What to do if a fistula forms after tooth extraction?

• Wisdom tooth removed - how long will it hurt?
• what are the complications?
• How long does it take for gums to heal after wisdom tooth removal?

The article was written by a dental surgeon with more than 19 years of experience.

According to statistics, after the removal of a wisdom tooth, inflammation of the socket of the extracted tooth occurs in 25-30% of cases. For example, after the removal of any other groups of teeth, inflammation occurs only in 3-5% of cases. This is due: firstly, to the higher complexity of removing wisdom teeth, and secondly, to the fact that they are surrounded by a large amount of soft tissue.

The last circumstance is very important, because the presence of moving soft tissues in the area of ​​the extracted tooth socket often leads to the loss of the clot - its loss or even destruction. If the socket of the extracted tooth is not closed by a blood clot, inflammation will inevitably develop in it.

Gums after wisdom tooth removal (normal) –

When wisdom teeth are removed, stitches are almost always required. This is necessary because these teeth are located deep in the soft tissues and in this place the mucous membrane is very mobile. The absence of sutures in this situation can lead to prolapse of the clot and inflammation. But if the patient has a long jaw and there is enough space for the wisdom tooth, the socket will look traditional (Fig. 3).

To learn how the sockets of extracted teeth should normally heal, and how to speed up this process, read the article: “How long should gums take to heal?”

Why complications often occur after wisdom tooth removal -

It must be said that the severity of negative symptoms after wisdom tooth removal directly depends on the degree of traumatic removal. In turn, the incidence of trauma depends not only on the simple or complex position of the tooth in the jaw, but, first of all, on the qualifications of the dental surgeon.

For example, surgeons often spend 1-2 hours trying to remove a patient’s wisdom tooth with just forceps and an elevator - instead of immediately making an incision in the gum, drilling out some bone around the tooth and/or sawing the tooth crown into several parts (after that, removing each root by separately), and spending only 15-20 minutes on it.

Another main cause of complications after complex wisdom tooth removal is the use of a drill by the surgeon, the surgical tip of which is not water-cooled. As a result, a thermal burn of the bone occurs, followed by severe pain and the development of suppuration in the socket of the extracted tooth.

Important: thus, the main causes of inflammation and other complications are the mistakes and negligence of the dental surgeon during the removal process.
However, a lot also depends on the doctor’s prescriptions. Correct prescriptions dramatically reduce the risk of developing inflammation of the socket.

What to do after wisdom tooth removal to avoid complications -

What to do after wisdom tooth removal will depend on the complexity of the removal. If the removal was simple (that is, it was not accompanied by an incision in the gum and cutting out the bone), then standard recommendations after removal will be sufficient. If the removal was difficult or was carried out against the background of purulent inflammation, then the following must be added to these recommendations...

• Antihistamines - these drugs are also called antiallergic. Taking them will reduce the swelling of the soft tissues of the cheek after removal, which will certainly appear the next morning, and in addition, they enhance the effect of analgesics. It is best to take Suprastin. This is a very strong drug, but with a hypnotic effect. Therefore, we recommend taking it in the first 2-3 days after removal shortly before bedtime (once a day).

• 
  NSAID-based analgesics

  – it is best to use analgesics from the NSAID group (non-steroidal anti-inflammatory drugs), which have both analgesic and anti-inflammatory effects. These include products based on ibuprofen, ketoprofen, etc.
  It is best to start taking these medications before your anesthesia wears off. Read about the right choice of medications at the link above. It is best to use them for the first 3 days, then as needed.

• Antibiotics – after a complex extraction, or if the removal was carried out against the background of inflammation in the tooth, taking antibiotics is mandatory. Because After tooth extraction, a bone wound is formed, then antibiotics should be specific to bone tissue. At the moment, the most popular antibiotics among dental surgeons are several drugs.
  Firstly, Amoxiclav. The dosage for adults should contain 500 mg of amoxicillin and 125 mg of clavulanic acid. At this dosage, the drug is taken only 2 times a day. However, if you previously experienced diarrhea after taking antibiotics, then it is better to purchase another drug - Unidox-solutab in soluble tablets (taken 100 mg 2 times a day, 5 or 6 days).

  Very often, doctors also prescribe a drug from the Soviet past - Lincomycin capsules 0.25 (adult dosage - 2 capsules 3 times a day, for a total of 5-6 days). It is inexpensive, effective, but kills the entire intestinal microflora, causing you to suffer from dysbacteriosis later.

What can you do to speed up the healing process?

Only “sterile conditions” in the oral cavity will allow the wound to heal quickly, although this is a rather relative concept. There are both harmful and beneficial bacteria in the mouth. In addition, internal diseases can sometimes negatively affect the gum healing process:

• intestinal dysbiosis;
• pathological phenomena in the gastrointestinal tract, esophagus.

The main thing is to prevent the development of secondary infection of the hole, adhering to certain rules so that the wound heals and heals. So, you need to do the following:

• hold the gauze swab placed in the hole by the doctor more tightly in the first few hours after tooth extraction, squeezing with the jaws;
• stop smoking, drinking alcohol and hot solid foods for the first 2-3 days until the healing process and formation of new bone takes place;
• do not wash out blood clots, which create a kind of plug (protection) from the penetration of harmful bacteria and microorganisms;
• avoid accidental injury to the socket, i.e. it is better to chew food on the other, healthy side;
• stop playing sports, visiting saunas and overheating in the sun for 3-4 days;
• It is advisable not to sleep on the sore side of the jaw in the first days;
• rinse your mouth with herbal decoctions, although doctors do not recommend doing this to avoid washing out blood clots.

Often, out of ignorance and mistake, patients begin to vigorously rinse their mouths with various traumatic means at hand (soda, salt, hydrogen peroxide) so that the hole space heals faster, thereby aggravating the process and significantly delaying the healing time of the hole. All that happens is irritation, destruction and washing out of blood clots, and increased pain. All this may be a reason to return to the dentist and perform a secondary operation.

Of course, some adherents of traditional medicine try to minimize unpleasant symptoms using herbal infusions, decoctions and lotions. Dentists approve ointments and gels with anti-inflammatory and wound-healing effects so that the wound begins to heal faster.

The main thing is not to neglect the frequency and duration of home treatments. You can make gentle infusions and lightly rinse your mouth to remove food particles after each meal. Although in the first days it is extremely undesirable to do this. Such leaching can lead to the liquefaction of blood clots, a process of “gurgling” in the mouth.

You can use weak solutions of herbal decoctions (chamomile, sage) or Furacilin, Chlorhexidine, as pharmaceuticals. It is better to first consult a doctor and apply it carefully, without overdoing it, so that the healing of the hole occurs comfortably and gradually.

What are the complications after wisdom tooth removal?

When a wisdom tooth has been removed, what to do after removal will directly depend on the symptoms that you experience. It must be said that according to statistics, complications after wisdom tooth removal occur in almost every 4th patient. Most often, patients encounter the following symptoms indicating the development of complications:

• severe spontaneous pain,
• pain when cold or hot water gets on the wound,
• swelling of the soft tissues of the cheek,
• unpleasant odor from the socket of an extracted tooth,
• painful swallowing
• difficulty opening the mouth,
• temperature,
• bleeding,
• the appearance of a hematoma on the face.

Other symptoms

Painful sensations may appear even before tooth extraction. Often wisdom teeth themselves lead to other diseases. Among them:

• pericoronitis - inflammation around the tooth, which leads to the formation of a gum pocket;
• caries;
• movement of other teeth, which is accompanied by pain;
• cyst formation;
• compression of the branches of the trigeminal nerve.

It is because of such complications, which ultimately lead to painful tooth extraction, that other symptoms of inflammation appear. You need to take care of the issue of wisdom tooth removal in time, then you can prevent at least some of the complications.

We have already dealt with inflammation of the gums, which is called alveolitis. There are several other types of disease after such operations. The first of them is a cyst. This is a growth over the tooth that contains fluid inside. You need to consult a doctor whether to remove it or not. Because in different situations under the influence of various factors, it is necessary to make a decision individually for each patient.

Sometimes flux may appear - this is an inflammation of the periosteum. It appears in cases where the infection penetrates much deeper into the gums. To obtain a more accurate diagnosis, you need to take an x-ray, and the treatment regimen is again set individually depending on the area of ​​​​inflammation.

Symptoms such as an unpleasant odor from the wound, painful swallowing and difficulty opening the mouth are side effects of swelling or suppuration. In case of such manifestation of inflammation, you need to consult a doctor. Otherwise, you will not be able to cure it.

Many problems can be avoided by suturing the socket of an extracted tooth. If the doctor has not done this himself, you can ask him about it. Although this action does not always solve all problems.

To prevent the appearance of pain and the development of inflammatory processes, you can rinse your mouth with special antiseptics. But even in this case, you need to take a responsible approach to treatment. Overly frequent rinsing and excessive use of such medications can ultimately lead to the formation of a clot in the socket. And this, in turn, leads to a new round of inflammation.

Pain after wisdom tooth removal –

Having a wisdom tooth pulled out, how long will it hurt is the most common question patients ask. How much your gums hurt after wisdom tooth removal directly depends on the degree of traumatic removal. Normally, pain after wisdom tooth removal should not be very strong and, once it occurs, it should gradually only decrease. After a simple removal, the pain usually goes away completely in 1-2 days, and after a complex one, normally in no more than 3-5 days.

If you have a wisdom tooth pulled out and the pain immediately after removal is very strong and practically does not decrease in the first days, this indicates that the removal is excessively traumatic and the possible development of inflammation of the socket of the extracted tooth (alveolitis). Here you need to urgently go to the dentist for a second examination. In the worst case scenario, pain can last up to 3-4 weeks.

Symptoms of inflammation of the wisdom tooth socket - upon examination, you can see that the socket is empty, or it is filled with food debris and necrotic decay of a blood clot. Sometimes patients feel sharp/moving bone fragments with their tongue. There is always pain, there is always an unpleasant smell from the hole. The mucous membrane is swollen and red. Such symptoms are characteristic of a mild form.

However, in some cases, inflammation of the socket occurs with abundant formation of pus, swelling of the cheek, difficulty opening the mouth and painful swallowing. And it must also be said that if you experience pain when responding to cold or hot water, this clearly indicates the presence of an exposed area of ​​bone. In any case, only a dentist can help you.

Inflammation of the socket of an extracted wisdom tooth: video

Below you can see what inflammation of the sockets of removed wisdom teeth looks like in the video. Please note that in video 2, when you press on the gums in the area of ​​both removed wisdom teeth, thick pus comes out of the patient’s sockets.

Reasons for the development of alveolitis - if the patient rinses his mouth vigorously in the first days after extraction, this can lead to a blood clot falling out of the socket of the extracted tooth. This leads to inflammation in 100% of cases, because... the hole is immediately filled with food debris and microbes from the oral cavity. But in most cases, alveolitis still develops due to the fault of the doctor -

• traumatic removal,
• fragments or slightly movable bone fragments are left in the socket,
• when cutting out the bone, the doctor used a drill tip without water cooling, which led to overheating and necrosis of the bone,
• the doctor was too lazy to suture the mucous membrane above the hole (in some cases this can lead to exposure of a section of bone in the next few days),
• The doctor did not prescribe antibiotics after a complex extraction, or in the case when the tooth was removed due to inflammation.

Important: alveolitis is the most common complication after wisdom tooth removal. If the described symptoms occur, you should immediately run to the doctor and treat alveolitis. From experience I can say that when a doctor sutures a hole even after a simple removal, the number of cases of alveolitis development is almost zero. In addition, studies have shown that suturing the socket reduces the severity of pain after removal by 30-50%. Therefore, before removal, you should definitely ask the doctor to suture your hole, even if you have to pay extra for it (about 500 rubles for 2 stitches).

Stages of socket healing by day

• The bleeding that occurs after tooth extraction stops after a few minutes , and a blood clot is formed that protects the wound from the penetration of microbes. Under the clot, damaged tissue is being restored, so it is so important to maintain its integrity until the hole heals completely.
• Day 1 – the processes of epithelization (healing) of the wound surface begin.
• Day 3 - signs of epithelization become noticeable, healing begins from the edges of the wound and moves towards the center.
• Day 4 - granulation tissue begins to form - a type of connective tissue that is formed in the body only during wound healing by secondary intention, when there is a strong defect in the skin.
• Day 7 - granulation tissue replaces part of the blood clot, it remains only in the center of the hole. Osteoid (bone) beams begin to appear, indicating bone formation. At the same time, epithelial tissue grows significantly from the edges of the gums.
• 14th -18th day - epithelization of the wound is completely completed, its surface is tightened and heals completely. By this time, the hole is completely filled with granulation tissue, and osteoid tissue is actively developing.
• After a month, a significant part of the hole is filled with new bone tissue. By the end of the second, sometimes third month, this process is completely completed.
• 4th month - bone beams in the newly formed osteoid tissue calcify, it matures: it becomes spongy and does not differ from the rest of the bone. At the same time, the edges of the socket dissolve, the alveolar edge in the area of ​​the extracted tooth becomes thinner and lower than it was before surgery.

Swelling after wisdom tooth removal –

If you have a wisdom tooth removed and your cheek is swollen the next day, then in some cases this is normal.
Normally, after simple removal, swelling rarely develops, and most often it occurs in people with an abundance of subcutaneous fat on the face. Such swelling most often becomes noticeable only in the morning of the next day. Normally, after a complex removal, swelling gradually develops immediately and gradually increases, becoming maximum the next morning. Usually the swelling is stable over the next 1-2 days, after which it begins to slowly decrease. If, against the background of swelling, there is no increasing temperature or pain, but on the contrary, all symptoms slowly decrease, then everything is OK.

• When removing an upper wisdom tooth, swelling of the upper cheek may occur (even if the removal was simple). The appearance of edema in this case is due to the fact that the area where the upper wisdom teeth are located is very richly supplied with blood, and therefore swelling of the surrounding soft tissues occurs. If the removal of the upper wisdom tooth was difficult or was carried out against the background of inflammation, then the occurrence of edema is all the more not surprising.
• When removing lower wisdom teeth -

  
  swelling is natural if the removal was complicated (an incision was made, a bone was drilled, a tooth was sawed), or the tooth was removed due to inflammation. Swelling of the surrounding soft tissue near the removed lower wisdom tooth can lead to painful swallowing or difficulty opening the mouth.

When to sound the alarm - if swelling continues to increase over the next 1-2 days after removal, pain and temperature may also increase, pain when swallowing increases, and the mouth opens less and less - all these are unfavorable symptoms indicating suppuration. If you have at least one of the symptoms listed, you need to urgently run to the dentist.

Important: to ensure that swelling does not appear after wisdom tooth removal or is minimal, it is advisable to take antihistamines (Suprastin is best) for the first 2-3 days before going to bed - once a day before bed. Antihistamines have not only an antiallergic effect, but also a decongestant.

Temperature after wisdom tooth removal –

• If the tooth was removed NOT due to inflammation - if your wisdom tooth was removed, the temperature may well rise to 37.5 degrees, but only on the first evening.
  The body sometimes reacts to injury with just such a low-grade fever, even if the tooth was not removed due to inflammation. This is especially true if the removal was difficult. Normally, the next morning after removal, the temperature should disappear (24stoma.ru). When to sound the alarm: if the temperature does not subside the entire next day after extraction, and even more so continues to increase, then this indicates suppuration of the hole of the extracted tooth. All you need to do is run to the dentist.

• If the tooth was removed due to purulent inflammation, in this case the temperature may be higher than 37.5. But normally, from the next day the temperature should decrease progressively. If it persists and, even more so, increases (this indicates an increase in inflammation), you need to urgently go to the dentist.

What to do when the hole has healed?

After the hole has healed and filled with full bone tissue, it is necessary to take care of restoring the dentition. The absence of even one tooth can lead to displacement of the remaining teeth, changes in bite, diction, aesthetic problems, and resorption (atrophy) of bone tissue at the site of the extracted tooth. A tooth can be restored using implantation, when an artificial root is implanted into the bone and a crown is installed on it. This method of prosthetics is by far the most comfortable and effective for the patient.

If bone tissue atrophy has already occurred, bone tissue augmentation is performed before installing the implant. The procedure allows you to perform high-quality prosthetics and restore the functionality and aesthetics of your teeth.

Bleeding after wisdom tooth removal –

Usually, in the socket of an extracted tooth, blood clots instantly, but with increased pressure or injury to a large vessel, prolonged bleeding may occur. Bleeding after wisdom tooth removal is not a big deal if it occurs while still in the dentist’s chair. The doctor will then immediately suture the wound with suture material and/or place a hemostatic hemostatic sponge into the socket of the extracted tooth (Fig. 8).

However, very often bleeding after tooth extraction occurs after leaving the clinic. Experienced doctors, to be on the safe side (especially if a large tooth is removed and the patient has a history of hypertension), usually always put 1-2 sutures on the wound, just to prevent bleeding. In addition, suturing allows the wound to heal faster.

Bleeding after removal of the upper 8th tooth: video

More detailed information on the possibilities of stopping bleeding at home is in the article: → “How to quickly stop bleeding after tooth extraction”

Hematoma after wisdom tooth removal –

A hematoma appears due to the fact that a vessel in the soft tissues has been injured. There is no point in blaming the doctor for this, because... When administering anesthesia, the doctor does not see where the vessels pass in your soft tissues. The needle can injure such a vessel and after a few days the skin may appear blue. Gradually it will pass.

However, the formation of a hematoma may require additional measures. A hematoma often festeres after the removal of a wisdom tooth. In this case, already on this day or the next day after removal, the patient experiences swelling of the cheek, a feeling of fullness, pain, and a slight fever. Here you need to urgently consult a doctor, because... when the hematoma suppurates, an incision is required to release the pus.

We answer frequently asked questions from patients -

If you have a wisdom tooth removed: what to do after removal, what to rinse with, how quickly the hole will heal and when it will be possible to treat your teeth... We answer all questions separately.

How to rinse your mouth after wisdom tooth removal -

It is best to rinse your mouth after wisdom tooth removal with the antiseptic Chlorhexidine. This drug is sold in every pharmacy and costs only about 30 rubles per 100 ml bottle. Please note that you can only rinse your mouth slowly, because... Strong rinsing can cause a blood clot to fall out of the socket of the extracted tooth. The latter will lead to the development of inflammation.

How long does it take for gums to heal after wisdom tooth removal?

How long it takes for the gums to heal after wisdom tooth removal depends on the complexity of the removal. Typically, you must wait 1 week to begin treatment after wisdom tooth removal. But after a complex removal, the gums may take longer to heal (up to 10-14 days), which will depend on the degree of traumatic removal. If inflammation occurs in the hole, healing may take 20-30 days. We hope that our article on the topic: Wisdom tooth removal, how much it hurts, turned out to be useful to you!

Sources:

1. Higher prof. the author's education in dentistry, 2. Based on personal experience as a dental surgeon, 3. National Library of Medicine (USA), 4. “Pathology of wisdom teeth eruption” (Rudenko A.), 5. “Qualified removal of third molars” (Asanami WITH.).

How to protect yourself from complications

All your actions depend on the degree of complications and how acutely you feel the pain. In cases of surgical intervention, which is subsequently accompanied by purulent inflammation, doctors recommend following this plan:

1. Antihistamines are prescribed to combat allergic reactions. They help remove some of the swelling from the tissues near the cheek. In addition, they stimulate more active work of analgesics, which also have to be used. They take the drugs once a day in the evening.
2. Analgesics act as painkillers and have anti-inflammatory properties. This includes medications that contain ibuprofen, ketoprofen and others. You should consult your doctor in advance about their use. Because you can drink them only when really necessary.
3. Antibiotics should only be taken in severe cases of inflammation. For example, if the tooth was cut out during inflammatory processes. Then a bone wound is formed, the pain from which intensifies.

In any case, the doctor should monitor your well-being and prescribe you treatment after wisdom tooth removal. And all medications, dosages and the number of times you take medications must be discussed individually.

You cannot do the following after surgery:

• take a hot bath for at least two more days;
• sleep or just lie on the side of this tooth;
• overwork your body with physical activity;
• visit the sauna, steam bath or swimming pool for another week;
• touch the wound with your tongue or other objects;
• When applying sutures, you need to be careful with active facial expressions.

In addition, analgin is strictly prohibited during wound healing. Because it thins the blood, and subsequently you get bleeding and a greater likelihood of bruising.