I recently had a wonderful elderly female patient who was complaining of jaw pain status/post Third Molar (wisdom tooth) extraction in my office.
The previous day, I had extracted the fractured vital tooth. Beautifully removed with minimal effort and stitched up to perfection by me. Her Past Medical History was unremarkable. She was taking no medications of concern that should have alerted me to potentially a risky post operative recovery. I had no reason to believe there could be an issue with the post operative care of the area.
Dry socket is always a concern. Dry socket ( alveolar osteomyelitis) is a condition where the extraction site clot is dislodged and the underlying bone of the socket gets exposed to the harsh oral environment. This is a very painful situation such that the pain is unique and radiates thru your entire jaw, face and neck on the side of the tooth extraction. Although a rare occurence for my patients, clinical experience demonstrates a higher predisposition to dry socket in the lower third molar area than any other area in the mouth.
She was in pain. She was feeling drawn out and called me directly on my emergency contact. Timing was essential and aided in my diagnosis of the origin of post operative pain.
The patient stated that she was sore and feeling slightly febrile the very next day; I estimated, twenty-four hours since the surgical event.
“I need antibiotics to Knock Out the infection” , she stated with confidence. She continued on stating that she was ,”….. a bit febrile,,,,I’m running a bit higher than usual”.
I conceded and with a very slight reluctance, but obeyed to the wisdom of this implacable women. I prescribed the antibiotics because I respected the patient’s desires. I do believe that some patients can be their best and worst doctors. It’s definitely was possible she was in the early cascade of infection,,, most likely, not. She presented initially non infected. It was too early for in infection to be present so soon after the extraction. Typically, infection would start on the THIRD DAY after a surgical event.
I called her one day after the initiation of the antibiotic therapy and she stated, “I am feeling so much better now. Thank you. Do I need to finish the antibiotics?”
MY ANSWER WAS…EMPHATICALLY…….. YES!
My feeling was such that she was not truly infected, but instead feeling beat up from the extraction event (the message not the messenger). Post operative edema peaks 24-36 hours a surgical event; that’s when the post extraction pain was the worst.
Dental extractions are always traumatic. It involves, local anesthesia which initiates an Adrenaline rush through your system. In response to the needle shot in anticipation of the surgical event, corticosteroids get surged out from your adrenal glands to help cope and compensate for the traumatic event you are about to endure; this is the Flight or Fright response. This is a totally natural occurring biological response to an average dental visit (comparable to getting charged by a saber tooth tiger—-that’s a joke….). It’s Normal to feel zonked after seeing me for a denatl procedure. You will be tired the next day, especially after an extraction.
The patient’s febrile component was most likely associated with a slight dehydration effect that impacts body temperature in the slightest fashion. That’s why it’s important to drink your fluids. It’s on the post op instruction sheet..
Upon follow-up phone call, on the Second day after extraction, and one single dose of antibiotic, she reported to be just fine…Her next question was, “Do I need to finish my antibiotic?”
Yes, was my response the current theory states that :” Treating bacterial infections with an antibiotic kills those bacteria, but this may take a week or more to accomplish. If you stop treatment early, you have only killed the weaker of the bacteria, those bugs most readily wiped out by the antibiotic. The ones leftover are the tougher bacteria, which would have been killed if the treatment continued but now, in the absence of antibiotics, have room to multiply and pass their genetic-based resilience to their progeny. Next time around, the infection is that much tougher.” Finishing your antibiotic
However, the same article states the mindset of this theory is changing. Each situation of infection type needs to be addressed individually. The debate is duration time period of antibiotic consumption. An Excellent read. I suggest you read the details.
Dedicated To Regina.
Dr. Emilio & Associates, Always Accepts New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.
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