I went in to have my back teeth extracted and he put a hole in my sinus cavity and he said he went back in and he put bone and mesh and a membrane in there to hold it.. all was well for a few days. Then it got real sensitive when I spoke and come to find out there were sinuses draining out of a hole that was in my gums. (not the one he fixed ) but anyway I kept complaining about how sensitive it was and he kept saying that it was healing not to worry. On Wednesday Night I was told to rinse with an antibiotic mouth wash. When I did this It started burning the back of my nose. So I got the flash light and looked at it. There was this sinus material hanging from my gums so I pulled it out and there was a hole in my gums. Where the sinuses were leaking was a big hole so I called the Doctor Thursday morning and they said I need to come back in for emerg surg. So I did. Doctor then looked at it and he took my cheek and sewed it up over my gums. Well I’m getting scared because I have been trying to talk a couple times today and it is getting real sensitive again and I just want this fixed…

Hi ackleyj
 

If you can, post directly to Bryanna. Welcome to Neruo Talk. Your dental issue does sound like this needs to be fixed, and that you may need to see some kind of specialist. Bryanna, is the most knowledgeable about dental issues, as she was assistant for 30 years. No dentist usually requires this kind of mouth wash anyway, that would burn healing areas. Ususally only salt water. The whole issue sounds like you need to be looked at again. Post to me, or even private message Bryanna, by clicking on your name, that leads you to where you can post this way, thereby getting directly to her.
I do wish you all the best. Tooth issues aren't fun. Let me know how you do. ginnie

Hi ackleyj,

To help clarify your description....
The roots of your back molar were either in or near the sinus membrane. You could also have had an infection in the tooth that spread through the end of the root, through the sinus membrane into the sinus cavity. When the tooth was extracted, the perforation was made larger in trying to remove the tooth and clean out the area.

Placing a bone graft at the time of this type of surgery depends on the size of the perforation and the infection present in the surgerized area. If the perf is large and/or there is infection, it is common to place a collagen membrane over the sinus opening and obtain primary closure with sutures bringing as much gum tissue together as possible. Then a second surgery is done weeks or so later to place the bone graft. In your case, the dentist decided to do the membrane and bone graft at the same time. Given the symptoms that you have been experiencing, this may or may not have been an ideal decision.

When there is minimal gum tissue, not enough to obtain primary closure (this means the hole is closed to some degree), and the area needs to be closed off, then the dentist will pull a piece of the inside of the cheek near the extraction site over the surgical opening and suture it closed. If you develop additional "holes" in the gum area of the surgery, then this needs to be examined to determine if the original opening is involved or not.

Anytime the cheek tissue is used to close over the hole, the area will be sensitive to speak, eat, chew, swallow, etc. because the tissue is being pulled every time you do this. It is wise to open the mouth minimally, eat a soft nutritious diet, drink lots of water and not open the mouth wide.

Did you have an oral surgeon do this surgery? If not, then I would suggest that you consult with one.

Bryanna






QUOTE=ackleyj;886803]I went in to have my back teeth extracted and he put a hole in my sinus cavity and he said he went back in and he put bone and mesh and a membrane in there to hold it.. all was well for a few days. Then it got real sensitive when I spoke and come to find out there were sinuses draining out of a hole that was in my gums. (not the one he fixed ) but anyway I kept complaining about how sensitive it was and he kept saying that it was healing not to worry. On Wednesday Night I was told to rinse with an antibiotic mouth wash. When I did this It started burning the back of my nose. So I got the flash light and looked at it. There was this sinus material hanging from my gums so I pulled it out and there was a hole in my gums. Where the sinuses were leaking was a big hole so I called the Doctor Thursday morning and they said I need to come back in for emerg surg. So I did. Doctor then looked at it and he took my cheek and sewed it up over my gums. Well I’m getting scared because I have been trying to talk a couple times today and it is getting real sensitive again and I just want this fixed…[/QUOTE]

Hole in Sinus
 

I just went to an oral surgeon who indicated that I had an infected wisdom tooth that must be extracted asap. He also indicated that there is a hole in my sinus that is leaking bacteria. He has recommended that I have the tooth removed and "simultaneous repair of the fistulae between the oral and sinus cavity with a bone graft and tissue flap." The tooth extraction is covered by my dental insurance but my dental insurance does not cover the repair of the hole in the sinus. My medical insurance would cover the repair of the sinus if I went to an ENT doctor.

To make matters a bit more complicated, I am almost 7 months pregnant. The dental surgeon suggested that if I don't get the procedure done asap, the leaking bacteria could potentially harm the baby.

My question is - should I have the oral surgeon do the extraction (covered by insurance) which is scheduled for this Friday and then go to an ENT for sinus repair or is it just better to do it all with the oral surgeon on Friday and bear the $800 expense for the oral surgeon to repair the hole in the sinus?
Is there any danger to me or the baby if I wait to get the sinus repaired?

Any guidance would be appreciated.

Dear Aney
 

Is there anyway you can fight your insurance company? It isn't like this is some small situation. You do need the proceedure. Most of the time doing the whole thing is advised to my understanding. I would eat the cost rather than have this at all dangerous to your baby. I don't know what the risk would be to wait, but Bryanna will. A hole in the sinus does not sound like something I would want to wait on. I wish you all the best, a speedy resolution, and of course a healthy happy baby. ginnie

Aney,

I am in the dental profession..

At seven months pregnant it is best to have one single surgery... do it all with the oral surgeon.

You could ask for a reconsideration of benefits from your medical insurance company after the procedure is done stating you were in an urgent situation and 7 months pregnant. Perhaps your oral surgeon will write a brief letter explaining the situation and what he felt was in your best interest.

Please let us know how you're doing.

Bryanna


I just went to an oral surgeon who indicated that I had an infected wisdom tooth that must be extracted asap. He also indicated that there is a hole in my sinus that is leaking bacteria. He has recommended that I have the tooth removed and "simultaneous repair of the fistulae between the oral and sinus cavity with a bone graft and tissue flap." The tooth extraction is covered by my dental insurance but my dental insurance does not cover the repair of the hole in the sinus. My medical insurance would cover the repair of the sinus if I went to an ENT doctor.

To make matters a bit more complicated, I am almost 7 months pregnant. The dental surgeon suggested that if I don't get the procedure done asap, the leaking bacteria could potentially harm the baby.

My question is - should I have the oral surgeon do the extraction (covered by insurance) which is scheduled for this Friday and then go to an ENT for sinus repair or is it just better to do it all with the oral surgeon on Friday and bear the $800 expense for the oral surgeon to repair the hole in the sinus?
Is there any danger to me or the baby if I wait to get the sinus repaired?

Any guidance would be appreciated.[/QUOTE]

Hi Bryanna.

So, my obgyn was concerned with why the oral surgeon felt the bone graft was necessary and questioned it. She was ok with performing the extraction for the infected tooth but she didn't understand why the expensive bone graft procedure was necessary at this point.

I then talked to one of my friends who is a periodentist and she looked at the xray and couldn't see why he thought the sinus was affected. To her, it looked like he just needed to do the extraction and fill with gel or collatape (sp?) and suture since there was no indication from the xray that the sinus was perforated.

I then went to an ENT doctor to get his opinion regarding whether my sinus was leaking bacteria. He said that based upon his exam and review of the xray, there didn't seem to be any indication of a perforation of the sinus and I am not experiencing any symptoms suggesting any sinus issues. He said my sinus looked completely fine. Also, from looking at the xray, the ENT doc felt that the sinus was sufficiently far enough away from the sinus that it didn't look like it would be affected by the extraction. He was very concerned as to why the oral surgeon was suggesting that the bone graft was necessary at this juncture, especially since the extraction was not even done yet.

Now, I am concerned that the oral surgeon is telling me I need to have a procedure that no other doctor seems to support at this juncture and pay for it in advance out of my own pocket while I am 7 months pregnant.

All other docs seem to think that the oral surgeon is looking to make a quick buck at my expense.

I want the oral surgeon to do the extraction tomorrow but not the bone graft. I called and left his practice a message so that he can explain to me why the bone graft is medically necessary at this juncture.

Aney



[/QUOTE]

Hi Aney
 

Interesting....Glad you are trying to educate yourself. many dentists do proceedures, that are not necessary and don't tell you the truth. I would not go back to that particular specialist. If you have no involvment with the sinues, and two doctors told you that, I would just get the tooth removed if it were me. I am of the opinion, that I personnally have been told alot of stuff from doctors looking to make money. For example with root canals. I wish you all the best, and if you have questions, go to another specialist, and ask Bryanna for sure. ginnie

Aney,

Without seeing an xray I can only go by your description, therefore, I cannot tell you why the oral surgeon recommended a bone graft. In general, the specialist who would be the most knowledgeable and diagnostic with a tooth and sinus communication is an oral surgeon because he is the one who deals with this type of situation every day. Periodontists specialize in the health of the gum and bone level. Some perform this type of extraction, but not usually. Xrays can be very deceiving and like anything else, some dentists are definitely better at reading them than others.

I am the first to admit that some dentists are not ethical. But I don't think an oral surgeon would suggest an unnecessary invasive procedure on a women who is 7 months pregnant. It's just too huge of a risk to his reputation. Perhaps the oral surgeon was preparing you for the "what if's" rather than definitively stating you needed such and such??

I would sit down and go over everything with this oral surgeon prior to having the tooth removed OR seek a second opinion from a different oral surgeon.

Let us know how things go...
All the best to you!

Bryanna





[/QUOTE]

Hole in Sinus
 

So...prior to all of the other doctors getting involved, the oral surgeon wrote my OBGYN a note advising that I had an infected tooth and a hole in my sinus that needed to be filled with a bone graft.

He asked me to pay in advance for a surgical extration (the co-pay) and the bone graft. A total of about $1000.

After all of the other doctors got involved, reviewed the xrays and his letter, and I questioned it, the oral surgeon said that he was just preparing me for the worst case scenario. He said he saw indications in x-ray of a likely sinus communication. No other doctor saw any such indication.

Surprisingly, when I went to the appointment for removal, he only asked me to pay $35 co-pay for a non-surgical extraction. The extraction took 2 minutes, and he said it came out beautifully and there was no sinus communication. That was on Friday. Today is Monday and I feel great and extraction seems to be healing nicely.

I honestly believe, if I had not questioned it, he would have made me pay $1000 in advance and done an unnecessary bone graft.

Very disappointing. He was caught!

Aney

[/QUOTE]