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Oral Surgery/post extraction pain


QUESTION: My wife had a pre molar extracted about a month ago (after extensive root canals and testing to determine where the pain was coming from). Following the procedure of ice warm salt water rinses, and hot towels to the face (4 days after) and some pills for pain and sleeping in an elevated position for 2 weeks, all was starting to be normal. Then last week this sharp, piercing pain returned in the same place of extraction. Now back to elevated sleeping position, some OTC pain meds, and having to chew on the opposite side and careful of what she can chew. She was told that some people take longer to heal and the 'gap' to heal over. This pain can be very painful, sometimes a dull beating pain and comes and goes at will. Is this something she will have to live with? I read that this could be caused by something called "TN"? We have already been the route of referred pain from another tooth on that side and that was corrected. Tired of her in pain and follow ups not really helping a lot. Where to now?

ANSWER: Bob -  I am so sorry to hear that your wife is suffering.  I, of course, cannot tell you exactly what is occurring without examining her, but I am going to ask you some questions and please get back to me and answer the questions and I might be able to give you directions to help her.

Is her pain a throbbing or just a severe ache?  Does she have a sore throat?  Is it and upper or lower premolar?  Does she have bad breath?  Does she have a bad taste in her mouth?  Does she have pain down the neck, in the ear, in the temple region?  Is it sore when she swallows?

I know these are a lot to answer, but it should define what is occurring.  So get back to me as soon as possible and I will try to come up with an answer soon.

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QUESTION: Is her pain a throbbing or just a severe ache?  
Usually a combination of both, but there are times when the pain is like a very sharp 'jabbing' pain from the extraction site.
Does she have a sore throat?
Is it and upper or lower premolar?  
Lower on her left side.
Does she have bad breath?
Does she have a bad taste in her mouth?
Not really, just a scummy taste one and a while.
Does she have pain down the neck, in the ear, in the temple region?
Just in and around that left side of her face up to temple region.
Is it sore when she swallows?
Let me add that she has had quite a bit of root canals and crown work done over the years and the tooth in front has a post in it and the tooth behind the extraction has had root work and a crown.

ANSWER: Bob -  Of course you know that I can't be sure without examining her, but it sounds like she is suffering for an inflamed healing process, called a dry socket.  This problem can best be resolved is she sees and oral and maxillofacial surgeon to place special mediation in the socket, if it is a dry socket.  

The best thing is to have her examined by an oral and maxillofacial surgeon to properly diagnose and treat this problem.  I wish her well and hope she can feel better soon.

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QUESTION: Tooth was removed by an oral surgeon and there was mention of dry socket, so a wad of numbing medication was placed in the 'site' and helped for a while. She was told to keep rinsing gently with warm salt water after eating. This helped and all ok for about a month. How long does this dry socket last? Going back for follow up first of the week and see what materializes. This oral surgeon is supposed to be one of the best here in Melbourne, fl.

bob - I'm glad that your wife is seeing the surgeon soon.  A recurrence of pain, like your wife is experiencing, usually means that some type of active process is ongoing.  If it is not a dry socket, then the surgeon will have to completely evaluate the area to discover the cause of her pain.  That might be additional xrays.

I hope the doctor discovers the cause.  I would be interested in the result.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired


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.


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

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

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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