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Oral Surgery/oral bone graft

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QUESTION: I had all four wisdom teeth removed 2 months ago. My surgeon said I had a difficult surgery (woke up twice during surgery) and I had to have a bone graft done on lower left side. I ended up going back two times in which I was given more antibiotics and pain meds for an abscess and infection. I had went for a follow up and was cleared and thought I was doing fine and healed. A couple days ago my jaw started hurting and I thought I needed a bite guard. Then my surgery site started hurting. I decided to try flushing it out with the syringe like I have been doing to the other side where there was a gaping hole. There was a pocket and it  became filled with the mouthwash. I pressed it out the best I could but now I am in a lot of pain and it seems very swollen. Do you think my body is rejecting the horse bone that was used? Can my bone be infected? How would I tell? My gums do not seem red.

ANSWER: Bethany - I do not believe that any graft material should be placed if there is an existing infection or a previous infection in the area within 8 weeks of placing the graft.  I have seen too many grafts placed in that situation that fail or percolate a quiet infection.  If you are now in pain the surgeon needs to honestly evaluate the area.  There could definitely be a percolating infection that could be producing that pain.  You should not decide, but make an appointment and let the surgeon be objective and properly evaluate.  Hopefully the surgeon can evaluate the area objectively.  If you don't get an answer from the surgeon get a second opinion from a different board certified oral and maxillofacial surgeon.

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QUESTION: Thank you for the response. I am doing better today after lots of salt water flushes. I will try to see the surgeon tomorrow but with the wind chill at -35 I may wait another day. Pain and swelling are down.

I am almost positive they said I had an infection in one of my wisdom teeth but not sure if it was that one. I was on clindamycin for at least a couple weeks. But that was about 14 days after the surgery and was for the other side of my jaw. Had been fine since. They sent me home with amoxicillin after surgery.

So in your opinion, it shouldn't have been done with infection present? I will definitely get another opinion if this does not clear up after seeing my Doctor. Is it possible to lose my tooth, next to the graft, to infection? That tooth that was the whole reason to get the graft.

Answer
Bethany -  In my opinion bone grafts should never be placed if there is a pre-existing infection in the same location.  That is my opinion and the opinion of many surgeons who work with bones.  It the tooth adjacent to the graft was not previously involved there should be no problems with it, unless the infection had spread.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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 Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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