a question for a dentist

[redstorm]

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so the general dentist extracted my impacted wisdom tooth in about 10 minutes. he said he got it all. Im going back on tuesday to get it looked at again. day number 2 and the pain is not bad. I took one tylenol number 3 last night and two advils this morning and thats it.

I was on the phone incidentally with one of my endodontist friends and he tells me he may have left a root in there and this can grow a cyst and scares the **** out of me and he tells me get a follow up x ray and all that.

How common is like roots being left in the socket and all the other complications that come along with extracted wisdom teeth?

 

[DrRob]

👎 😕 How can your friend tell you the GP may have left a root up there over the phone? Post - op pain is NORMAL. If you only took 1 T3 and 400 mg of Ibuprofen then your pain is under control.

I'm curious as to why you think there is a root tip left and why you would believe someone over the phone over someone who actually did the procedure. 😱

 

[redstorm]

because i am a worry wart. thats what i do. i worry about stuff like that.

my friend tells me that if a root tip or something is left there it can be bad surgery later???? if a cyst forms or something


is this common or totally uncommon???

 

[dentalman]

I am a dental student and recently had periodontal surgery. Let me tell you... I was in pain. And I will be doing that to patients some day! Yet I still thought something was terribly wrong with me (more importantly, different from the rest of the human race, such as not being able to heal properly.) It took a little longer to heal than normal, thanks to me playing with the wound exudate instead of leaving it alone, but it turned out great. If you are still worried, just ask the dentist for an x-ray at your follow up. If it's there, you'll see it in an xray. Your endodontist friend can't diagnose it without an xray, either (unless you see the extracted tooth has a broken root tip!)

I haven't done a fair number of extractions yet, but I do know that sometimes even the best break root tips. But if you are acting like I do, then this is probably you worrying too much.

Good luck and stop worrying. Take the pain like a man, not like I did!

 

[Pi__Guy1]

I have a root tip left from #32 that was extracted over 10 years ago. Didn't find out the dentist left it in there until I took my own bitewings last semester in dental school. It's no big deal. If it is asymptomatic, then it is not a big deal to just leave it there.

I am a dental student and recently had periodontal surgery. Let me tell you... I was in pain. And I will be doing that to patients some day! Yet I still thought something was terribly wrong with me (more importantly, different from the rest of the human race, such as not being able to heal properly.) It took a little longer to heal than normal, thanks to me playing with the wound exudate instead of leaving it alone, but it turned out great. If you are still worried, just ask the dentist for an x-ray at your follow up. If it's there, you'll see it in an xray. Your endodontist friend can't diagnose it without an xray, either (unless you see the extracted tooth has a broken root tip!)

I haven't done a fair number of extractions yet, but I do know that sometimes even the best break root tips. But if you are acting like I do, then this is probably you worrying too much.

Good luck and stop worrying. Take the pain like a man, not like I did!

 

[DrRob]

He Took A Tylenol 3 And 400 Mg Of Ibuprofen! What Pain Is That? As Far As I Am Concerned This Is Not Extreme Pain By Any Means.

And Yes Small Root Tips That Are Assymptomatic Can Be Left. But There Is No Question Here If There Is A Root Tip Or Not - If The Dentist Said He Got It All Then He Got It All. Why Would He Lie - Especially When It Is Acceptable To Leave Small Root Tips Behind Or If The Tip Was Larger A Simple Referral To The Os Would Have Covered Him.

There Is No Reason For The Dentist To Lie About This. 🙁

 

[UNLV OMS GUNNABE]

It took a little longer to heal than normal, thanks to me playing with the wound exudate instead of leaving it alone,

That sounds really gross. Did you collect it or something?

 

[omsres]

so the general dentist extracted my impacted wisdom tooth in about 10 minutes. he said he got it all. Im going back on tuesday to get it looked at again. day number 2 and the pain is not bad. I took one tylenol number 3 last night and two advils this morning and thats it.

I was on the phone incidentally with one of my endodontist friends and he tells me he may have left a root in there and this can grow a cyst and scares the **** out of me and he tells me get a follow up x ray and all that.

How common is like roots being left in the socket and all the other complications that come along with extracted wisdom teeth?

These guys are right. Even with a retained root tip your chances of getting an infection resulting in a periapical cyst/granuloma/abcess are very low as long as the tooth was not infected to begin with and even if it was the chances are still low. If you are worried about dentigerous cysts, OKCs or ameloblastomas, these come from the follicle which surrounds the crown only and would not occur with a root tip. On exceedingly rare occasions the epithial rest cells in PDL can undergo a neoplastic growth. Finally an traumatic neuroma can sometimes form if the alveolar nerve was damaged, again not a common occurence. There are probably other things that I'm leaving out but I doubt you'll have any problems. I think it is very irresponsible of that endodontist to put these types of ideas in your head.

 

[redstorm]

thanks omsres

yeah my friend the endodontist is like that. he likes scaring the **** out of me . I said I would have let him do it but he said he doesnt know how to extract wisdom teeth. Is that common for a endodontist not to be able to do that. i thought that was a basic skill of a general dentist?

ALso, How common is it for a general dentist to tackle a impacted wisdom tooth. Is it standard of care to refer patients to Oral surgeons. this guy told me he could do it it did not look to bad.

ANyway he called me and he said there were no fractures or anything like that. Does that mean he got it all no root tips in there left????

 

[omsres]

thanks omsres

yeah my friend the endodontist is like that. he likes scaring the **** out of me . I said I would have let him do it but he said he doesnt know how to extract wisdom teeth. Is that common for a endodontist not to be able to do that. i thought that was a basic skill of a general dentist?

ALso, How common is it for a general dentist to tackle a impacted wisdom tooth. Is it standard of care to refer patients to Oral surgeons. this guy told me he could do it it did not look to bad.

ANyway he called me and he said there were no fractures or anything like that. Does that mean he got it all no root tips in there left????

Your friend probably hasn't done it in a while and is out of practice. Some general dentist refer all extractions, and some will do uncomplicated stuff. I only did 1 or 2 impactions in dental school but a lot of simple extractions. I wouldn't say it is the standard of care for a gen. dentist to refer all all impactions, but an oral surgeon will definitely have a lower complication rate and will be able to sedate their patients. I would rather my family members have impacted teeth treated by an oral surgeon.

 

[Doctor Bagel]

stupid question here. as long as you get regular x-rays, wouldn't they be able to spot early development of a cyst caused by a remaining root? my dad had a cyst develop from a non-descended wisdom tooth and had to have real surgery (inpatient) to have it removed. he still has no feeling in part of his mouth and lost a second molar during the procedure. i was always puzzled as to how the cyst could totally surprise him like that since he did go to the dentist regularly before that. this was all in the 70s and early 80s, though, so maybe things have improved.

 

[redstorm]

so if the dentists told me there were no fractures does that mean he got the whole tooth???

 

[toothcaries]

so if the dentists told me there were no fractures does that mean he got the whole tooth???

it's difficult to answer those type of questions since i'm assuming none of us were present during the extraction...

i'm curious..
..why do you not express your concerns to your dentist?


btw,
many family dentists refer extractions simply b/c having your patients in pain is not exactly a good practice builder (the original poster is a perfect example)
in school, i try to do everything i get my hands on... but in private practice, i'll probably punt on even borderline pita wizzies...

concerninig the time spent with you..
again, i'm just a slow dental student...but even i give myself 20 minutes per tooth (after pt is numb)...which is way more than enough time..

about a potential root tip..
root tips may be left if it is small, the tooth was not infected..and/or recovery would req excessive descruction or endanger vitality of adjacent nerves..
and i highly doubt the dentist would leave a tip without informing you..especially if he/she said they "got all of it" or there were no "fractures"
...most dentists have been well trained in CYA..

jmo.

 

[Dr.SpongeBobDDS]

...most dentists have been well trained in CYA..

Exactly. Those who aren't don't tend to stay in practice long. 😀

 

[UBTom]

stupid question here. as long as you get regular x-rays, wouldn't they be able to spot early development of a cyst caused by a remaining root? my dad had a cyst develop from a non-descended wisdom tooth and had to have real surgery (inpatient) to have it removed. he still has no feeling in part of his mouth and lost a second molar during the procedure. i was always puzzled as to how the cyst could totally surprise him like that since he did go to the dentist regularly before that. this was all in the 70s and early 80s, though, so maybe things have improved.

Heya,

Yes, a dentigerous cyst (tooth encased in bone that failed to erupt) can indeed show up on x-rays... These are definitely visible on panoramic X-rays, but can be missed sometimes on periapical X-rays (the small films). So if all your dad had were PA x-rays over the years, yes it can be missed. Having a panoramic is pretty standard for comprehensive exams on a new patient these days though.