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Oral Surgery/Extraction, bone graft, and pain

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Question
Hi Dr. Teig,
I was reading a question and your answers from another user and it sounds all too familiar to me.  I had a tooth extraction with a bone graft 15 days ago.  The pain has never subsided.  I have been taking 600 mg ibuprophen and 750 mg Tylenol at four to five hour intervals and the pain starts returning after about 3 to 4 hours.  I have talked with the dentist several times and have gone in twice and each time he has assured me that things look fine.  He has taken X-rays twice and both times said they look good.  He placed an implant at the same time of the tooth extraction and bone graft.  It was a brutal extraction.  I honestly thought he was going to break my jaw he was digging so hard and leaning his whole body weight into it.  It was a horrible and frightening experience for me and I am not a wimp.  After the first few days of the pain and swelling not decreasing, I called him and he put me on a Z pack thinking I may have an infection.  I took all as instructed and it did not make any diffence in the pain.  After one week he removed one of the stitches and said it looked good.  He left the "membrane" in and had me come back a week later.  My gums started swelling around the stitches and he told me to continue to use the periogard twice daily.  Which I have done.  he said I will probably feel better when the other stitches are removed and the membrane pulled out.  Yesterday was the day he took out the last stitches and removed the membrane. I really thought it would be such a relief to have that huge membrane out of my jaw, but today the pain is even worse and it looks awful.  It is so swollen and red and the pain radiates high up into the roof of my mouth and all sides of the extraction site.  I do not trust this dentist anymore.  I do not know why I am not healing and still in such pain.  Can this be just a normal process of healing after such a deep extraction and bone graft? It is my upper tooth #13.
Thank you for your help!

Answer
Sharon -  I am so sorry to hear about your experience with a doctor who never admits to a problem created by him.  From what you are describing, it sounds like you have developed a condition called a dry socket.  This condition can occur with anyone, but when there is excess pressure and trauma to the extraction site, like you describe, it more frequently occurs.  

Of course, without a direct examination it is a little difficult for me to be sure, but if the antibiotic treatment along with rinsing has not affected the problem, it probably indicates that a dry socket condition exists.  Besides the pain, a couple of other symptoms also help define the problem.  Bad breath and a funny taste in your mouth can also indicate a dry socket.  

If this dentist does not know what is occurring and how to properly address the situation, you should seek a second opinion from a board certified oral and maxillofacial surgeon.  If for some reason you are not familiar with a surgeon, you can get back to me, tell me where you live and I can send you names of appropriate surgeons near you.

I really wish you well and hope you feel better soon.  As a suggestion, you should begin a regimen, until the surgeon examines you, of warm salt water rinses.  Warm salt water, besides cleaning the area, increases the flow of blood into the area to help promote healing.  You should rinse for 1-2 minutes, 4-5 times a day.

Oral Surgery

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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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