Wife Had Infected Tooth Removed and Socket Grafting Same Day. Its Been 4 Days and Shes Still in Severe Pain?

It is normal to have pain/ swelling after this procedure. Most of this should subside after 4 days. However, this is something that is patient dependant , based on pain tolerance   Some patients take pain meds for only a day. Some need to take for longer. It also depends on extent of surgery, amount of bone graft/ bone loss. 

Antibiotics are standard for grafting procedures. If the tooth is already infected, antibiotics usually are prescribed 3 days before. Atleast 1 hour prior to procedure to reduce risk of infection. 

In this case, you should return to the dentist, if the graft is infected, it might have to be removed to prevent further problems in the site. 

Good luck 

I do feel antibiotics make sense in this case if not cleared up in another few days see your dentist asap sometimes the graft will need to be removed to clear up the infection good luck

 

Kevin Coughlin DMD, MBA, MAGD     CEO Baystate Dental PC

When dealing with a difficult and traumatic extraction the chances of dry socket are increased. It is still best she recieve antibiotics. The continued pain may be related to either nerve damage or that the infection is still present. The best thing to do if the pain is due to infection is to have the graft removed. The area needs to be cleaned and dress the wound (without sutures). Once everything is healed replace the graft.

She should return to the dentist immediately for re-evaluation.  There are some questions to ask... was all of the infection removed with the dental extraction?  Was your wife on antibiotics prior to procedure?  Is there another tooth in the area that could be the source of pain?  Was a barrier membrane placed over bone graft?  If stitches were placed, are they placed in mobile tissue?  If placed in mobile tissue the sutures can sometimes cause pain.  Does Ibuprophen help?  If so, the source of the pain is inflammatory... meaning there may still be a source of infection in the extraction site or another tooth.

Hank D. Michael - Dentist, Sarasota FL
 

From your comments it sounds like the dentist should have given your wife antibiotics right away. The tooth could have been extracted right away, but many times it is better to wait 2-3 days before taking it out. This will help to reduce the infection and make the local anesthetic more effective. Also, it sounds like it was a difficult extraction and she was already in pain from the infection. No question that I would have perscribed antibiotics. Alternative medicine like Ozone therapy is not proven in random/independent studies.

Pieces of bone or tooth can sometimes be inadvertently left which can cause pain, however after a difficult surgical extraction, the doctor must debride and irrigate copiously to prevent this.

My question is: why was grafting done? If there is a significant amount of infection, it should not be grafted. The area can be grafted after healing. Also, if there no plan to replace this tooth with a dental implant, then grafting is not indicated and will not cause any harm to skip it. The only reason to do it is to charge more.

My recommendation is that you find a more traditional dentist. Ask the oral surgeon for a recommendation to a good general/restorative dentist. Ask him/ her who they go to.

Good luck

Dr. T

That's good that you made it to the oral surgeon and had him take a second look at the area.  If she hasn't been having any numbness associated with her jaw, then I would not be concerned about the "nerve damage."  I hope she continues to improve and doesn't have to go through this again.  Make sure to continue seeing a dentist on a regular basis so he can identify any potential problems and treat them before it gets to this point again.

For an extraction and socket graft there is usually not a significant amount of discomfort.  If there is pain it is usually mild to moderate and last from 1-3 days.  Without a radiograph it is difficult to say what the issue is.  I am also curious about the use of hte term "nerve damage" in this context.  If there was a nerve in the proximity to the tooth maybe a specialist should have been involved in the case.  If there is graft material near or on a nerve this needs to be addressed.  There is limited information so I would see your dentist and if he does not have the answer, ask to be sent to a board certified Oral & Maxillofacial Surgeon for a consultation.  She should be getting better by now

Your wife may have developed a "dry socket", in which the blood clot in the socket was lost, and there is now exposed bone in the socket, which can be quite painful.  Have her dentist apply some medication into the socket.