friendlyd52,

Thank you for the detailed reply, it was most helpful.

The area of infection above the tooth that oozed pus when pressed on is called a fistula. This is typically seen with infected and with root canaled teeth. The fistula is the end of a tract of infection that has burrowed a path from the tooth, through the bone and out the gum. The fistula on the gum is the outlet from where the infection is draining from the cyst that has formed in the bone at the apex of the tooth. Unfortunately, this path of infection can be difficult to eradicate completely because it hides in the nooks and crannies of the bone. So it is imperative that when the infected tooth is removed, the bone is debrided thoroughly to remove as much visible disease as possible. Bacterial cultures can be obtained at the time of the extraction and sent to a pathologist for testing. That result helps diagnose issues that are not otherwise visible and also determines the proper antibiotic to be prescribed for the specific bacteria that is lurking in there. Unfortunately neither of those steps are routinely performed when extracting teeth.

The more details you offer, the more it sounds like there is some sinus involvement. I really think it would ideal to have on board... the ENT, an oral surgeon and an infectious disease specialist.

It also sounds like you do have a bruxism habit that you may not be aware of most of the time. Teeth are the hardest substance in the body. So for a healthy tooth to fracture, it has had to undergo some tremendous force. The amount of force your body can produce by grinding your teeth while awake is about 250 pounds per square inch, about 800-900 psi when sleeping and about 2000 psi if you take anti depressant or mood altering meds.

I recently came upon this very informational video about muscular related TMJ issues. You may find the information interesting...
https://www.youtube.com/watch?v=Q0xkJNF0l_E

I can understand why the pathologist was reluctant to culture the specimen that the ENT took from your graft. It most likely was contaminated because in order to take a clean specimen, he would have to open up the area to retrieve it rather than swipe it. If he does do the debridement then I assume he would remove the graft because opening up the site means letting in contaminants which disrupts the sterility of the graft. Be sure to get clarification about what his treatment plan will be before you do anything.

Glad to hear that you are eating a clean diet and cleansing your system. Are you noticing any improvement in how you are physically feeling?