all to be honest.

I will do that.
And I hear you about moderation.

That’s fascinating, and certainly explains why it can take a long time for (especially) bigger fillings to settle and for you to accept them let alone ruddy great holes in your mouth! I’m learning so much since joining this forum.

My dental anxiety certainly peaked this year and it’s not that I don’t believe the things my dentist tells me, but when you get conflicting advice it can be reassuring to get another take on things on here from someone you know is totally unbiased as they’re not actually treating you. I feel it helps me understand better, and know what sort of questions I should be asking when I do see a dentist. And when I’m having a really bad day and thinking things are never going to get better, which I’ve had a lot of recently, it helps me to hang in there. So thankyou again.

 

[Gordon]

Dentistry seems to suffer from a lot of misinformation, especially regarding stuff like amalgam, TMJ issues and "OMG Dental Abscesses will kill you", it's easy to get sucked into a rabbit hole of pseudo-science and not get out again

 

[Niki87]

@Gordon I think I read somewhere that you said you thought it was ok to put a smear of sensodyne over teeth, under a night guard, I just wanted to ask if there is likely to be any contraindication with doing the same with the duraphat?, like to keep it in contact with the teeth a little longer? I haven’t tried it yet as wasn’t sure with it being a ‘stronger’ toothpaste. Just wondered in theory if it would be ok, I’m only talking a tiny smear not to like fill the guard with it or anything

 

[Gordon]

It's perfectly OK to do that, just as you say, just a smear, don't go nuts with it

 

[Niki87]

@Gordon thanks!