I had #13 tooth extracted last week. This tooth previously had a root canal, broke and began decaying. I guess my sinus wall is very close to my teeth, leaving not much bone for my teeth. What causes this?

Is this just the way my sinus cavity, wall, bone has always been? I do remember a dentist telling me something about my sinuses do go far down close to my teeth in the past after my check up with x-rays. A general dentist told me she wanted to do the root canal the next day because it may take a long time if the tooth breaks while she extracts it. She wrote me a prescription for an antibiotic to take to prevent an infection from developing, and scheduled my extraction for the next day. I came in, she gave me a local numbing injection and let it settle in for a while and then began.

It was horrible and I was upset afterwards because there was a lot of filing and drilling and pulling and breaking and it was horrible... with no sedation at all. I started to just get over it, but as I go along in my journey, I found out it was pretty unwise to allow her to do this extraction. I should have gone to an oral surgeon, however I was in pain so I didn't look into it..and she never mentioned doing that or that was a necessary.

She stitched me up and sent me on my way and scheduled me to return in a week for follow up and check on the stitches. There were some things said after the extraction that scared me though. She said that she had to do a lot of filing of the bone because it had spread and the bone had turned soft. She said that the molar behind the tooth that was extracted didn't have much bone supporting it but hopefully it more bone would grow around it.

Why would bone now grow around it.. because the decaying broken tooth that had a root canal in the past was removed? When I returned for a check six days later because that same molar hurt, and something seemed like it was moving near the extraction site. (There has been a feeling of stickiness when it touches the tooth below it when I clench my teeth, and I can feel the very slight like gel/sticky layer of something on the bottom of this molar...what the heck is it?)

Her staff did a full work-up of xrays. The dentist took a look of externally said the molar was fine and that I was healing really well, and everything looked great from the outside. She then looked at the xrays for a really long time. She seemed concerned but was not willing to share what she found on there. She now said that the site isn't all way healed yet, but it was just a small hole and it would heal soon. She did a full scan of my mouth and showed me (small so couldn't see detail at all) image on the screen of how my sinuses dipped really far down and said she wanted to be sure there's no hole in my sinus wall, and by looking at it there may be a small hole but she couldn't be sure.

She said that if there was a hole in my sinus wall above where the tooth was extracted it was because of an infection. I went home confused and continued taking 800mg of Ibuprofen. There is a lot more to be said of how I was treated badly at this office, and my questions were discouraged...often told that she wasn't going to tell me everything because I seem to worry too much. I won't even go into detail about the staff person that insisted that this molar next to the extraction site hurt because the nerve is sensitive and that I have sensitive teeth and just needed to use Sensidine toothpaste.

There is much more I could share, but won't because that is not what is going to help me get my questions answered. The next day I took my last antibiotic and by the end of the day my side of my face within the sinus cavity was hurting so badly I could barely drive home. I really distrusted this dentist by now for several reasons, so I wanted a second opinion. Was I really going to be okay to just deal with it until I am checked again in two weeks?
Was it really okay? I may or may not have a hole in my sinus wall... and I am in pain but we are just going to wait two weeks.. no more antibiotic, no care advice...? The 2nd opinion dentist that came highly recommended by several friends (now I know better than to just go to just anyone), and her office was able to schedule me for the next morning. Once I got home I immediately took another Ibuprofen and laid down with an ice pack on the side of my face over my cheek bone and it felt sooo much better that way!

The next day I was still in pain in the same area but it was not as bad. I was careful to tilt me head to the right whenever I drank something. I saw the 2nd opinion dentist. I told her some of what I was told and what I was feeling. They did one x-ray of the tooth (I didn't want this dentist notified, because I wanted to be sure if surgeon needed my records they could get ALL of them... I had no idea of what was found because she was so aloof about everything.

This was the first time I had been to a doctor that didn't show me x-rays of a area in question or an area/tooth they are discussing with me. This 2nd dentist said that it did appear to her like there was a hole and she needed to call her oral surgeon friend and see what he suggests. He wanted to see me that afternoon. 2nd dentist said I should have been on antibiotics still and doing other things to make sure the sinus area was clean.

The oral surgeon sees me has the xray the 2nd dentist took on the large screen in the room but doesn't mention anything he saw on it (I should have asked him to go over what he could see on it, but I was so nervous because of how traumatic that extraction was with that first dentist, so there were questions I had but didn't ask.) I am still unwilling to identify who did the extraction at this point. I was really fearful that he could have a relationship with her and give me bad advice to cover up something she may have done...

I really felt like she had done something, and was covering it up and going to blame it on a different condition so she wouldn't be held accountable for any of a surgeon's bill. Maybe she was afraid of being sued for more than that?..I don't have any intention of doing that though. I just want the truth of what was done and why. So the surgeon asked me some questions like.. was it I sedated.. (not at all)... how did it go.. did something go wrong?.. (I was wondering why the 2nd opinion dentist didn't tell this guy already she said was her friend and was calling for advice, she said she was going to tell him.) I told it was horrible and long and frightening.

I told him I bled changing gauze every 10 minutes for over 12 hours. He asked if I had food and liquid coming out of my nose when I ate. I said I don't think so, he said well you would know... is there liquid pouring out of your nose when after you drink something? I said no, and so he said that is good. He was informative of what he was doing and said I did have a dry socket (the sutchers came out today and he seemed okay with that.)

He was going to stick something up into the hole to see and I THINK it was to see if it went through my nose?... but he couldn't because that dry socket pain and my nerves prevented him from doing so. He then squirted some water up the hole with a syrienge and it hurt really really really bad and he said that was because of the dry socket (I have heard they hurt like that so I don't doubt that.) He also squirted with water to try to clear that area up so he could see up there better. I think he also was looking to see if water came out of my nose, it didn't. I did feel some high up in my nose but it didn't pour out and that was all he was concerned about.

He said if there's a hole it's small because there wasn't liquid or food pouring out of my nose, so he wanted to treat this dry socket first, put me back on some high dosage of antibiotics, have me use that medicated mouthwash. He asked me if there was a lot of filing and drilling going on during the procedure (I thought that was an odd question to ask, didn't he know that by looking?..or didn't he read the file thoroughly and didn't the 2nd opinion dentist tell him?)

I said yes, the (1st) dentist said she ended up having to file a lot of bone because it had turned soft from the decay. He also asked me if she knew that I had sinus problems / fistula before she did the procedure. I said that if she knew then she didn't tell me, and I don't doubt that because there were other things she didn't tell me. He asked me if I was taking narcotics after the procedure, I said no.. just the 800mg of Ibuprofen. I told him that I didn't even know I had sinus problems. ;...

and as another after thought to me when he says it that way it sounds chronic. I see a diff doc in the group for a change of dry socket packing tomorrow morning and possible Monday. Then I see the surgeon on Wednesday again. I seems as though if I want to know anything about what looks like was done I need to ask him direct questions. What do I ask so that I know my health is not at risk? I am not looking for revenge on the dentist, I just want to know... if bone was soft then why was is hard when she filed it? What did he think was drilled?

Are my sinuses low because of something wrong? Why did I get a dry socket when I had stitches, and didn't do ANY sucking, was so careful, don't smoke, only gently let warm salt water pass the extraction site by using gravity. Why did the dentist take soooooo long looking at my x-rays behind me and all she had to say was I may have a small hole in my sinus cavity but it's too small to tell? What was the area filled with that he couldn't see what he needed to look at? Why was he only concerned if food and water poured out of my nose? ...

wouldn't that have been discussed over the phone when his dentist friend had me in the office? I don't doubt the 2nd dentists and the surgeon's ethics and skills. I do trust they will not give me negligent care.. I just don't understand. I hate how I still have no idea why the 1st dentist was so freaked out when the 1st dentist started looking at my x-rays and seemed just as freaked out when she was finished talking to me. Or why the 2nd dentist said there was a hole in my sinus wall by looking at the x-ray she took, but the surgeon wasn't confirming that with the same x-ray but would only if I had food/water pouring out of my nose or once my dry socket healed so he could see/ and stick something up into the area to see if it went through...?

I know some professionals feel that it's okay to do drill something, file something, withhold information they have about your condition, all of these things and it's okay, that it is their choice to make.. but is it really? Shouldn't I know what was done to my own body? Shouldn't I be told if something in my body looks unhealthy and how it possibly got that way? Why the heck did that hygeniest want to clean my teeth when she clearly saw I still had the stitches from the procedure she assisted in? Can someone , hopefully Bryanna, shed some light on this for me? I know I ask a lot of questions, but I feel better when I know what is done and why it is done...... can someone please help with this?

I don't want negative consequences for that dentist. I do plan to continue care by the surgeon and hope that everything turns out okay, and I plan to keep the 2nd dentist as my family dentist from now on.... but I feel like there's so many unaswered questions and it's like they have some sort of loyalty to that first dentist. They are all three affliated with a specific dental school out here. It's difficult to find any dentist or oral surgeon that isn't affiliated with that school in this area.

There is definitely a hole in my sinus. I felt pretty good the first half of the day. A surgeon changed out my packing for me this morning. I got that jolt of sharp pain when he packed it and several times before I drove away. The packing began to settle and all was good until about 2pm. I started feeling pressure in my sinuses all over my face. The pressure and aching increased and went from under my eyes, my temples, my cheek bones, and my glands near under my ears and running down the sides of my neck. I began hearing the fluid pressure in my ears, and nose. Then around 4:30pm, the dry socket "popped" just like when your ears pop in altitude changes, and when that happened I had another jolt of pain from the site (or dry socket) except this one was much much more painful. Also, when this happened all the pressure released in my head. Then I noticed this same fluid leaking from the site... the packing for the dry socket pain is no longer in contact with the bone or whatever it is that is hurting. It didn't slowly move, it was pushed by pressure! I wasn't doing anything to cause that to happen. I have been really careful not to apply unnecessary suction or pressure in my mouth, because I know it makes the dry socket worse.
I continue experiencing this random extremely painful and strong jolt of pain from the site. It hits me out of nowhere and I am so emberassed by my reaction. I very obviously jump and gasp, and it's a reaction that I can't seem to prevent/control. I keep trying to figure out how to prep myself so I won't do it, but I react the same every time. It is so embaressing. I react to it in public and at work. It takes my breath away afterwards... and I don't know how to save face after I do it. It looks bizarre and I know it freaks people out. I look like someone that is shocked in front of just about everyone.

I get full of pressure like I mentioned and then it releases through the site. I was in so much pain from these jolts of pain, so I called the on-call. The same surgeon that packed it this morning. I explained what was going on, and asked to please call in a narc for me. I have gone without narcs for the pain up until now. I only used Ibuprofen after the extraction even. The shocking has slowed down since I've taken the narcs.

The surgeon said that the site did not appear red or have pus, and he said that I did not have a sinus infection, and he pointed out that I am back on antibiotics anyway. He went on to explain how he would treat a perforated sinus, and that included using nasal decongestant spray. He said that I just need to keep it clean and it will heal on it's own. That was the only thing I was not already doing so I bought some. I most definitely have a hoe in my sinus wall. When I sprayed the medicine into my nostril it went pouring into my mouth. That tasted disgusting. I sprayed it into my other nostril and none of it went into my mouth.

I am now taking narcs, and I continue to feel this build up of fluid and hear the fluid build up... and then it drains out of my extraction site.

Ugggg ... this sucks so bad.

Can anyone give me their opinion?... If I do not have a sinus infection what would be causing this increased amount of fluids in my sinuses? I don't normally have a problem with sinus fluids.

Does anyone else that is still a part of this forum understand what I am going through? Does this just not happen to people anymore?

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

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!

Hi sarajmb,

Perhaps I misunderstood your last statement.. <<I guess it would have possibly gone differently if they did the xrays before the extraction. >>
DID THE DENTIST REMOVE THE TOOTH WITHOUT TAKING XRAYS?

The dentist legally has to turn your xrays over to you within 7 days of the request. She is allowed to charge you a fee for them, but she cannot hold them if you request them. The same goes for your written records. Did you request these things in writing? That can sometimes gets things moving quicker. Also, it is important that she release the original xrays and not a printed copy. If they were digital xrays she can email them very easily.

I would press her for these things and not take the wait and see approach. Irrelevant of whether she has anything to hide or not, she has to release them. It is common for this type of request to go unnoticed for several weeks by the dentist and her staff .... it's not always at the top of their priority list and if there are any concerns on their part they just hope that the patient forgets about it.

The soft bone that was removed from the socket was diseased necrotic bone from the infection. So that should have been removed. I just wanted to reiterate that to you

Bryanna

Thanks for your quick response Bryanna. No, the dentist had taken one close up xray of the tooth before beginning the extraction. I received the full work-up of xrays off all my teeth, and then the panoramic scan of my mouth six days after the extraction. It was at this time when she was able to see how low my sinus cavity was and was looking at and asking me if I get headaches etc. She would not tell me what was concerning her except that I may have a small hole in the sinus wall and wanted to be sure I understood how close my sinus wall was to my teeth and gum line. She did not want to go over and show me what was removed.


[QUOTE=Bryanna;996389]Hi sarajmb,

Perhaps I misunderstood your last statement.. <<I guess it would have possibly gone differently if they did the xrays before the extraction. >>
DID THE DENTIST REMOVE THE TOOTH WITHOUT TAKING XRAYS?

The dentist legally has to turn your xrays over to you within 7 days of the request. She is allowed to charge you a fee for them, but she cannot hold them if you request them. The same goes for your written records. Did you request these things in writing? That can sometimes gets things moving quicker. Also, it is important that she release the original xrays and not a printed copy. If they were digital xrays she can email them very easily.