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Oral Surgery/Wisdom Tooth Extraction Infection


Hi Dr. Ryan,

I have read over your past answers/advice to others, however I do have questions of my own which is hard to research on the Internet so thank you for taking the time to hopefully provide advice.

I'm a healthy 16 year old, and got my wisdom teeth extracted 12 days ago due to X-rays showing that there was not enough space for my wisdom teeth, thus all four teeth were extracted.

Up until day 7, the swelling had almost disappeared and my gums were still slightly tender, but there were no pain or concerns.

On day 10, I observed puss coming out from the lower left extraction site however there was no pain or swelling in this area, but I still called my oral surgeon. Unfortunately my oral surgeon lives in a different city and only comes to the city I live in every few weeks, so I had to contact him though phoning him. We booked a post-op appointment, which is booked for 25 days after my surgery and he advised that I should be okay up until then.

On day 11 my lower right extraction site was slightly tender, which I then assumed was from possibly chewing on some food which may have slightly 'aggravated it'.

On day 12 (which is today) I noticed my right cheek begin to swell and that the incision on my lower right extraction site felt like an ulcer. Again I have contacted my oral surgeon again, who faxed through a prescription of combined amoxicillin 875g and clavulanic acid 125g, twice a day for 5 days. Obviously if I continue to have problems, I am to contact my oral surgeon.

Ultimately, my question is, could you please give me a slight insight as to what may be going on? Obviously not much information could be given without examining it, but just a slight indication on the various things that could be wrong would be great!

Thank you so much for your valuable time,

Trish, Thank you for your question. What you are describing sounds like the site might be infected. Obviously, if the swelling gets large you should seek emergency medical care ASAP. Swelling with pus draining is a sign of an infection. The problem with infections in this area is that if the swelling gets big enough, it is possible to block the airway making it difficult to breath. The fact that it is draining into the mouth is a very good. DO NOT PUT HEAT OF ANY KIND ON THE SWELLING. That will make it much worse and make it a life threatening problem. Start taking the antibiotics as directed by your surgeon and keep a very close eye on the size of the swelling. If you have any difficulty swallowing, difficulty breathing, or shortness of breath, seek emergency care. The antibiotics amy help keep it under control until you can see your surgeon. Remember, NO HEAT TO THE FACE...Stay away from warm showers also. Good Luck.

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


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


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

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.

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

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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