Pdne,

Thank you for going into such a detailed explanation about this tooth situation. For me, the picture is very clear and here is why.

At the onset of the pain in your cheek, the xray showed that the tooth was having a problem. Because you did not complain of tooth pain, you couldn't get a dentist to admit the tooth was infected. <Keep in mind how I have told you how evasive dentists can be if the patient is not complaining about tooth pain.> This tooth could have been dying from having a previously deep filling in it and/or because it was fractured and/or as a result of your clenching/grinding habit the nerve became traumatized and died from the constant banging against it. All of these things are contributing factors to why a tooth becomes infected in the first place. One or more than one of them can be present. However, it only takes one of them to kill a tooth :/

So dentists were not of any help other than making you a night guard which temporarily helped BECAUSE it took the pressure off of this ailing tooth. It didn't make it healthy again because the nerve was too far gone. ENT's and others were not helping because they were finding you to be healthy. The one ENT saw a minor flaw and figured why not... let's fix it and see what happens. Grasping for answers you went along with him. But low and behold your problem was still apparent... why?... because it was a tooth problem all along.

Yes, the oral surgeon will be able to check the health of the bone and the sinus. But do NOT assume this will automatically be done. If you've read through some ..many... of these posts you will see repetitively how people report back saying their OS did not do a thorough surgery when extracting their tooth. I know, stupid.... unbelievable.... I know.... I know.

So here is where your self advocacy comes in to play... You have to be the one to express to him that you want to be sure he removes the periodontal ligament and all necrotic bone and tissue as you want a thorough debridement done once the tooth is removed. You are also concerned about a possible sinus communication so you want to be informed after the surgery if there is one, how large it is and if he had to repair it. You also want to be informed after the tooth is removed the health status of the sinus and if infected does it need intervention. Tell him you are considering a dental implant in the future if the area is healthy enough to place one. He may discuss bone grafting with you. Ask him if the site is infected or there is sinus involvement, would he still place the graft?? This is a judgement call for the OS and he will only know the real answer after he debrides the bone. But it is still good to discuss with him prior.

Most of my years in dentistry have been perio and oral surgery. I always get a kick out of an informed patient and appreciate their diligence in researching this stuff!! Some oral surgeons will take "slight" offense to a patient being so well informed.... others get their ego bruised a bit because they want you to assume they are great at what they do .... and others will say hey this is an informed patient who cares about his healthy, I'd better do a good job!

This is a tough situation for anyone to be in. The pain you have may not go away completely right away or it may linger forever. It has to do with the longevity of the infection and where it has resided all of these years. Sometimes there is permanent irritation to the facial nerves from being inflamed for so long. This is why I am not an advocate of root canal therapy even in a temporary situation because it can be difficult to eradicate the aftermath. But I also want you to know that many people seem to do really well and go on to be okay!!! So please think positively and take very good care of yourself

Bryanna