Seeking advice on extraction complication

[tt27307]

25m smoker

Hi, hoping someone can offer their advice here. Please bear with me as this has become complex. I would appreciate if this could be read in full as one thing has led to another.

On 5 March I had my lower right 1st molar surgically extracted. I subsequently developed dry socket and infection 1 week later. The socket took a good 5-6 weeks to heal and eventually, it closed over.

Since the beginning of April, I noticed I was unable to chew on the lower right 2nd molar. The bite felt completely off and the tooth touched first when I bit down. I then noticed slight mobility, inflammation and soreness in the area.

Over the course of 3-4 weeks I returned to my dentist who checked the tooth. It responded normally to their tests but they noted slight looseness. I was not offered a bite check and I had to practically beg for an X-ray because I knew something was off.

The tooth itself looked normal with no obvious sign of infection, but their was a gap on the side toward the extraction site between the gum/bone and showed as a small line of “blackness” between. At this point my dentist wasn’t sure what treatment would help and I asked for a second opinion with the owner.

The owner said he “didn’t like the look of those roots” and offered no clinical or meaningful advice, I was sent home with antibiotics. I have begged them to take out the tooth because it has caused me daily discomfort for the past 2 months and he said “ideally, you don’t want to lose this molar” which is true but not helpful when I am in pain with it.

I have ruminated about this for weeks and have found nothing online which suggests anything similar. I feel completely isolated from friends and family due to the discomfort I am in, as I have had to cancel numerous plans. Consequentially, due to months of one-sided eating on the left, I have developed a partially locked left jaw, in which I have had an OMFS referral made.

Although I am not clinically trained, this problem seems to be a periodontal issue OR something completely different which I have not been able to figure out. I do have gingivitis.

I have what feels like a swollen lymph node under my jawline in this area (soft squishy bump which I can move with my finger) and it pulsates too. I have gotten to the point where I want to extract the tooth BUT I would be left with no molars on my lower right side. The heat makes the pain worse and starts to throb toward my jaw and ear.

Unfortunately my dentist is an NHS dentist and the appointments they schedule for me are 10 minutes long. My dentist is frustrated with me constantly asking for a checkup on it and I am frustrated at my situation, neither of us can identify the problem.

I will attach a photo of the tooth here and an OPG from April, the socket has healed since this xray. Unfortunately they have not responded to my request for a copy of the X-ray, which shows the tooth is not completely attached to the “socket”.

Any advice would be appreciated, before I go ahead and extract the tooth (and replace with a partial denture)

Thank you

 

[Gordon]

The tooth will have tilted forward slightly due to loss of the molar in front. This will mess up the bite on the tooth leading to pretty much all your problems.

It should be a fairly quick and simple (and painless!) job to adjust the bite to suit. I'm somewhat perplexed that 2 different dentists didn't already do this to be honest.

 

[tt27307]

Hi Gordon. Thank you. I have an appointment on Monday with a private dentist who can hopefully help.

I have a question though, if I chose to extract the remaining lower right molar, so there is no molar on that right side, will it cause bite problems on the left? I worry that if I extract the last remaining molar on the right due to periodontal damage and daily soreness, it will mess up my bite further and cause problems to the left which will result in another extraction.

I am getting a partial denture this week and if I chose to extract, I would need to adjust the partial and add that tooth onto it. As I only have one lower molar on each side now unfortunately

Hope that makes sense

 

[Gordon]

It might, or it might not, sorry!

It does complicate the partial denture a bit, by creating what's called a "free end saddle", it would be better if you didn't have it extracted.

 

[tt27307]

Hi Gordon. I had my private dental appointment in which an occlusal assessment was given, termed a “functional smile design and analysis”. The dentist spotted the high contact and labelled it a “non-working side interference”. He said he’d need to shave a lot of the tooth down so that it was level but then said he wouldn’t do so because it could cause a problem on the opposite side, and my partial denture should help balance the load of chewing/grinding food. I’m definitely wanting it extracted now if they can’t fix it. I paid over £200 for that appointment. feeling very deflated about it!

 

[Gordon]

That's an expensive visit, did you get some kind of treatment plan from them?