Hi Byanna,

Firstly I must remark on how kind it is of you to help and advise people on this forum.

I'm a male and 36 years old with a life-long history of dental problems. I'll give a timeline of events as it should be quicker and more succinct than writing a load of waffle!......

Approx 4 - 5 years ago: Had toothache in upper left 2nd premolar. It was badly decayed and so dentist extracted it. Around the time I would occasionally wake up with an ear ache on the same side but it would always go away after I got up.

Approx 4 years ago: Upper left first molar was hurting. Dentist took x-ray and said it was fine, but she drilled into it as this would apparently relieve the pain(??). It did seem to work.

Approx three years ago: Small pimple like fistula appears on gum where premolar was extracted. It occasionally formed a yellow head and if I pressed around it, I could burst it and release a small amount of pus. The top of the gum (reaching as I high as I can within my mouth) feels a little fibrous and tender to rub above the first molar.

Approx two and half years ago: Saw dentist re fistula. He said it would be infected root tips from extracted premolar. Prescribed amoxycillin. It does nothing.

Two years ago: Caught a standard cold virus. Blew nose on one occasion and mucus was bright yellow (almost fluorescent!). Stopped after cold went.

About 22 months ago: Bent forward whilst putting out trash. A few bright yellow drops came out of my nose. This became an occurence every now and again, around once every few months and would be more likely if I caught a cold.

Aprox 18 months ago: Strange - the molar starts hurting but only in certain situations. I suffered pain every night when I layed down to go to bed, and that would last around one hour and then subside. I also suffered when drinking anything hot and would soothe it by immediately swigging cold water on the tooth. After about a month, the pain went away again.

Approx 15 months ago: Fistula and tender (ish) gum remains. Palate starts to feel strange behind first molar and forms a yellow hanging pocket which seems to be pus. I visited the dentist (a new one, as my usual had left). Was given antibiotics again and told they would not wish to treat until i'd seen an oral hygienist to improve overall gum health.

Following this, my palate remains permanently swollen although there is no pain. It feels hard and raised behind the first molar with a bony formation which seems to be similar shape and structure to the molar. Just above it, the swelling is soft and of pressed, releases pus out of the front of my gum.

As there was no pain (just a horrible taste if I pressed on the palate), the dental practice advised that they didn't consider it an emergency and so scheduled an appointment for months later. I got fed up at this and (stupidly) ignored it.

Two months ago: Molar (which was filled) breaks whilst eating a cookie. The back, palate side of the molar breaks off at the gum line. The filling came out, leaving just the front, gum side in tact. Fed up of the dental service at my old practice (i'm in the UK and they were NHS funded), I arranged an appointment at a private practice to have my mouth looked at.

The dentist observed the palate swelling and unhealthy gum on the other side. She took an x-ray of the area and advised that the root appears to be communicating with the sinus. With this in mind, she's referring me to a specialist oral surgeon at the hospital for further evaluation and probable extraction. She made a couple of further observations though - that there were no premolar root tips remaining and so the source of infection wasn't known with certainty. She mentioned the possibility of cysts etc but if there were, they would be higher up as there was no such thing on the x-ray.

I have a photo of the x-ray which I can send to you? I have a few questions which I don't know if you can help me with?

1. Can the molar be causing all of these symptoms despite it not hurting anymore?

2. If it isn't the molar and there are no root tips from the premolar, what else is likely to be causing tender gum, palate swelling, and pus discharge?

2. Is it normal for infected molar roots (particularly those within the sinus) to cause chronic palatal swelling?

3. The dentist mentioned having the molar extracted and the hole 'packed' to prevent an oronasal fistula. Is this normally done via local or general anaesthetic? I would prefer local, which shocked her as she said that most people would prefer not to be aware of it.

I'm looking forward to getting this treated but am also nervous that it's something more serious like a hidden tumor or something. I'm also really confused as to what causes this type of thing and what to expect from treatment. I just haven't heard of anyone else getting the same thing - especially with the palate!

Any advice would be much appreciated.

Best wishes and happy new year.

PJ