Hi Bryanna,

More delay and incompetence..... and they are just not coming through with getting a radiologist report for me. I guess it's been at least a month now. Mood is exasperated. ;-)

Would an ENT have some kind of xray or noninvasive test to get helpful information as to whether or not it is okay to proceed with crown or flying....or better to wait and not do those things yet? I know they like to use a scope and look in your nose. I'd rather not have that done. If they are looking for inflammation etc. I know the sinuses are very clear from the other xrays that were done, and also feel very clear. I thought I read something about an xray of the nose that ENT's might do. Is that useful at all for this?

Thanks! Carol

Hi Carol,

This is crazy! Legally, they have to supply you with this information and any scans that were done have to be of diagnostic quality. You could file a complaint with the dental board simply stating that they have been uncooperative in providing you with this information. The board will send them a letter requesting their side of the story. Ultimately, they will have no choice but to provide you with the information. Other than that, you are living in limbo of what to do!

An ENT can take a sinus scan that may be helpful. But these scans are not without radiation. So if you don't have to expose yourself again... why should you?

I cannot tell you if it would be ok to fly or not. It does sounds like your sinus perf is healing. But whether it is healed enough to fly, I don't know.

If you don't want to go to the dental board, then perhaps a personal unexpected visit to that office requesting the copy and report might be worth a try???

Hang in there.... keep me posted.

Bryanna

Hi Bryanna,

Well, I finally got the radiologist's report. Not sure if I need to see an oral surgeon or if anything needs to be done.

Here are the radiologist's comments:

The area of interest is a possible sinus perforation involving the area of extraction site #16. The tooth
was extracted 4-6 weeks prior to the first scan on 9/9/2010. The floor of the sinus is uniformly corticated
but the lower lateral wall of the sinus demonstrates what appears to be a small perforation. There is no
thickening of the lining mucosa that would suggest an inflammatory process. There is an otherwise
normal healing response noted in both scans.

The following incidental findings were noted:
 Tooth #3 with an associated periapical radiolucency with superior elevation of the floor of the
maxillary right sinus, consistent with apical rarefying osteitis.

I could email you the scan privately if you wanted to see it. It definitely shows a break in continuity.

I don't know what that means about tooth#3. That tooth was extracted about 4 years ago, and not replaced.

Would appreciate your input! Thanks. Carol

Hi Carol,

Well, as you probably can tell from the report the sinus perf associated with #16 site appears to be healing well and there is no indication of inflammation, so that is good. It could take several months for that perf to close completely.

With regard to the #3 site.... Osteitis in the jawbone is inflammation within certain sections/areas of the bone. Rarefying means the bone in that area is less dense, thinner than it once was and that is typical bone healing after a tooth has been extracted. However, Rarefying Osteitis following a tooth extraction could be an ongoing infection that either originated from the tooth itself (prior to the extraction) or infection post operatively as in a dry socket and/or bone trauma during the extraction. Did you have a dry socket after that tooth was extracted?

However, what is a little odd is that the term Apical means end of the root. So I'm wondering if you or the radiologist have the teeth numbers mixed up and either you had a different tooth extracted and thought it was #3 or he's making reference to an Apical Rarefying Osteitis associated with an existing tooth perhaps #2?

To help determine what is going on in the area of 2/3, I would have an oral surgeon look at the scan and radiology report. Do you ever have any pain, achiness or swelling in that area?

I will try to IM you my email address. I am curious to see the scan. Thanks.

Bryanna

Hi Bryanna,

I had the surgeon who did the extraction look at the scans, and the place who ordered the scan called me with info. So of course, two different opinions about the apical rarefying osteitis on #2/3.

The surgeon who did the extraction is a jerk. When I went to him 3 times after the extraction about the perforation symptoms, he kept telling me that he didn't understand the symptoms, there was no perf, and I wanted something to be wrong. About tooth #2/3 he said it doesn't show up on his panoramic scan, so it's nothing to be concerned with. Pretty amazing, huh? There was some justice in showing him the scan with the perf when he had been such a jerk about everything.

The other opinion about #2/3 was that it was mentioned for future possible extraction info. He said tooth #2 is attached to some bony fragment, and that is good info to have if tooth ever needs extraction. Since there was a difficult extraction of infected #3, do you think that infection is still there or could spread to #2 area? I started thinking though.....if the radiologist thought it was an immediate problem, he probably would have suggested a consult with an endo or oral surgeon.

Thanks! Carol

I edited this post but, it did take. When I showed the scan to the OS, he floored me. His response was that it was a "possible perf". I said there are 3 views of it, so it does exist. (nevermind my symptoms) He then realizes it's real, he can't get around that fact......then he adds that he didn't work any where near the location of the perf, so he didn't cause it. FLOORED AGAIN! Assuming that the radiologist would suggest a referral is assuming that he has higher technical and moral standards than this OS. One can hope. ;-)

Hi Carol,

Well I can't agree with you more..... I've known many a jerky dentist!!
I also have seen so many patients repetitively given the wrong or inaccurate diagnosis only for the problem to become far worse before any admittance of wrong doing or incompetence on the dentists part. I could write a book on that subject alone..... but no one would read it!

I am a bit puzzled about the finding of the "bony fragment" that tooth #2 is attached to. Is it a piece of root that broke off during the extraction of #1 or 3? Or is it a piece of splintered jawbone that may have occured during either extraction? My concern is that if an osteitis is forming around that bony fragment, then that might be indicative of inflammation and/or infection.

To answer your question about residual infection from tooth #3..... yes, that is possible. Could it progress to other teeth and possibly contribute to a systemic problem, yes it could. It is not uncommon for the bacteria from inside a root canaled tooth to burrow through the tooth and go directly into the jawbone. In fact, that is most likely what happened to your tooth #3. This type of infection is referred to as an abcessed tooth. If the infected and necrotic jawbone is not removed thoroughly during the extraction of the infected tooth, then post operatively the necrotic bacteria is going to continue to thrive and proliferate.

Believe it or not....... and I say this in all seriousness..... many dentists rely on symptoms before they recommend definitive treatment. In some people, infectious bacteria grows and spreads very rapidly making a minimal problem very aggressive. In others, the bacteria proliferates more slowly.

The radiologist may be thinking, well her symptoms of a perf are diminishing and she is not complaining of any symptoms on tooth #2. So let's wait and see what happens. It is difficult to know what that bony fragment is based on the scan or xray. The only sure way would be to have it removed. If it is attached to tooth #2, then most likely the tooth would be removed as well.

If you are comfortable with monitoring the site, then let the perf heal...... have another panorex done in 6-12 months from now to see if there are any changes. If you develop any swelling, pain or unusual symptoms in that area or with tooth #2, then have the panorex done sooner.

How does that sound to you?

Bryanna

Hi Bryanna,

The dental office that gave me the opinion that tooth #2/3 is attached to a bony fragment is just a general dentist office. When I look at that bony fragment on the scan.....I don't think that is the area that is magnified to be the problem area of apical lesion.

I was thinking of possibly showing the scan to the oral surgeon who I saw for a second opinion regarding the perf, to ask him about the osteitis. The appointment I had with the surgeon who did the extraction was a useless opinion. I have the email of the radiologist who read the scan, but maybe it wouldn't be the right thing to ask him for more info. I do sometimes have a bad flavor of infection coming from that area. It's not very often but happens infrequently. It's the same bad flavor I had when tooth #3 was infected and needed a root canal.

Thanks for all your great comments and insight. Carol

Hi Carol,

Sorry, I misunderstood who saw the bony fragment. Cyber communications can be ...... interesting =)

It's funny that you mention about having a bad flavor coming from that area of your mouth. Did you mention that to the dentist or oral surgeon? It may behoove you to take it to that second oral surgeon for his opinion. I would definitely mention the bad taste and ask him to give you some idea of what that fragment could be.... root tip... splintered root or bone. Also, if you emailed the radiologist asking him to be more specific, the least he could do is not reply! Again, I would tell him also about the bad taste.

Bryanna

Another case of sinus perforation
 

Bryanna,

I'm not sure if it's appropriate to revive an old thread - but I found this thread on a Google search and it seems to be directly inline with my situation. I hope you're still around. I've been extremely impressed with your knowledge and willingness to share it.

Today I had an extraction of an upper tooth (#3 I believe). He also did an "alveolar ridge graft" and a "sinus elevation graft". It seems clear that there is a perforation of the sinus floor and sinus membrane. I can feel air pass easily between my mouth and sinus during relatively normal activities such as swallowing. I heard the doc talking about placing collagen (gel?) - which seems consistent with the discussion I've seen here. He did not suture the membrane, and seems to be acting as if he's not sure it's perforated - but it seems absolutely obvious to me that it is.

Since this all happened just today, I'm not sure if I have any cause for concern. Is this fairly common? Would I normally expect it to heal on it's own in a matter of days or weeks?

I'm just about to buy tickets to fly east 5 weeks from today. Would that be a concern at this time?

Thanks so much for any advice you can offer.