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Oral Surgery/puffy feeling in gums 5 weeks after upper root canaled molar extraction

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QUESTION: Hello ! I had my #2 tooth ( right side upper molar ) which was root canaled 17 years ago, extracted 5 and 1/2 weeks ago.The extraction went well, I had on and off not too bad pain for 2 weeks after, when this gum puffiness started on the 11-th day after the extraction and it's still there. Was back to the OS at that time ( 2 weeks after ) he gave me clindamycin for just in case if there is an infection, but he said it's healing well. 3 weeks after the extraction ( the day after I finished taking the antibiotics which didn't changed anything )I saw my general dentist, who took an x ray,nothing wrong, she said it's healing well, maybe I'm just a slow healer. I had a sinus ct scan via my ENT dr. also nothing wrong.The gums don't look swollen, just feels that way. I would like to know, what's going on. Thanks ! Sue

ANSWER: Sue - a prolonged infection in the site of the implant placement usually indicates a few possible causes.  1) small fragments of the tooth might have been left at the extraction site; 2) food may have become trapped in the socket during the healing period or 3) there might be some bone fragments from the extraction left in the socket and is breaking down.  

I, of course, do not know what is the cause, but besides the antibiotics, the doctor should have advised you to do warm salt water rinses in the area of the infection.  Well now that is what you definitely need to do.  Rinse in the area of the extraction and hold the warm salt water there for about 3-5 minutes, 4-5 times a day.  The warm salt water will help to drain any infection and particles present in the socket.

So do the warm salt water rinses for a couple of weeks, and I think you will notice a difference in about 2 weeks.

If you have additional questions, feel free to contact me again.

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

QUESTION: I do the salt water rinse and everything is still the same. this pufiness never went away. sometimes it's better in the morning, but as the day goes on I can feel it more. And yesterday for the first time I bended down to pick up something from the floor and the pain returned. I had to take motrin.

Answer
Sue - With your history of doing the warm salt water rinses and the recurrent episodes of puffiness and pain, you need to be examined immediately.  The oral surgeon needs to be more aggressive is determining the cause and correcting the problem.  If the surgeon you see is not taking appropriate action, it would be important that you get a second opinion from a different oral and maxillofacial surgeon.  Make sure that the surgeon you see is board certified.  

I wish you well and hope your surgeon helps you, but if not, seek a second opinion from a board certified oral and maxillofacial surgeon.  

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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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