Crazy amount of pain from wisdom tooth surgery but NOT dry socket
September 4, 2018 4:40 AM Subscribe
I had my left two wisdom teeth taken out last Tuesday afternoon. Ever since the local anaesthetic wore off I've been in a lot of pain around the wounds from the lower tooth, which was unerupted, took a lot of digging to get out, and turned out to be attached to a probable dentigerous cyst. A dentist examined my mouth on Friday and confirmed that the socket is fine and there's no infection, so it's just a question of healing. I'm dosing up on painkillers and trying not to freak out. I'd really love some reassurance that I'm fine and the pain will eventually go away.
Timeline of events:
Three weeks previously - I had the two left teeth taken out; it was far simpler and I just took OTC painkillers, rested up and was back to more or less normal within a week
Last Tuesday, 2pm - I had the remaining two teeth taken out. Local anaesthetic, no sedation. I seem to be rather difficult to anaesthetise as both times I had to be injected multiple times in order to be fully numbed. The surgeon had to be careful with the lower tooth as it was a bit close to a nerve and there was a slightly increased risk of post-operative facial numbness. There was some drilling and she had to force my jaw open so wide it made my ear hurt. I gather she didn't understand at first why it was taking so long to come out even after having been loosened a lot, but when it finally did come it turned out to be attached to a little cyst (which has been sent to histology but I gather is likely to be entirely benign). The cyst had been visible on imaging, but they didn't think it'd be so firmly attached to the tooth - the dentist and nurses were rather admiring.
I was warned that I might have more swelling this time and require slightly more pain relief but the feeling was that I'd be ok with ibuprofen and OTC co-codamol (which has 8mg of codeine)
Tuesday, 5pm - the anaesthetic was wearing off and I took the first dose of pain medication. As the anaesthetic faded out, it became super clear that the pain relief I'd taken had barely touched the pain I was in. Swearing and gasping, I called the dental hospital's out-of-hours on call surgeon, who told me to go to A&E. I then spent the whole evening in A&E, and ended by sobbing uncontrollably in an exam room because I was in so much pain and was so worn out and confused. They sent me home with a bunch of the stronger co-codamol that has 30mg of codeine, and some stronger ibuprofen.
Wednesday-Friday - I kept taking the meds they gave me, which worked okay although clearly not lasting the full 6 hours they were supposed to - I'd be in pain again after 4 hours, and was woken up early every morning by the pain as the meds wore off.
Friday - I was going to run out of meds over the weekend, and so I called the dentist to find out what to do. They had me in to take a look; the registrar who examined me said that it was all healing very well and wasn't infected. There wasn't even any food stuck in there, and she praised my salt water rinsing technique. She thought it would just be a couple of days before I felt better, so she gave me three more days' worth of meds
At the weekend - I kept taking the drugs, but rather than decreasing the pain if anything increased very slightly, in that I was getting even more breaking through before I had the next painkiller dose. I switched from taking ibuprofen to taking the naproxen I have for period pain, in the hope this would get me through the night. It helped a bit, but when I did wake I was still waking in a lot of pain.
Monday morning - I made an appointment with my GP for that morning, and called the dentist again. They asked if I thought I might have an infection (I said no as I don't have any of the signs) and if the pain was 'excruciating' (I said I wouldn't go that far, it was okay as long as I was medicated, the challenge was just maintaining that). They said it was 'normal to have pain for 5-7 days' and that I didn't need to come back in.
My GP prescribed some dihydrocodeine (she wanted to give me Tramadol but I can't have that as I'm on an SNRI) and signed me off work for the next week. She also confirmed that nothing seemed to indicate I have an infection.
I just feel exhausted. I've been in so much pain for a week now, and it's really worn me down. I have looked in my mouth and it's clear that the wounds are pretty deep - the stitches have mostly dissolved so it's just deep gashes and caverns in my cheek and gum, which are obviously filling in somewhat with that yellow-white stuff that is what your mouth does instead of scabs. I feel like I'm going crazy as every time I speak to the dentist or other medical professionals they tell me that, on the one hand, the pain I'm feeling is totally normal and expected, and on the other hand I will certainly start to feel better in a couple of days - but then a couple of days later they tell me the exact same thing. I am sure the dentist has me down as some kind of problem patient, but I am really anxious because I don't know how I'm supposed to be responding to this. I'd really love any kind of advice, especially from people who had this much postoperative pain, since it doesn't seem to be well documented as a possible outcome; most stuff I've read only talks about dry socket.
Timeline of events:
Three weeks previously - I had the two left teeth taken out; it was far simpler and I just took OTC painkillers, rested up and was back to more or less normal within a week
Last Tuesday, 2pm - I had the remaining two teeth taken out. Local anaesthetic, no sedation. I seem to be rather difficult to anaesthetise as both times I had to be injected multiple times in order to be fully numbed. The surgeon had to be careful with the lower tooth as it was a bit close to a nerve and there was a slightly increased risk of post-operative facial numbness. There was some drilling and she had to force my jaw open so wide it made my ear hurt. I gather she didn't understand at first why it was taking so long to come out even after having been loosened a lot, but when it finally did come it turned out to be attached to a little cyst (which has been sent to histology but I gather is likely to be entirely benign). The cyst had been visible on imaging, but they didn't think it'd be so firmly attached to the tooth - the dentist and nurses were rather admiring.
I was warned that I might have more swelling this time and require slightly more pain relief but the feeling was that I'd be ok with ibuprofen and OTC co-codamol (which has 8mg of codeine)
Tuesday, 5pm - the anaesthetic was wearing off and I took the first dose of pain medication. As the anaesthetic faded out, it became super clear that the pain relief I'd taken had barely touched the pain I was in. Swearing and gasping, I called the dental hospital's out-of-hours on call surgeon, who told me to go to A&E. I then spent the whole evening in A&E, and ended by sobbing uncontrollably in an exam room because I was in so much pain and was so worn out and confused. They sent me home with a bunch of the stronger co-codamol that has 30mg of codeine, and some stronger ibuprofen.
Wednesday-Friday - I kept taking the meds they gave me, which worked okay although clearly not lasting the full 6 hours they were supposed to - I'd be in pain again after 4 hours, and was woken up early every morning by the pain as the meds wore off.
Friday - I was going to run out of meds over the weekend, and so I called the dentist to find out what to do. They had me in to take a look; the registrar who examined me said that it was all healing very well and wasn't infected. There wasn't even any food stuck in there, and she praised my salt water rinsing technique. She thought it would just be a couple of days before I felt better, so she gave me three more days' worth of meds
At the weekend - I kept taking the drugs, but rather than decreasing the pain if anything increased very slightly, in that I was getting even more breaking through before I had the next painkiller dose. I switched from taking ibuprofen to taking the naproxen I have for period pain, in the hope this would get me through the night. It helped a bit, but when I did wake I was still waking in a lot of pain.
Monday morning - I made an appointment with my GP for that morning, and called the dentist again. They asked if I thought I might have an infection (I said no as I don't have any of the signs) and if the pain was 'excruciating' (I said I wouldn't go that far, it was okay as long as I was medicated, the challenge was just maintaining that). They said it was 'normal to have pain for 5-7 days' and that I didn't need to come back in.
My GP prescribed some dihydrocodeine (she wanted to give me Tramadol but I can't have that as I'm on an SNRI) and signed me off work for the next week. She also confirmed that nothing seemed to indicate I have an infection.
I just feel exhausted. I've been in so much pain for a week now, and it's really worn me down. I have looked in my mouth and it's clear that the wounds are pretty deep - the stitches have mostly dissolved so it's just deep gashes and caverns in my cheek and gum, which are obviously filling in somewhat with that yellow-white stuff that is what your mouth does instead of scabs. I feel like I'm going crazy as every time I speak to the dentist or other medical professionals they tell me that, on the one hand, the pain I'm feeling is totally normal and expected, and on the other hand I will certainly start to feel better in a couple of days - but then a couple of days later they tell me the exact same thing. I am sure the dentist has me down as some kind of problem patient, but I am really anxious because I don't know how I'm supposed to be responding to this. I'd really love any kind of advice, especially from people who had this much postoperative pain, since it doesn't seem to be well documented as a possible outcome; most stuff I've read only talks about dry socket.
Lifelong aphthous ulcer sufferer here.
It sounds to me like you have them where your teeth were removed. Takes roughly two weeks to clear up.
When it gets bad I find that eating more often helps. The triggered saliva production eases the pain a lot. Aspergum was a godsend when I used to get them on the underside of my tongue. Salt rinses provided some very temporary relief (about half an hour at best) but got really tiring and taste damn gross. I eased off toothpaste because it was too irritating but perversely found diet cola really soothing.
posted by srboisvert at 5:20 AM on September 4, 2018 [1 favorite]
It sounds to me like you have them where your teeth were removed. Takes roughly two weeks to clear up.
When it gets bad I find that eating more often helps. The triggered saliva production eases the pain a lot. Aspergum was a godsend when I used to get them on the underside of my tongue. Salt rinses provided some very temporary relief (about half an hour at best) but got really tiring and taste damn gross. I eased off toothpaste because it was too irritating but perversely found diet cola really soothing.
posted by srboisvert at 5:20 AM on September 4, 2018 [1 favorite]
This sounds a lot like what happened to me after having my wisdom teeth out. They came out on a Tuesday, on Friday afternoon (because I was scared of running out of pills over the weekend) I went back to the surgeon and he said, "You don't have dry socket, pain is normal after extraction, here's some more codeine." After a week of suffering and taking codeine around the clock (literally setting an alarm to take a pill every four hours, because by the four hour mark I was typically in so much pain I couldn't function), I finally went to a different oral surgeon and he said, very simply, "You have dry socket."
To this day I have no idea why the original surgeon missed it. He seemed very dismissive of the idea that I could possibly have dry socket so part of me wonders if he really took a good look when he "checked." In any case, after the second surgeon looked he put in a special kind of packing which lessened the pain significantly, and three days later when he removed the packing the pain was basically gone.
It sounds like you're dealing with the NHS, but can you at least get back in to see a dentist (even the same one) again? Post-extraction pain is normal for a few days but the pain should not be getting worse or requiring increasing doses of opiates. Just because they didn't see a problem the last time they looked doesn't mean they won't see anything this time.
posted by telegraph at 6:22 AM on September 4, 2018 [3 favorites]
To this day I have no idea why the original surgeon missed it. He seemed very dismissive of the idea that I could possibly have dry socket so part of me wonders if he really took a good look when he "checked." In any case, after the second surgeon looked he put in a special kind of packing which lessened the pain significantly, and three days later when he removed the packing the pain was basically gone.
It sounds like you're dealing with the NHS, but can you at least get back in to see a dentist (even the same one) again? Post-extraction pain is normal for a few days but the pain should not be getting worse or requiring increasing doses of opiates. Just because they didn't see a problem the last time they looked doesn't mean they won't see anything this time.
posted by telegraph at 6:22 AM on September 4, 2018 [3 favorites]
I was in a lot of pain after a really tough extraction too. It wasn't dry socket, but the trigenimal nerves in my jaw and face had become so inflamed that my whole head hurt so bad for like a week. It did eventually go away. Everything healed up fine in the end. Hang in there.
posted by elke_wood at 7:50 AM on September 4, 2018 [1 favorite]
posted by elke_wood at 7:50 AM on September 4, 2018 [1 favorite]
When this happened to me (and the oral surgeon finally conceded that something might be wrong after THREE WEEKS of debilitating pain), it was because my jaw had given off some tiny chips of bone, which led to "disorganized tissue" in the site where one of the teeth had been extracted. I had to have follow-up surgery, to scrape the bone chips off my jaw, and everything was fine after that. But I still vividly remember that feeling of exhaustion, and that feeling of not knowing whether or not my pain was normal. Yours sounds very much like mine, which was decisively not normal, despite my surgeon's best attempts to tell me it was.
In fact, everyone at his office consistently told me my pain was normal, even at the first follow-up appointment, a week after the extraction, when I said "pain is radiating through my face" while I was on opiates, ibuprofen, and tylenol. All they said was that nothing was infected and I didn't have dry socket. Which was accurate, but something was still very wrong! At the three week follow-up, I had to insist that something was very definitely wrong, though once they looked closely they could see the problem. A day after the follow-up surgery, I was fine.
posted by dizziest at 8:34 AM on September 4, 2018 [2 favorites]
In fact, everyone at his office consistently told me my pain was normal, even at the first follow-up appointment, a week after the extraction, when I said "pain is radiating through my face" while I was on opiates, ibuprofen, and tylenol. All they said was that nothing was infected and I didn't have dry socket. Which was accurate, but something was still very wrong! At the three week follow-up, I had to insist that something was very definitely wrong, though once they looked closely they could see the problem. A day after the follow-up surgery, I was fine.
posted by dizziest at 8:34 AM on September 4, 2018 [2 favorites]
One week of pain after the surgery pretty much tracks with my experience, but if you're still at this level of pain a few days from now I'd definitely go back to the surgeon for another follow-up.
posted by tobascodagama at 10:05 AM on September 4, 2018
posted by tobascodagama at 10:05 AM on September 4, 2018
Pain is very subjective, so your pain and tolerance thereof are unique to you. That being said, I think many people underestimate the amount of discomfort involved in taking a tooth- sized thing out of a jawbone. No one tooth is even like another, and post-op discomfort can absolutely be related to the amount of effort (and particularly pressure) it takes to achieve that aim.
The reason that dentists and oral surgeons wait out that 3 week or so period is that in the vast, vast majority of cases the normal process of forming the clot, having the clot resorb and be replaced by new tissue and the remodeling of the ridge that follows takes care of many of the minor things that cause discomfort. the process itself involves a lot of inflammation, and all of the anatomy adjacent to that complicated space is prone to discomfort just from that process, from one degree to another.
It's completely reasonable to have it seen a few days after the procedure if you suspect an infection or dry socket, but once those things have been ruled out the healing just has to progress to its completion. Going in and prematurely disrupting that process just prolongs the entire ordeal.
I'm not your dentist or surgeon, so I have no knowledge of the particulars of your case, but if you have come to trust your relationship with your docs and they are reassuring you that what you are experiencing is normal then it's likely best to wrap your head around trying to control the inflammation (with anti-inflammatories if you can take them). Extreme swelling or unusually high fever are the two exceptions.
Hope you feel better soon.
posted by OHenryPacey at 11:50 AM on September 4, 2018 [1 favorite]
The reason that dentists and oral surgeons wait out that 3 week or so period is that in the vast, vast majority of cases the normal process of forming the clot, having the clot resorb and be replaced by new tissue and the remodeling of the ridge that follows takes care of many of the minor things that cause discomfort. the process itself involves a lot of inflammation, and all of the anatomy adjacent to that complicated space is prone to discomfort just from that process, from one degree to another.
It's completely reasonable to have it seen a few days after the procedure if you suspect an infection or dry socket, but once those things have been ruled out the healing just has to progress to its completion. Going in and prematurely disrupting that process just prolongs the entire ordeal.
I'm not your dentist or surgeon, so I have no knowledge of the particulars of your case, but if you have come to trust your relationship with your docs and they are reassuring you that what you are experiencing is normal then it's likely best to wrap your head around trying to control the inflammation (with anti-inflammatories if you can take them). Extreme swelling or unusually high fever are the two exceptions.
Hope you feel better soon.
posted by OHenryPacey at 11:50 AM on September 4, 2018 [1 favorite]
I had similar pains post extraction and it was magically better with a dry socket dressing. What would be the harm in your dentist giving it a go?
posted by FungusCassetteBicker at 8:14 PM on September 4, 2018
posted by FungusCassetteBicker at 8:14 PM on September 4, 2018
I had all four of my wisdom teeth out at once and had dry socket in the lower two. It was VERY obvious to me which ones were affected, as it is obvious to you that one of your tooth removals is NOT like the others. I had been over-enthusiastic with the salt-water rinse and had removed the protective blood clots on the bottom two, exposing the wounds. The packing that they put in the wounds for dry socket is soaked in eugenol (clove oil), which is the secret ingredient that causes the pain relief. You can get eugenol over the counter if you want to try to put a few drops in the socket yourself to see if it helps. It is a natural antimicrobial and is safer than Orajel. If you take too much it just numbs your tongue while also somehow making everything taste like cloves and you drool a bit. Make sure you do not have an allergy to cloves before taking it.
posted by domo at 12:21 PM on September 5, 2018 [1 favorite]
posted by domo at 12:21 PM on September 5, 2018 [1 favorite]
This thread is closed to new comments.
posted by frumiousb at 4:48 AM on September 4, 2018