NeuroTalk Support Groups - View Single Post - so many questions following tooth extraction

sarajmb · 06-30-2013, 05:46 PM

Hello Bryanna,

No apologies are necessary. Thank you so much for answering these questions. Yes the OS that was on call the other night repeated what the consulting OS advised, to use a nasal spray decongestant along with oral decongestant but then he changed his mind because it would not mix well with my ADHD medications. They both continued to suggest Afrin spray. I actually had a a couple minute conversation with the on call OS about it because I still wasn't using it a few days after my consultation with the OS. I have been unable to obtain my xrays and scans from the first DDS, and since I "don't have food and liquid coming out of my nose" they are only treating me for a dry socket, but they stated they do have perforated sinus walls treated the same I'm now being treated with them. An extra week of antibiotics, because the first DDS only prescribed one week. I am so glad someone finally explained it to me. The first DDS told me that she wouldn't tell because I didn't need know (which is bizarre to me, it's my body) and I think it's just a guessing game for the OS because I went there referred by the DDD I went to in order to get a second opinion. I felt like there were more precautions I needed to take ... More antibiotics to prevent another ...separate infection, ...something....besides just a yearly xray. I also had no idea what was going on, all I knew was that something was not okay. I really am concerned about this sinus pressure I getting and this only started a week ago. A took the antibiotics exactly as prescribed and was prescribe another week by the OS because he said he always prescribes two weeks. Anyhow, maybe it will become easier for the OS to treat me if the first DDS release my xrays and records. They have not done so yet, so we are all guessing at what the DDS found, performed, and saw on the xrays...since she would not tell me except that my sinus walls goes really low, there may be a hole in the sinus wall, and that there was soft bone around the tooth that the had to file away. She did say it was good that I came in when I did because it would have been a lot worse had I waited.... But then she became worried again after the looked at the xrays they took a few days after the extraction. I guess it would have possibly gone differently if they did the xrays before the extraction.
Thank you so much Bryanna!

Quote:

Originally Posted by Bryanna

Hi sarajmb,

Very sorry for my delay in replying to you. I only volunteer on this site, so I get here when I can. Also, it is really best to post detailed facts only about the dental problem and not write about the personal stuff regarding the dentist/office etc. You can start a whole new thread on that other stuff if you want but I just need to be able to graze through the pertinent details of the tooth problem in order to help you. Okay

Here is my perception of what's happening based on your descriptions since you have not posted any xrays....

...Tooth #13 had been root canaled and as usual it became badly infected.
...The infection had spread to the jaw bone surrounding #13 which included the mesial bone (front) of #14.
...The infection had likely invaded the sinus membrane as it laid in close proximity of the root of #13.

The dentist who performed the surgery to remove #13....
... All of that drilling and filing of bone was called Debridement and it was necessary to do because the diseased bone had to be removed. Yes, it was invasive but that was because the infection had become invasive.
... She may have punctured the sinus membrane during the extraction and/or during the debridement. OR the perforation was already there from the infection and it became more evident once the tooth was out. In cases of severe tooth infection, the slightest thing that irritates or vibrates the membrane could open it up. Even just sneezing or blowing your nose could do it!
...It sounds to me like she was trying to be thorough in her surgery but also careful not to go to far into the sinus area as she may not have experience in doing that sort of surgery. I think she may not have realized how infected it was until she got in there. Most general dentists back off of the sinus membrane during an extraction even if it means leaving infected bone behind.
Which is the wrong thing to do. So it sounds like she at least attempted to clean things up.

A dry socket....
...This occurs irrelevant of whether the site was sutured or not. This occurs when the blood clot has not formed properly and/or was disturbed. Sometimes during the surgery, the bone is found to be so decrepit and diseased that it's difficult to then get a good blood flow going into the socket. The blood flow is what becomes the clot and that is what keeps the bone moist and healthy during the healing phase. Unfortunately, the bacteria from long term infected and/or root canaled teeth will cause an ischemic reaction to develop in the surrounding bone and this can result in an ongoing bacterial problem in the bone even after the tooth has been debrided. That's why strong antibiotics and/or IV antibiotics and/or long term oral antibiotics get prescribed post op the extraction. Even then, there is no guarantee the bone will become healthy again.
....The reason why it was painful to have the site irrigated was because the bone was dry which makes the nerve ending vulnerable to stimulation.

Sinus infection... perforated sinus... fluid coming into your mouth when irrigating the sinus....
...Did your OS tell you to buy oral decongestants or a nasal spray???
...It may not be wise to use a nasal spray as that could keep the sinus perf from healing closed and it could also push bacteria up into the sinus cavity. Please check with the OS as to which he wants you to use. Make sure you tell him your experience with using the nasal spray.

Regarding the fleeting and sudden pain...
... Typical of a tooth infection that had spread. This site may or may not still be infected and the antibiotics may or may not take care of it. If it is infected, then it may need to be retreated with another debridement. If it is healing (and it is really too soon to tell that from an xray unless the bacteria shows up definitively diffuse) then it will take a long time to calm down and for the nerves to rejuvenate.

Regarding your dental situation and if it is commonly seen.....
It is very common and most often associated with extracted root canaled teeth that have been brewing with infection for some time. This is why those of us in the dental and medical profession who are knowledgeable and forthright with the information about the whole body connection discourage people from retaining their infected and/or root canaled teeth for any length of time. It would be ideal if the tooth were never root canaled in the first place.... as none of this would be occurring if the tooth had been removed at the onset of the initial infection.

I'm sorry you are dealing with this .... but as you can now see, there can be any number of things going on. Perhaps an ENT physician would be helpful in diagnosing a sinus issue.

Bryanna