Persistent Pain after extractions

My husband had two teeth extracted one week ago after several weeks of severe pain. These were done by a general dentist highly recommended by friends. This was strictly a financial decision as the treatment to "save" the teeth (either #s 19 & 20--) involved thousands and thousands of $$$.

Tooth #20 was actually dead via a previous root canal but no crown had been placed over the tooth. The one that was seemingly causing the problem was not thought salvageable w/o a root canal & crown though a bridge was discussed as alternate Tx. Again w/o a wheelbarrow full of $$$ this was not possible.

After many more days in extreme pain and starting & stopping antibiotics plus OTC & prescription pain meds the decision was made to remove both teeth.

Currently the problem is the pain he is experiencing is as bad, or even worse, than that before the extractions. My husband went back to the dentist yesterday to be checked for possible dry socket, or other complications, and was told some people just take longer to heal but that all looked "fine". He was prescribed Vicodin and given and antibacterial mouth wash.

In reading of other's plights we wonder if a piece of the tooth's root could be in the bone, or perhaps he actually does have a dry socket. How is this condition actually diagnosed? Is it so obvious a dentist could not possibly miss it or does it present in more subtlety? What other causes of persistent pain might his symtoms (symptoms) indicate--TMJ, TMD sinus involvement or??? How do we find out? No follow up visits are planned right now.

Also could he be receiving less than stellar care because he refused the expensive treatments? He is 66 yrs old and living on Social Security with no dental insurance. Do you think it likely his concerns were just dismissed due to his lack of funds?

[Jerome Tsang, DDS]

I don't think it would be due to lack of funds.  I certainly hope not because the dentist can get in trouble for substandard care.  If he or she decided to perform treatment at a certain cost, then they have to do it to a standard of care.  A possible root tip may be left although an x-ray would be needed to verify that.  Its possible the extraction was difficult due to the root canal, as root canal treated teeth tend to be more brittle and are more difficult to get out.  Some surgeries are more involved and may have required removal of some of the adjacent jaw bone to allow the roots to come out.  

Dry socket is usually diagnosed by visual exam.  You can see the socket is exposed and not healing properly.  You may want to ask your dentist to pack the socket with some dry socket paste to see if that helps but again, if the dentist doesn't feel like that's the case, it might not be but I can't really know for sure.

Has the pain improved at all or has it worsened?