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Dentistry/bone fragments coming thru gum

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QUESTION: Started with a sore spot on my inner gum below the last molar where my tongue rubs mid Sept, 2014..  Went to the dentist on Oct 1st who took x-rays and said I have bone loss for one thing and significant tori on the bottom inner and outer gums which of course I was already aware of and knew at some point I would have to have it removed as it was beginning to interfere with speech.  I was referred to an oral surgeon. Appointment for oral surgeon was about a month later for a consultation.  Surgeon explained the bone lost it's blood supply and therefore it was "dead bone" which the body was expelling.  He said he would remove it and the tori, smooth it out and remove an old root canal gone bad that was in the same area.  (Bone fragment was NOT below the old root canal but below the next tooth behind it.  Waited about 3 more weeks to actually have the procedure.  Day of surgery I told the Dr. that the original bone had come out on it's on a couple days prior to my surgery but had a "ridge" there which I suspected more bone may be getting ready to come out.  Told him I almost didn't come in for the surgery since the ORIGINAL PROBLEM that I was in for had passed but was concerned that if I didn't follow thru it may start up again (expelling bone) over the holidays.  Sick of all the pain and just wanted it all taken care of so wanted to proceed with the surgery.  Fifteen minutes before the surgery he sold me on doing ALL the tori removal, both sides of my mouth...inner and outer, both left and right sides of my mouth.  Within 2 days of having the surgery and the numbness completely worn off....there was the ridge...and all the stitches I had didn't go back to the area where the bone fragment came out of and the "ridge" was.  I was perplexed and worried that the original problem I went in for, the one that causes so much pain wasn't even addressed.  Called the oral surgeons office a week later when it was obvious there was more bone coming thru, left a message ( you can't get a human, you have to leave a message) was probably a bit angry sounding and even said that in the selling of all the other services (push for implant and additional tori removal) I felt maybe my orginal problem was overlooked?  I wouldn't have had the tori removed at this time had I not had the original bone fragment problem right before the holdiays.  Anyway they DID NOT return my call.  Went to the referring dentist a few days later.  They removed stitches that were basically hanging in my mouth after 5 days post op and was very reluctant to say that it didn't look like there were any stitches in the bone fragment area but did say it didn't appear there were any stitches in the area. She also acknowledged the appearance of more bone coming thru and suggested she may be able to remove it and smooth it out or could refer me to a different surgeon.   She said to give it a couple weeks to see if it came out on it's own, but if it became intolerable to let her know.  Also my outer gum line where the gum adheres to the sides of my molars would come away from my teeth when I manipulated them with my finger, tongue or toothbrush after eating.  This dentist told me I should go back to the oral surgeon and I told her I would not go there again.  I should also mention I woke up during the procedure...IV sedation...and I woke up moaning that it hurt and lifted my hand to point to my jaw and was told to "PUT YOUR HAD DOWN".  Next thing I know I'm waking up, procedure was finished.  Blood splattered on the floor in an area about the size/dimension of one and a half the size of a basketball.  Apparently they didn't apply adequate pressure after removing the IV.  I woke up to her cleaning my hand up.  They called my husband back to recovery and said the procedure that they said would take maybe 45 minutes took an hour due to having to do some "extra work".  I was too loopy to ask what that extra work was and my husband thought I already knew so he didn't ask what the extra work was either.  Now I have what feels like a rough edge under my gum on the side where the bone fragment was, and a red line extending from the bone fragment area all along where the tori was removed. this bone that is protruding is larger than the first and very painful.  Now there seems to be some swelling in the area and more pain.  It hurts in the area and the pain has spread to the jaw and my lymph nodes feel bruised.  Also, are there saliva glands back there, sort of under my tongue?  Because now when I begin eating, I have a piercing type pain, under my tongue that seems to coincide with the release of saliva.  Weird.  What should I do?  This has been going on for a while now and I'm not sure I was given the best treatment from the oral surgeon.  Not sure If I should contact the insurance company for any recourse.  Should I pay for deep sedation if I was allowed to wake up even if only briefly?  I'm stressing over this.  Thanks for any input you may have.

ANSWER: Karolyn - I am so sorry to hear that the surgeon did not honestly prepare you for all the surgery that was actually performed.  I think, for piece of mind, you should have yourself examined by a different oral and maxillofacial surgeon.  Rather than having your dentist attempt too repair the area, a surgeon should examine to see if the salivary gland was inflamed.  Call the insurance company and ask them for a referral to a different oral surgeon.

I wish you well and hope you feel better soon.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your prompt reply.  After re-reading my question it does seem I rambled on a bit and think maybe I wasn't all that clear.  My original problem that I saw the Dentist for was the bone fragment coming through the inside of my gum.  By the time I was actually there for the surgery the piece of bone had come out several days earlier.  I told the surgeon that because it came out on it's own, I almost didn't come in for the surgery because the old root canal removal and the tori removal could have waited.  All the pain I was having was coming from the bone fragment which took well over a month to come out.  It was flat, about the thickness of a womans fingernail, and about as big around as half of a pencil eraser.  Don't know if that description makes any sense.   Anyway, I explained that I wanted to go ahead with the surgery because I was concerned the new ridge that was in the same spot as the first bone fragment I was feeling was more bone fragments getting ready to come through and wanted to make sure he got it removed.  Within 2 days of the surgery that exact same area, the ridge, produced a new bone beginning to come through.  Exactly what I didn't want to have happen. That new bone which appeared 2 days after the surgery, on NOvember 20th finally came out yesterday.  The surgery was on November 19th.  I was relieved to have it come out...but today I think I feel a new ridge and am worried there may be MORE getting ready to come out.  Both times this has happened since mid September it seems to take 6 weeks or so to come out on it's own.  Since he removed the tori...should I even have any more bone coming out?  Shouldn't that have been chipped away and smoothed out?  Is this going to continue?  The bone that come out yesterday was bigger than the first.  It was probably nearly a quarter of an inch long and not that big around and again it was about the thickness of a fingernail but of course it come out side ways...painful!  Is this normal, I mean this is what caused me to go to the surgeon in the first place and the problem continues.  Yes he removed the old root canal and all my lower tori, but I'm still left with my original problem. Also the piercing pain I had under my tongue when beginning to eat seems to be getting better since the second bone fragment came out yesterday.  so I guess my questions are is this normal, shouldn't this have been taken care of during my surgery and will it continue?  I'm just at a loss, and not sure what to do.
Thanks for your time.
Karolyn

Answer
Karolyn -  I too question why additional bone fragments are coming out if the surgeon properly exposed the area and cleaned it of any fragments and sharp areas.  I wish I could tell you if it could continue, but if it was done properly no additional fragments should have come out.  I think the only two ways to determine if additional fragments are there is either surgically opening the area and or doing a CT and or MRI of the area.  If your surgeon is unable to cure it or come up with a reason for the continuing problem, you will need a different surgeon.  Sometimes bone degeneration can occur from bacteria.  Are you taking a medication to prevent osteoporosis?  I ask, because that can occasionally produce what you are experiencing.  

So first of all, are you taking anything to maintain bone density.  Many women take this type of medication.  If so, the surgeon needs to know this and other treatments might be necessary.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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