Intraoral Swelling After Extraction: Best Course of Action?

Why did you go back and reopen the wound. I would have to disagree with this treatment plan.

Hello Dr. N, I am assuming your rationale for NOT placing the allograft on same day as extraction was due to the infection present. Understandable. When you go in after 3 days, and curette out a healing socket, you are actually creating a DRY SOCKET iatrogenically. Moreover, I think (and I dont see the post-graft p.a. X-ray), I think that some of the graft material went beyond the socket into the sinus, where it will be treated like a foreign body, and the signs then explain themselves. Just my 2 cents of input. Cannot comment definitively.

Disagree with assessment this is dry socket. I would suspect your graft is infected and the membrane also possibly contaminated. Is your patient a diabetic? Eichenella typically is common in chronic odontogenic infections in diabetics and is notoriously resistant to Clindamycin. Personally I am finding more and more resistance to clindamycin. Sounds to me even though your pt is on 2 antibiotics you have a resistant bug. Why clindamycin? Is pt allergic to penicillin? Need more information.

Dr N You really should post a preoperative radiograph and another post- complication. You will get many well educated "guesses" since we do not have enough information. Was there infection before the extraction? Was the sinus membrane compromised during the grafting 3 days later? Is the patient allergic to Penicillin? Did you try aspirating or I&D in the swollen area? What does the post-op radiograph show? Can you post the x-rays? Hope this helps.

Hi Dr N, Why did you re-enter so soon? Three days in no where near enough time even if on multiple antibiotics. Don't rely on antibiotic to magically remove dead bone/tissue etc. Curettage (macro) and time (cellular removal) is needed to remove the necrotic "bio-load", antibiotics can at best only keep the pile of "bio-load" bug free at best. Posts about "re-opening"...how can this be re-opening, it was never closed. Going back into the would not cause a dry socket (which is beginning to be put down to a over-reactive host immunological response - probably to prevent deep bone infection). Re-opening is skin wound a hundred times won't cause dermatitis/eczema etc. Your treatment plan at best requires three surgeries. Could you have achieved primary stability placing the implant in at 8wks post xtn (with no socket grafting)? If yes (even with a fenestration or defect) then you can just graft on implant placement day. This would reduce a surgery, give you a cleaner field/bone and the implant can help you "tent" up the membrane. Is your membrane non-resorbable? - did you get primary closure? Hope my comments help

Dear Dr. N, There will usually be some amount of pain and swelling after an op like that even up to 3 to 4 days. Is it getting worse or is it gradually improving? Continue with the said medication if you think that it is gradually improving. If you think it is getting worse, change the medication and review the patient's medical history. .....diabetes and other conditions that may compromise the patient's healing powers. Observe for improvement and hopeful resolution. Give it a week or so. Be patient, there is no need to hurry unless the patient has spontaneous pain and is obviously getting worse. If there is no improvement, go back in and clean it up thoroughly and close it again. This should be the last resort. All the best.

I absolutely agree with Drs P&H. Why on earth did you go back into an open socket at 3 days post extraction (just enough time for the socket to have become contaminated) and shovel a whole load of foreign material into the hole? I suggest the only thing to do is to give things a chance to settle down for a few more days then return to the scene of the crime and remove the membrane plus as much of the other gubbins as possible. Then just sit on your hands and wait for the site to heal before fiddling about with it any more. Incidentally antibiotics are there to aid good surgery, they are not a substitute for good surgery.

Put patient on Penicillins for 5-6 days. advise to rinse with salt water5-6 times a day. No smoking . It will be ok.