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Oral Surgery/Tooth Pain After Extraction and Bone Graft

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QUESTION: Dear Dr. Teig,

  Thank you for being available to us! I read a few of your (awesome) answers, and like "Millicent" (http://en.allexperts.com/q/Oral-Surgery-3405/2010/3/pain-extraction-week.htm), I am having bad luck with an extraction/bone graft.

  As of now, I have had three dry sockets at different times, one on an upper root canal extraction and two during removal of my molars (the one on the right side took 9 months to stop being 'dry socket'). #31, #32, #13. My (new) Dentist said it was highly unusual for a dry socket to be so severe and last so long. When both extractions were done, neither Dentist cleaned out the area prior or after the extraction. The new Dentist was the one who treated the nine month dry socket, which was fitted with bovine bone graft and nearly immediately (a few weeks) ceased hurting.

   Five days ago, I had to have another tooth removed, #16...and was immediately fitted with bovine bone graft after scraping, ozone water rinse and a relatively easy extraction (for me, he said it was one of his hardest, but it didn't require anything but the lightest of numbing nor any fishing around for pieces of broken tooth, which I was very grateful for). However, now I am now experiencing ear ache, jaw ache, tooth pain on the left side both upper and lower, and subtle hints of dry socket like I remember (though not as severe as first ones)...I'm hoping it's not just because my brain has stopped receiving/acknowledging pain signals! I can also see the [cow] bone, but it definitely is not as painful as the others I've had.

    I guess what I'd like to know is: 1. if bone grafts are not supposed to be immediately placed on an extraction? 2. Why would someone be so prone to dry socket, the clots seem to dissolve very quickly and without the usual treatment that creates them (like sucking, etc.). 3. What can I do now to lessen the pain (I'm using clove drops about every few hours) without taking meds?

     I'm 35, have a pretty healthy diet, was indeed very stressed a few days after extraction due to the money required for it and running out of heat in -5 degree temperatures at the same time...and a pretty large population of spirochetes living within my head/body.

     Any advice would be greatly appreciated! Thank you Dr. Teig!
Emily

ANSWER: Emily -There are a number of different possible causes for the pain and discomfort you are now suffering.
The roots of the upper molar that was extracted might have had its root into the sinus above the tooth.  If that opening is still present and the saliva from the mouth has access to the sinus, an inflammation or infection in the sinus is possible.  Another possible cause could be the extraction cause a small change in your bite.  That change could irritate the jaw muscles.  

A dry socket on the upper jaw is not common but possible.  My suggestion is to begin warm salt water rinses for about 1-3 minutes, 4-5 times a day.  If there is no improvement within 5-7 days, you should have yourself examined by an oral and maxillofacial surgeon or Ear Nose and Throat doctor.

I wish you well and hope you feel better soon.

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

Extraction Site
Extraction Site  

Front lower
Front lower  
QUESTION: Dear Dr. Teig,

  Thank you for your response! I am hoping it is just a bite issue, as it's been over 7 days since the extraction I'm now about to search for a maxillofacial surgeon...though I did just ask my current Dentist for a comprehensive exam to specifically rule out the bite issue. He did check for sinus holes/connection, and found nothing, found no dry socket, and the stitches came out without a hitch. I did the salt water rinses as you and my Dentist recommended, and once the site healed enough, began using my hydrofloss again. I have had TMJ, and it does feel similar minus the popping and clicking. Like you said, the muscles could be an issue because I constantly want to massage them...however, there's another pain that is within the gum itself/cheekbone that I cannot begin to relieve.

   The pain is a throbbing, sharp, pain that is worsened when the outside temperature is cold. Right now, it feels like there is a tooth there with a giant cavity...but the tooth is gone. The part that worries me is that the pain is encompassing my entire left side, both up and down. There may be a hint though...about a year ago, I was playing with my Dog and she accidentally scraped her claw on my gum, and it did make a little 'dent' in the gum line, which seemed to get inflamed at the time, but quickly healed. Since the extraction, the site area that was damaged has become very sensitive...so I'm wondering if these two things have created an infection together?

   I truly appreciate your input and am eager to solve this with any advice given! Thank you Dr. Teig

Answer
Emily -  I can't be sure what is actually occurring.  I wish you well and hope you can find a dentist near you to help you.  If your dentist cannot find the reason, I suggest that you might be better seeing 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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