How To Smoke After Tooth Extraction Without Getting Dry Socket

Q1. It has been six months since my 7-year-old niece lost her front teeth, and there is no sign of new growth. Is this normal?

— Mary, Arkansas

There is a range of time during which tooth eruption is considered normal or "within normal limits." The upper and lower front teeth (central incisors) normally erupt into the mouth between the ages of 6 and 8.

Factors that can affect normal tooth eruption include:

1. Genetics/family history.

2. Infection or cavities of baby teeth before the permanent teeth erupt.

3. Early loss of a baby tooth before eruption of the permanent tooth.

4. Trauma to a region of the mouth affecting the primary teeth.

5. Fevers and systemic health problems can also play a role in delayed eruption.

My suggestion is not to panic, because age 7 is the average age at which the permanent teeth typically erupt in the front upper and lower areas. I certainly suggest consulting an excellent dentist and/or orthodontist, who will take X rays and check the status of the permanent teeth underneath the gum and bone, as their formation and position are critical.

Q2. I had a lower jaw tooth pulled several weeks ago and I have been in constant pain ever since. My dentist says I have a dry socket, which he packed with some type of medicine. That helped for a while, but now the pain is almost unbearable again. What can I do to speed up the healing? How long do I have to suffer with this pain?

– John, Washington

Pain following an extraction is most often caused by one of the following four conditions:

Dry Socket
Fracture of Jawbone
Osteonecrosis
Infection

A dry socket occurs after an extraction due to the lack of formation or the loss of a blood clot in the space. Normally, a stable blood clot covers the bony walls of the socket and helps new bone to form. When lost, the nerve endings of the "dry " bone are exposed and cause extreme pain until the body covers the bone with connective tissue and epithelial cells. It can take several weeks for this natural healing process to cover over the bone.

A fracture of the jawbone can occur in difficult extractions. Sometimes part of the jaw can crack and pain may occur from this fracture.

Osteonecrosis of the jawbone has been a hot topic in the dental community over the last two years. Osteonecrosis means, "bone death"; it is a condition marked by death of bone tissue. It appears more frequently in patients taking Fosamax and other bone-building drugs (often used in treating arthritis or osteoporosis) after a tooth extraction or periodontal surgery. It only occurs in a small percentage of patients and it should be discussed with both your physician and dentist.

Infection symptoms include fever, swelling, pain, redness to the affected area, and a foul smell. Infection can be treated with antibiotic therapy and curettage or drainage.

If your dentist is not sure of the proper diagnosis, then I would recommend you ask for a referral to a specialist such as a periodontist or oral surgeon.

Q3. After having a tooth pulled, I developed a dry socket. During one of the follow-ups, the dentist noticed that a piece of bone had died due to no blood flow. Should I be concerned about more bone death?

Sometimes when a tooth is removed, a dry socket can occur. This is when the blood clot that forms after an extraction (or a blood clot combined with some bone filler) doesn't properly fill the socket where the tooth used to be. Ideally, a tooth should be removed as gently and slowly as possible so that loss of the blood clot or any bone is prevented. A bone-filling material can help keep the blood clot inside the socket, so that more bone fills back in.

Unfortunately, in your case, a dry socket occurred and that can be very painful. This is because the bony walls of the socket have nerve endings that can cause a lot of pain when not covered. Over time, pieces of bone can start to die off from the lack of blood supply, causing them to slowly come out of your socket or jaw bone. This is nothing to be alarmed about, especially if you know what it is. Usually only a few very small pieces of bone will come out, though there is no way of saying exactly how many potentially could. There is not much you can do about it except to let nature take its course and rinse the area with warm salt water.

If you have any kind of swelling or fever, consult your doctor for an antibiotic.

Learn more in the Everyday Health Dental Health Center.