Angels,

Thanks for the clarification.

I completely believe you have an ongoing problem but your case did not have to become this difficult. I also believe if the ENT and the OS had collaborated at the onset, intervention by one or both would have taken place by now. Or the ENT, after speaking to the OS, may have referred you to another surgeon if he felt this guy was not willing to address the problem. Your symptoms, your complaints, are all frequently seen and heard with dental patients who had infected root canaled teeth extracted, especially in cases where there is sinus involvement. So this is NOT an unusual case for them ... it's just been poorly handled in my opinion.

Here's some things that could be contributing factors and if you put them together like a puzzle the situation may make more sense to you.....

1) You had a long term, chronic and active infection in your teeth that spread to the jaw bone, the ligaments, and the sinus. The infection had also become further systemic as indicated by your swollen glands.

2) **Re read this paragraph as you review the others**
Any debris left in the extraction sites, meaning pieces of tooth, infected and/or splintered bone, periodontal ligaments, root canal material, infection in the sinus, that was not removed at the time of the extraction surgery has continued to fester or at least kept the infection alive.

3) If I recall correctly you were prescribed Levaquin by the OS. This drug should only be prescribed very carefully and with caution. The FDA, of which I am not really a big fan of, has issued strict warnings on this drug to be administered with extreme caution. The potential side effects of Fluoroquinolone drugs are to be considered very seriously before prescribing this medication. In spite of taking this medication, you continued to have assorted symptoms of an infection along with swelling in the neck. So the risk of taking it may not have outweighed the benefits. I would urge you to use caution if you are prescribed a Fluoroquinolone drug again.

4) Then the ENT diagnoses a Klebsiella infection in the sinus. So how effective was the Levaquin and did the oral surgeon explore the sinus when he extracted the teeth?

5) Placing bone graft material in a site that still harbors infectious bacteria, whether it be from the "debris" that I mentioned or from a sinus infection, is not going to heal properly. The patient will continue to feel unwell, glands will swell, pain may be present, mucus may discharge from the mouth and/or the sinus, post nasal drip from the nose down the throat, sour or unpleasant taste, etc.

6) When bone graft material is placed in a clean and healthy site of the jaw bone, within a few months the graft material has integrated well enough with the healthy bone that it would not stand out on an xray or a scan as something that resembles a piece of tooth. When grafting does not integrate well with the jaw bone, it can give a radiograhic appearance of a tooth root or resemble a blob rather than bone. These are things that would be discussed between the ENT and the OS.

7) You have had enough scans to detect and diagnose the problem.

In my opinion, I think the oral surgeon figures when he goes in to do the implant he will explore and may debride the site at that time. Or he may not do either of those things and just place the implant and then prescribe more antibiotics. Unfortunately the later is often what is done in cases such as yours and the outcome is often unfavorable. Ideally the surgical site and the sinus should already be free of infection and all irritants "long" before the implant is placed.

Have you asked the ENT to discuss your case with the Oral Surgeon?

Bryanna