Dental implant pain - how long?
July 27, 2022 7:20 PM Subscribe
Last Thursday I had a lower right molar extracted and a dental implant post placed, apparently with some bone graft material (not taken from me) tucked in there to help it grab on. There was no infection in the tooth or bone at the time. Everything still hurts. A lot. What to do?
Please note: I can't take NSAIDs. I'm extremely prone to stomach ulcers due to previous stomach surgery and it's completely, utterly, forbidden. Please don't suggest I take any.
I'm going to call the oral surgeon tomorrow but I'd like some crowdsourced guidance so I know what to expect and some ideas I might suggest for handling the pain. Would love to hear thoughts from actual dentists or doctors who might have ideas, but also open to info from people who have been through this.
My oral surgeon knew I wouldn't be able to take nsaids, so he prescribed tylenol, a handful of oxycodone, and antibiotics. Oh, and a chlorhexidine(?) rinse twice a day.
I've followed all the instructions about what not to eat and what not to do.
I've now been taking the maximum allowable dose of tylenol every day for 6 days (30 ml of liquid acetaminophen (1000mg) every 6 hours). The tylenol helps a bit for 3 hours, and then I have to white-knuckle the last 3 hours before I can take the next dose.
I took all the antibiotics - finished them yesterday.
I've taken a few of the oxycodone here and there when I absolutely couldn't take the pain any more; taking just one doesn't touch the pain, but does make me nauseated, while taking two helps significantly but also knocks me out for a few hours. I only have 4 left of the 10 they gave me.
I've been using the rinse twice daily.
I have some stitches in, one of which sort of came floating out last night. I've also had some tiny bits of what appears to be either bone or tooth debris wash out when I'm doing the rinse or drinking things. Just a chip here or there, not a lot.
I went back to my dentist two days ago to have him look at a small bump that had come up at the site of the novocaine injection that was hurting a bit. I wanted to make sure it wasn't an abscess. He said everything was healing beautifully and asked about the pain. I said it was manageable - I was getting by, it was just a couple days out, I figured it would start to fade pretty quickly. He told me to keep taking the tylenol and oxycodone, and added, "It's a shame you can't take ibuprofen, it would knock that pain right out." THANKS DOC. And now, a few days later, it hasn't faded; it's actually about the same as it's been all along.
This is a deep throbbing ache. It's not sharp, but it is big. It feels like it's coming from all the bottom teeth on that side, but weirdly the upper teeth on that side also throb and ache. The tiny bump I went back to ask about also hurts quite a bit, considering how tiny it is.
Is this normal for an implant that's placed the same day as an extraction? Or does it sound like something might have gone wrong? If something is amiss, what might it be?
Is there anything *NOT an NSAID) that I could take instead of or in addition to the tylenol that might work better? I have to work tomorrow but then I'm off for 3 days, and if I have to take something that will knock me out, this is the time. The internet isn't very helpful on this; the only suggestion I've found that I might try is a saltwater rinse, but even that seems unlikely to help much with this kind of pain...
Please note: I can't take NSAIDs. I'm extremely prone to stomach ulcers due to previous stomach surgery and it's completely, utterly, forbidden. Please don't suggest I take any.
I'm going to call the oral surgeon tomorrow but I'd like some crowdsourced guidance so I know what to expect and some ideas I might suggest for handling the pain. Would love to hear thoughts from actual dentists or doctors who might have ideas, but also open to info from people who have been through this.
My oral surgeon knew I wouldn't be able to take nsaids, so he prescribed tylenol, a handful of oxycodone, and antibiotics. Oh, and a chlorhexidine(?) rinse twice a day.
I've followed all the instructions about what not to eat and what not to do.
I've now been taking the maximum allowable dose of tylenol every day for 6 days (30 ml of liquid acetaminophen (1000mg) every 6 hours). The tylenol helps a bit for 3 hours, and then I have to white-knuckle the last 3 hours before I can take the next dose.
I took all the antibiotics - finished them yesterday.
I've taken a few of the oxycodone here and there when I absolutely couldn't take the pain any more; taking just one doesn't touch the pain, but does make me nauseated, while taking two helps significantly but also knocks me out for a few hours. I only have 4 left of the 10 they gave me.
I've been using the rinse twice daily.
I have some stitches in, one of which sort of came floating out last night. I've also had some tiny bits of what appears to be either bone or tooth debris wash out when I'm doing the rinse or drinking things. Just a chip here or there, not a lot.
I went back to my dentist two days ago to have him look at a small bump that had come up at the site of the novocaine injection that was hurting a bit. I wanted to make sure it wasn't an abscess. He said everything was healing beautifully and asked about the pain. I said it was manageable - I was getting by, it was just a couple days out, I figured it would start to fade pretty quickly. He told me to keep taking the tylenol and oxycodone, and added, "It's a shame you can't take ibuprofen, it would knock that pain right out." THANKS DOC. And now, a few days later, it hasn't faded; it's actually about the same as it's been all along.
This is a deep throbbing ache. It's not sharp, but it is big. It feels like it's coming from all the bottom teeth on that side, but weirdly the upper teeth on that side also throb and ache. The tiny bump I went back to ask about also hurts quite a bit, considering how tiny it is.
Is this normal for an implant that's placed the same day as an extraction? Or does it sound like something might have gone wrong? If something is amiss, what might it be?
Is there anything *NOT an NSAID) that I could take instead of or in addition to the tylenol that might work better? I have to work tomorrow but then I'm off for 3 days, and if I have to take something that will knock me out, this is the time. The internet isn't very helpful on this; the only suggestion I've found that I might try is a saltwater rinse, but even that seems unlikely to help much with this kind of pain...
Response by poster: I won't threadsit (much) but I did want to say I have/am doing some icing. I just find that it only helps for as long as the ice is actually on my face.
I don't really have significant swelling - a little bit, around the gum, but not enough anyone can see it.
I have tried anbesol for the little novocaine-injection-site bump, and it helps a little bit, but only for a little while. I haven't applied it to the extraction/post site because it feels like the pain is deeper. But I'll definitely ask him if he thinks it would help tomorrow.
posted by invincible summer at 8:09 PM on July 27, 2022
I don't really have significant swelling - a little bit, around the gum, but not enough anyone can see it.
I have tried anbesol for the little novocaine-injection-site bump, and it helps a little bit, but only for a little while. I haven't applied it to the extraction/post site because it feels like the pain is deeper. But I'll definitely ask him if he thinks it would help tomorrow.
posted by invincible summer at 8:09 PM on July 27, 2022
Wow. I have had two implants (no bone grants). I had hydrocodone and needed it for only a few days. All this pain means you are way overdue for returning to your oral surgeon. I would even consider going to the emergency room to get medicine to help you over night. If nothing else, get OTC sleeping pills, and maybe they will help some.
posted by NotLost at 8:33 PM on July 27, 2022 [5 favorites]
posted by NotLost at 8:33 PM on July 27, 2022 [5 favorites]
Also, ice cream or milkshakes might help numb the area a little.
posted by NotLost at 8:35 PM on July 27, 2022 [1 favorite]
posted by NotLost at 8:35 PM on July 27, 2022 [1 favorite]
I am going through the implant process myself and have a few thoughts.
I'm not a dentist, so I don't know if it's normal, but from what my Oral Surgeon told me about the process, it's very surprising to me that they placed the implant post in the same procedure as the extraction. With mine, they extracted and packed with the bone graft, and stopped there. The protocol was three months for the bone graft to place / heal / whatever, and I recently went back and had the post placed. After another three months I go back to finish off with the final placement of the cap / crown. Here is a link from the Mayo Clinic that explains the reasons for the time between each of the procedures. Your surgeon may have their own way of doing things I suppose, but it definitely seems out of the ordinary and I would suggest asking them about it next time you see them.
As for pain management, I too can't take NSAIDs due to being on blood thinners. Tylenol mostly managed for me, but the pain worsened more or less daily in the week after the procedure. I had some leftover Oxy from a prior procedure and that did take the edge off a bit but like you I tried to limit it. I also had quite a bit more bleeding than normal folks, again due to blood thinners.
[squicky graphic description warning]
About a week after the procedure, I woke up with what I thought was a giant (like, nickel-sized) blood clot in my mouth, which was oddly squishy but looked like a solid mass of blood when I spit it out. This was a little worrying so I called and was able to get back in for a quick look that day. The surgeon said what I saw was likely the collagen sponge that they put in place to help the healing, and having it come out is expected and completely normal, and that everything was healing perfectly.
Oddly enough, my pain dropped to about 10% of prior levels over the course of that morning, and the surgeon suggested the sponge was irritating the area as it healed and having it come out relieved the pressure / stopped aggravating the nerves / whatever, which seemed to match the type of pain I was feeling. Pain was gone a day later. I've found that tooth / jaw pain seems to radiate into parts of the face that aren't where the work was done, so it's not surprising you are feeling pain in your upper jaw. Don't know if you got a collagen piece as part of your procedure but something to consider / ask.
Sorry I don't have any additional tricks for pain management for you, other than moral support and the anecdata above. It does get better!
posted by SquidLips at 8:42 PM on July 27, 2022 [7 favorites]
I'm not a dentist, so I don't know if it's normal, but from what my Oral Surgeon told me about the process, it's very surprising to me that they placed the implant post in the same procedure as the extraction. With mine, they extracted and packed with the bone graft, and stopped there. The protocol was three months for the bone graft to place / heal / whatever, and I recently went back and had the post placed. After another three months I go back to finish off with the final placement of the cap / crown. Here is a link from the Mayo Clinic that explains the reasons for the time between each of the procedures. Your surgeon may have their own way of doing things I suppose, but it definitely seems out of the ordinary and I would suggest asking them about it next time you see them.
As for pain management, I too can't take NSAIDs due to being on blood thinners. Tylenol mostly managed for me, but the pain worsened more or less daily in the week after the procedure. I had some leftover Oxy from a prior procedure and that did take the edge off a bit but like you I tried to limit it. I also had quite a bit more bleeding than normal folks, again due to blood thinners.
[squicky graphic description warning]
About a week after the procedure, I woke up with what I thought was a giant (like, nickel-sized) blood clot in my mouth, which was oddly squishy but looked like a solid mass of blood when I spit it out. This was a little worrying so I called and was able to get back in for a quick look that day. The surgeon said what I saw was likely the collagen sponge that they put in place to help the healing, and having it come out is expected and completely normal, and that everything was healing perfectly.
Oddly enough, my pain dropped to about 10% of prior levels over the course of that morning, and the surgeon suggested the sponge was irritating the area as it healed and having it come out relieved the pressure / stopped aggravating the nerves / whatever, which seemed to match the type of pain I was feeling. Pain was gone a day later. I've found that tooth / jaw pain seems to radiate into parts of the face that aren't where the work was done, so it's not surprising you are feeling pain in your upper jaw. Don't know if you got a collagen piece as part of your procedure but something to consider / ask.
Sorry I don't have any additional tricks for pain management for you, other than moral support and the anecdata above. It does get better!
posted by SquidLips at 8:42 PM on July 27, 2022 [7 favorites]
I’ve had two implants, one this year, but in both cases the extraction and implant were months apart, with time for the graft to take and everything to heal in between. I don't think it’s unheard of to do it in one visit, but it may be contributing to the soreness. But I found extraction of the molar (even when uncomplicated) vastly more painful and longer to recover from than the implant procedure, and your description of the pain is exactly how mine felt. Nothing was wrong, it healed fine, but it was a deep, throbbing ache that blotted out everything else, and only hydrocodone helped. All I could do was try to stretch out the meds and give it time. (I can take ibuprofen, but it did not touch that pain. I was very glad that even in today's climate my oral surgeon was willing to give me something stronger.)
I did have definite improvement over the course of the first week, but I wasn’t past the damn-that-hurts stage until the week was up. I hope you’re about to reach the turning point too.
posted by kite at 9:09 PM on July 27, 2022 [1 favorite]
I did have definite improvement over the course of the first week, but I wasn’t past the damn-that-hurts stage until the week was up. I hope you’re about to reach the turning point too.
posted by kite at 9:09 PM on July 27, 2022 [1 favorite]
Anecdata: When I had a molar extraction with a bone graft and stitches, I had a weeks-long period of deep, consistent pain that immediately resolved when the last of my stitches worked themselves out. I think the healing area was being irritated by them, similar to what SquidLips said above about the collagen plug. And similar to you, I visited my dentist out of concern after several days and he told me it was actually healing very well, so I was stuck just waiting for it to resolve on its own. Physical irritation is definitely a better problem to have than infection, but it was alarming how long the pain lasted!
posted by brookedel at 12:36 AM on July 28, 2022
posted by brookedel at 12:36 AM on July 28, 2022
"It's a shame you can't take ibuprofen, it would knock that pain right out."
Right but you could take Gabapentin and it would likely do the same.
posted by DarlingBri at 1:25 AM on July 28, 2022 [1 favorite]
Right but you could take Gabapentin and it would likely do the same.
posted by DarlingBri at 1:25 AM on July 28, 2022 [1 favorite]
I had 11 implants installed a few years ago, done at the same time as a full extraction (no bone grafts, but lots of stitches). The worst day of my life so far. The pain was pretty bad for a few days, but nothing Ibuprofin Forte couldn't knock back to a dull ache and I only needed that for three or four days. For those first few days, on-off application of ice packs helped a lot. After that it was more tender than painful, maybe a little sore now and again and I took ibuprofen occasionally if I had any pain for a couple of weeks, on the advice of my dentist who told me there's no need to put up with pain in that situation and to take ibuprofen early and often rather than toughing it out. I also took antibiotics for a couple of days before the procedure and about a week after.
If you're six days in, I would have thought you'd see at least some improvement in the pain, but I'm no expert. There is probably at least some swelling that you can't see and it only takes a little bit of swelling around teeth to cause pain to radiate out to other teeth in the area. Strange that you are feeling pain in the upper jaw as well and that suggests maybe you are clenching your jaw without realising it? That could explain the pain to some extent - it's something I used to do and it often resulted in pain in both jaws.
posted by dg at 3:30 AM on July 28, 2022 [1 favorite]
If you're six days in, I would have thought you'd see at least some improvement in the pain, but I'm no expert. There is probably at least some swelling that you can't see and it only takes a little bit of swelling around teeth to cause pain to radiate out to other teeth in the area. Strange that you are feeling pain in the upper jaw as well and that suggests maybe you are clenching your jaw without realising it? That could explain the pain to some extent - it's something I used to do and it often resulted in pain in both jaws.
posted by dg at 3:30 AM on July 28, 2022 [1 favorite]
Have you had failed root canals?
This all happened to me recently.
I had 2 implants and can't take ibuprofen. They were healing well and at my 2 week checkup looked perfect.
3 days after, I developed a raging infection and they had to be removed.
Go back to the surgeon now because you may need them removed asap.
Apparently, this is a known issue and it happens to people who have failed root canals, because there is sometimes bacteria living in the bone. When the deep drilling is done for the implant, it will reopen that bacteria, which takes some time to spread no matter how well your post op care was.
My oral surgeon removed the implants and apologized for not checking my dental history, because had he, he would have seen that I was getting implants in the area where 3 root canals had failed in the previous 6 years.
posted by yes I said yes I will Yes at 5:32 AM on July 28, 2022 [1 favorite]
This all happened to me recently.
I had 2 implants and can't take ibuprofen. They were healing well and at my 2 week checkup looked perfect.
3 days after, I developed a raging infection and they had to be removed.
Go back to the surgeon now because you may need them removed asap.
Apparently, this is a known issue and it happens to people who have failed root canals, because there is sometimes bacteria living in the bone. When the deep drilling is done for the implant, it will reopen that bacteria, which takes some time to spread no matter how well your post op care was.
My oral surgeon removed the implants and apologized for not checking my dental history, because had he, he would have seen that I was getting implants in the area where 3 root canals had failed in the previous 6 years.
posted by yes I said yes I will Yes at 5:32 AM on July 28, 2022 [1 favorite]
Return visit to your surgeon stat,
I had similar symptoms including emissions of graft material and swelling around implant site (albeit, mine was not same day removal and implant but many months in between). I would not have lasted six days with that aggravating pain and I’m similarly unable to take nsaids. Ultimately my implant pain settled down but unfortunately the implant failed. I’m not predicting this for you, but *now* is the time to get back to your surgeon. Mine was away and I saw a regular emergency dentist who didn’t get on top of things quickly and my surgeon was really upset with himself for having unavoidable demands so that I didn’t get to see him asap.
posted by honey-barbara at 6:25 AM on July 28, 2022 [2 favorites]
I had similar symptoms including emissions of graft material and swelling around implant site (albeit, mine was not same day removal and implant but many months in between). I would not have lasted six days with that aggravating pain and I’m similarly unable to take nsaids. Ultimately my implant pain settled down but unfortunately the implant failed. I’m not predicting this for you, but *now* is the time to get back to your surgeon. Mine was away and I saw a regular emergency dentist who didn’t get on top of things quickly and my surgeon was really upset with himself for having unavoidable demands so that I didn’t get to see him asap.
posted by honey-barbara at 6:25 AM on July 28, 2022 [2 favorites]
Response by poster: Thanks everyone! I did go back to the oral surgeon's office today, but they were really not very helpful. My actual surgeon was out of the office so I saw his partner, and he really seemed like he did not want to be bothered with any of this.
He checked everything, said there was no infection, but there was inflammation. He prescribed tramadol, but only enough to get me through till Saturday, when his partner will be back and apparently on call. I'm supposed to call the office then and talk to him.
Meanwhile I took a tramadol and it did nothing - even less than the tylenol has been doing. I'll try to get through until morning with ice and tylenol and oxycodone as I have been doing, and then tomorrow I'll call my GI surgeon and find out if there's any way I can survive taking ibuprofen just for a few days.
In short: Ugh.
posted by invincible summer at 4:53 PM on July 28, 2022
He checked everything, said there was no infection, but there was inflammation. He prescribed tramadol, but only enough to get me through till Saturday, when his partner will be back and apparently on call. I'm supposed to call the office then and talk to him.
Meanwhile I took a tramadol and it did nothing - even less than the tylenol has been doing. I'll try to get through until morning with ice and tylenol and oxycodone as I have been doing, and then tomorrow I'll call my GI surgeon and find out if there's any way I can survive taking ibuprofen just for a few days.
In short: Ugh.
posted by invincible summer at 4:53 PM on July 28, 2022
Response by poster: Just an update for anyone looking into this topic in the future ... almost a week later, still in pain, I've been taking the ibuprofen off and on just to knock things back a bit. Today I went back to the oral surgeon (the actual one who worked on me, not his partner) so he could see what was going on.
It turns out I'm rejecting the bone graft. Not the implant, which seems fine, but the actual graft material they put in. He's given me metronidazole to take 3 times a day for 7 days to be sure to knock out any infection (which there doesn't seem to be; this seems to be "just in case") and then we'll check in again. Depending on what we find then, I may need another bone graft.
So in short: Pain bad, rejection of graft material bad, but at least I know what's going on? So I can at least feel good about that.
posted by invincible summer at 4:03 PM on August 3, 2022 [3 favorites]
It turns out I'm rejecting the bone graft. Not the implant, which seems fine, but the actual graft material they put in. He's given me metronidazole to take 3 times a day for 7 days to be sure to knock out any infection (which there doesn't seem to be; this seems to be "just in case") and then we'll check in again. Depending on what we find then, I may need another bone graft.
So in short: Pain bad, rejection of graft material bad, but at least I know what's going on? So I can at least feel good about that.
posted by invincible summer at 4:03 PM on August 3, 2022 [3 favorites]
This thread is closed to new comments.
Benzocaine is the other thing I would try, either in Orajel/Anbesol or Chloraseptic (or store brands). Run that by the oral surgeon first, but when my wisdom teeth were bad, I did use sore throat spray sometimes. It is not good for long term use but it works for immediate problems.
posted by soelo at 7:52 PM on July 27, 2022 [1 favorite]