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Expectations and Aftercare of Dental Extraction and Bone Graft

3/11/2017

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Individuals with any form of arthritis, arthritis-related inflammatory disorders (Fibromyalgia for instance), or autoimmune disorders are at HIGH risk of developing many diseases of the oral cavity including, but not limited to:

Developing periodontal disease more than twice as likely as others

​Developing severe jawbone loss  moderate to severe

​Extractions  averaged 12 missing teeth in studies


Researchers at the University of Maryland Medical Center published findings linking periodontal disease to autoimmunity in October 2010. This evidence of autoimmunity explains why regular flossing helps prevent periodontal problems, and it also explains why some people are affected by periodontal disease more than other people. This theory can also be linked to the fact that the risk of both periodontal disease and autoimmune disorders increase with age.

“In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.”

If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you 
sleep through the procedure.

Once the tooth
, a few things can happen.  First of all, it’s important to understand that your jaw bone is what holds your teeth in place.  The roots of your teeth are surrounded by bone and attached by some other anatomical structures. If you are missing a tooth, you definitely want to replace it with something, usually a dental implant or a bridge. Once a tooth is removed, the bone doesn’t have anything to support anymore. 

Over time, it begins to slowly erode until it creates a hollow or a basin shaped divot in the jaw bone.  If you try to place a bridge or a 
dental implant in a spot where the natural bone and gum tissue level is much lower than the surrounding areas, it’s going to look kind of funny.  A tooth in an area where the bone level is very low is going to make you look really “long in the tooth”. 

​Ideally, your dentist or oral surgeon will remove the damaged tooth and preserve the bone in the area using a simple bone grafting procedure.  In this procedure, demineralized, sterile human bone granules, (which look like coarse sand), are packed into the tooth socket immediately after tooth extraction.  The granules are covered with a protective collagen membrane and a couple stitches are used to close the tooth socket.  This procedure is simple and usually does not add to your recovery time.  Over the next several weeks, your own bone will fill the tooth socket and preserve the bone height long enough for you to have the area restored.  If you replace the missing tooth with a dental implant, the bone level will remain indefinitely.  If you replace the missing tooth with a bridge, you will lose some of the bone level over time.

A temporary bridge may be added so that you may chew as normal after the procedure.  

Congratulations! You made it through the worst of it.  But, as you know healing can be slow and frustrating for those afflicted with Fibromyalgia.
You can expect to have some discomfort when the anesthetic wears off. It is suggested that you take a pain pill before the anesthetic wears off so that the transition will be smooth. You may want to take your usual pain medication after the procedure even begins.  Many doctors suggest taking some form of anti inflammatory perscription BEFORE your procedure to reduce swelling and pain.  Check with your dentist first, of course.  If you pain medication contains codeine, wash it down with a dairy product to sooth your stomach.

Some oozing of blood from the surgical site is normal during the first twenty-four hours; so do not be alarmed if you notice pink streaks in your saliva. If the flow increase and your mouth is filling up with red blood, try to locate the area that it is coming from. Sit quietly, make a new roll of gauze and place it gently over the surgical wound if you did not have a temporary bridge in place. Bite firmly but gently for at least two hours and call your dentist.

You may experience some swelling of the face or jaw around the surgical area. It may start during the first day or two, last a few days then begin to subside. This is a normal defense mechanism and is no cause for alarm. You may place ice packs near the region.

If you were prescribed an antibiotic, take it conscientiously as directed until all pills are gone. By stopping in the middle, you can actually do more harm than good.

You may notice a funny, fowl taste coming from the extraction area immediately and days after surgery. Don’t be concerned with brushing or flossing during the day of surgery. After that, it is fine to resume your normal routine. Be gentle but thorough and be careful of the wound where it approaches your natural teeth.

After the first twenty-four hours, it is important for all patients to begin gently rinsing warm salt water several times a day, especially after meals. Mix 1/2 teaspoon of salt in a glass of warm water. Do not SWISH, let the mixture gently "roll" around your mouth and the affected area.  You might eventually be given a prescription for an antimicrobial mouthwash to use as healing progresses.

The importance of a nutritious diet cannot be overemphasized, especially during this initial healing period when your body is stressed. If you consume good liquid or soft foods, you will feel better, remain more comfortable and heal faster. A liquid or blender diet is best for the first meal or two after surgery. You may also include soups, milkshakes, sport shakes, Instant Breakfast, and blender concoctions.

Around DAY FIVE you may resume Oil Pulling.  Be careful that you are not SWISHING too rigorously. Coconut oil kills bacteria and viruses that may be trying to inhabit that compromised area.  Once in the morning an late afternoons should bring on faster healing.

At night, before bed, once you drink your nightly chamomile tea, gently press a bit of excess moisture out of the tea bag, and place it on the outside and inside of the dental area that is swelling.  Leave it on each area for approximately five minutes  This reduces swelling and infection.

Plan to take time off work.  Do not expect to have a tooth pulled on Friday and return to work on Monday. Your body will send you for an intense loop.  I have personally found five days to be stretching it as fibromyalgia will be still sending intense pain signals around the affected area and throughout the body for at least a week.  Expect to feel compromised for at least two weeks before true healing can be felt.  

Most importantly, due to feelings of panic that suppress our natural ability to deal with the difficulties of life, have your dentist's phone number handy.  Be sure to explain you are a patient of fibromyalgia and thoroughly explain all your fears.  Usually a short phone call will alleviate some of the anxiety.  Be strong! This will pass eventually:)

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