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Oral Surgery/infection/bone graft

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Hi,

I had incredible pain suddenly, in my rear lower molar (#19 I believe)  tooth about 1 month ago and went to an endodontist, that was over 1 1/2 hour away (had used him before and he was great so didn't mind going the distance).   In addition to the pain, I had numbness in my chin and lip.  The endodontist  said my tooth was abscessing.  He took an X-ray and did a ct scan to be sure the bone was not infected.  He cleaned it out, and left it open so the abscess could drain, and told me to rinse it out after meals with warm saltwater also put me on Amoxicillen.

I went back to him a week later, and the tooth looked better, but I still had some numbness in my chin.  He cleaned it out again, and he said he wanted to give it one more week, so I continued to wash it out after I ate, and also continued on the Amoxicillen,

I went back to him one week later (this was the third week) and my chin and lip were fine, and I didn't have any real significant pain.  So, he then temporarily pack the tooth and closed it up.  I made an appointment to have it sealed two week later.

Within a few days of the tooth being temporarily closed, I began having pain again.  I called him and he put me back on the Amoxicillen.  A few more days went by and then I woke up in the night and felt like my tooth was on fire.   I contacted him, and it took him two days to get back to me.   He then put me on Clyndamycin since the amoxicillen didn't seem to be working, and suggested I come in.

At this point, I was feeling like a root canal was not going to be able to resolve my issue, and that I was going to need the tooth pulled, and I didn't feel the need to travel such a distance to the endodontist to be told this.  I was having horrible jaw pain both where the tooth was, and near the hinge of my jaw, and also my ear on the same side was painful.  My chin was beginning to go numb again I went to a dental clinic who was local, and they took an X-ray and said there was bone loss around the tooth and there was infection in the bone.  The next day, I went to an oral surgeon from the same group, and he said the tooth needed to come out.  He was very matter of fact about it, and I was in an incredible amount of pain, so I had him pull it.

I did ask him about doing a bone graft, as I will want an implant, and he said that was the least of my worries, and that I needed to get rid of the infection.

So my question is---if I have bone loss around the molar to to an infection in the bone, and then had it removed, at what point would I want to get the bone graft done?   I have read about how you can lose bone in your jaw and have your jaw look like it's misshapen, among other things
Thank  you,
Diane

Answer
Diane - Yours is a very good question.  This situation is often ignored by dentists whose major goal is not the health of the tooth and the patient. but to both get the situation over with and to make some money.  I know that sounds rather weird, but it is imperative, before any graft is placed that all infection is eradicated.  The surgeon did the correct thing to extract the tooth and not do a graft at the same time.  The graft in that situation acts as a medium where bacteria will grow.  It is important to wait until all infection in the socket and surrounding bone is gone.  Antibiotics should be continued for at least another few weeks along with warm salt water rinses to increase the blood flow and promote a healing.  It is important to allow complete healing of the bone.  It should be a minimum of four months after the extraction to be sure.  At that stage a dental implant, bone graft or both can be done to restore the area.  

Bone loss can reshape the jaw, but an infection of that individual tooth will not greatly change the jaw.  It is best to wait and then address the loss.  If you have any additional questions, feel free to contact me again.

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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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