Dental Question

[GMO2003]

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while I was brushing my teeth last night..I noticed some pretty obvious and pronounced decay and cavity formation over the lateral aspect of my left third molar in the maxillary arcade...

I guess I've got a cavity in my "wisdom tooth?" there is no obvious pain or swelling in the tooth or the overlying gingiva...do I need to be seen right away or can I be seen in like 1-2 weeks? Also, what will happen? Will the dentist just give me a filling or will he/she take some x-rays and possibly extract the tooth?

Please excuse my ignorance...anything dental and I'm like huh??

 

[DDSSlave]

1-2 wks is prob fine.

The dentist will definitely need an x-ray or 2 regardless if they fill it or extract it. As far as treatment, it really depends how much decay there is. If you can see it, it's probably a lot. The dentist may put a filling in it or may just recommend extracting it. 3rd molars are notoriously difficult to keep clean over a lifetime. I definitely wouldn't do a root canal or crown it. 3rd molars just aren't worth it.

 

[GMO2003]

1-2 wks is prob fine.

The dentist will definitely need an x-ray or 2 regardless if they fill it or extract it. As far as treatment, it really depends how much decay there is. If you can see it, it's probably a lot. The dentist may put a filling in it or may just recommend extracting it. 3rd molars are notoriously difficult to keep clean over a lifetime. I definitely wouldn't do a root canal or crown it. 3rd molars just aren't worth it.

thanks DDSSlave...also, one more question...what is dry socket...do most people get it or can you avoid it..are narcotic pain meds avoidable if you have a pretty high threshold to pain or is it normally pretty excrutiating?

 

[DDSSlave]

Dry socket is a potential complication when you can't form or maintain a good blood clot in the socket. Often a problem for smokers. It's not uncommon, but most patients don't get it.

For simple extractions (he isn't bringing out the drill or mallet and chisel) ibuprofen (600 mg every 6 hours) works well. Of course you can always have your friendly oral surgeon or dentist write a script for Vicoden just in case you change your mind.

 

[toofache32]

Nobody really knows what causes dry sockets, but we do recognize certain correlations such as with smoking.

A dry socket is a disruption in the normal healing of a socket. Normally, the empty tooth socket (bone) fills with a blood clot. Then it undergoes healing with granulation tissue, vascular ingrowth, and all that other junk we all learned about. A dry socket occurs when the clot becomes separated from the bony socket for some reason. Some people think it's due to trauma (patient non-compliance), some think its too much Factor XIII, and there are lots of other theories. The classic story is that it was healing nicely and feeling better, then on post-op day #4 it started hurting, and developed a bad taste and bad smell. The pain is because the clot is separated from the bony socket...now you have dry bone exposed to the oral cavity (and therefore exposed to the outside world). The bad smell and taste is from a dead clot sitting in your mouth. Sometimes there's even food mixed with it.

The treatment is palliative because it will heal just the same, but with more pain. Most commonly, the dentist will pack the socket with a eugenol-based obtundant or something similar while it heals.

I hope this helps.