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Oral Surgery/infection after wisdom tooth extraction

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Hello,

3 weeks ago, I had my lower right wisdom tooth surgically extracted. It was done at a dental school and took about 2 hours to get out due to the size and hook of the tooth root. The pain went away within a couple of days, but the swelling did not. It hurt to open my mouth for a while and then about a week in I noticed the swelling was still there. I contacted my student dentist who said this was normal after such a "rough surgery".

This week, the swelling was still there (my cheek was still puffy), I was having some random on-and-off again shooting pains through my jaw and up to my ear, and I had noticed a bump about 1/2" in size over the back of the wound. I called my student dentist who told me to go to the urgent care center at the school. I went in and a member of the faculty looked at it and said I had a fistula and an abscess. He poked the fistula with an instrument and pus and blood poured out. It tasted awful and he sent me down to oral surgery to have the wound reopened and cleaned out.

When I got to oral surgery, they took a panoramic x-ray to look for bone shards or food. They said they did see something but it looked like bone shards that would come out on their own. Then they wrote me a prescription for amoxicillin and peridex, and told me to come back in a week for a follow-up. At that time they would determine whether or not I needed another surgery to have the wound re-opened and cleaned out. I feel like none of this is normal and it doesn't make any sense to me and is causing me quite a bit of anxiety.

I just had a few questions that I feel they didn't explain to me:

First- I'm terrified that this is dangerous and I am going to die. I am an extremely anxious person and I've had 6 root canals and a few other tooth extractions and never before have I had this problem. I do smoke, but I did not smoke for 5 days following the extraction.

When the Faculty Dentist poked the wound and pus came out, is that going to kill me since I'm sure I swallowed some?  What is a fistula and will it always be there? I have been on the antibiotics for a day now (3 doses).

Is this normal? I feel like they aren't communicating with me and see me as a pest when I ask them questions and I am scared. Should the amoxicillin not clear up the infection, the Faculty Oral Surgeon said they'd have to "reopen" the wound and clean it. What does that mean? He told me they'd put me under IV sedation this time, though when the tooth came out I just had novicane. Is this dangerous?

Lastly, I am brushing 3x per day, taking the antibiotics religiously and rinsing with Peridex twice per day (morning and night). The Oral Surgeon did not mention whether or not I should be doing anything to the abscess or for it, and he also did not tell me whether or not I am allowed to smoke or if that is going to make the infection worse (realistically- I KNOW it's bad to smoke but I am EXTREMELY panicked right now!)

Please help! Thank you so much.

Answer
Dear Kathleen, Thank you for your question. 1) You are not going to die because of this. Even if you swallowed some puss and some bacteria, the acid in your stomach will kill everything. So no need to worry about that. 2) It sounds very normal what is going on. 3) A fistula is...When you have an infection at the base of the tooth the bacteria grow and multiply, your body will start to fight the bacteria and try to kill the bacteria. When your body is successful at killing the bacteria, the byproduct of that is puss. The puss will begin to build up and get bigger and bigger. As this happens it need to go somewhere in the tissue or bone. It will usually follow the path of least resistance. That path usually will go to the gums and create a hole in the gums or a tract from the infection into the mouth through the gums. That tract is called a fistula. The newer term is a stoma. 4)The reason they want to wait is because your body is very good at repairing itself and your body will most likely take care of the problem. If it does, it will spare you another surgery. The best thing to do is give it time. Do not put any heat on the area, that will make it worse!  Since the tooth is out there is no more source for the infection and the antibiotics will help clear it up. Smoking will restrict blood flow to the area and delay healing. Its not just a local issue its a systemic one. Every cigarette will restrict blood flow to the healing area for about 6 hours. I hope I have answered all your questions and if not please ask again and I will address them. I hope that helps.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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