Grace,

Thanks for posting this xray. It is an excellent shot!
Let me explain about xrays ..... dental xrays are 2 dimensional views and they are meant to be taken straight on as this one is, however, it does limit the viewing field. That's why we sometimes take a different view called a bisecting view. But it is evident that your tooth #14 is directly in line with your sinus. Because the view is 2 dimensional, I cannot be sure if the root is actually into the sinus or directly in front of it. As I said previously, the sinus can become infected even if the root did not perforate the membrane.

If the OS debrided the socket after he removed the tooth he would have been able to tell if this sinus was perforated and/or in communication with this tooth. A new periapical xray like this one may tell the story!

I'm hoping you are feeling better but I get the sense that you're not feeling that well and still having issues with your sinus... yes?

Bryanna




The OS

Thank you very much Bryanna.

I saw the OS this morning. I confirmed two things:

First: He didn’t debride the site after the extraction. He said the site didn’t look infected after the extraction. He also said that if he scraped the bone, some damages could be made to the sinus. I don’t understand it.

Secondly: He didn’t see any sinus perforation after the tooth was removed. He also said that I could get sinus infection without a perforation. Bryanna, if he didn't see a perf after extraction, does it mean there was no perf?

He gave me a prescription for Levaquin and a referral to an ENT. I am at the end of my wisdom. The is the fourth antibiotic given to me within a month (four different ones). Should I take it? Should I go to see another oral surgeon/dentist or ENT?


Have you seen any cases before that the body can heal itself from this infection? Is there any natural way/remedy that I can use? Physically and mentally I am so exhausted. I live in a big metro area, and I couldn't believe finding a doctor who I can trust is so hard.


I have been dragging the dental appointments due to the autoimmune disease (and also afraid of X-rays). I was hit so big this time. Sigh. My last molar on left side (bottom) starts hurting too.

Many thanks,
Grace

Hi Grace,

First of all please consider NOT taking that script for levaquin. That drug can cause some very bad permanent problems. Please google levaquin toxicity and think twice before taking it. He can prescribe something other than in the Fluoroquinolone family.

Please read...
http://articles.mercola.com/sites/ar...e-effects.aspx

Second..... It is irrelevant as to whether he thought the tooth was infected or not.... although the xray is clearer than clear.... ALL extraction sites need to be debrided. It is not okay to leave the periodontal ligament in there. A graphic but perfect example would be .... like leaving the placenta in the uterus after childbirth! The ligament protects and feeds the tooth nutrition.... the placenta works on the same principal.

I urge you to call your dentist, the one who referred you to the OS, and tell him exactly what has (has not!) happened and ask for another referral to a different oral surgeon. Your dentist needs to know that this guy did not follow not only his recommendations but also did not follow the proper surgical protocol.

Infection in the bone does not heal on it's own. Antibiotics can only do so much if the bacteria has overwhelmed the sinus or beyond. I cannot tell you what the outcome will be in your situation.... I just know that you need to get an opinion from a different surgeon asap.

There is nothing "natural" that you can do to eradicate necrotic bone or tissue. You need to have a definitive diagnosis first, get the proper treatment and then there are things you can do to help yourself heal.

You know that stress can cause you to feel more cruddy than usual :/
So I want you to stay focused and think positive ..... be thankful that you are rid of that infected tooth.... that you have met me and ginnie ...... and that you can and will get through this!!

Look to your general dentist as an ally and let him know that you are seeing him that way. He is (legally) obligated to see this through as you are his patient and he has to either take care of you or release your care to someone else.

It may be a good idea to let him check out that bottom molar too.

Stay strong, stay positive!
Stay in touch with us here....
Bryanna

Bryanna,
Thanks a lot for all the info and the encouragement. I do appreciate I find people like you and others here.

I have no doubt that this tooth was not healthy since it had bothered me for at least two years.

I stopped seeing my original general dentist after his root canal treatments for this #14 (at the begining of June). My gut told me I got this bad sinus infection from his third root canal treatment for this tooth (He was filing and drilling there and all of the suddent, I felt a sharp pain around my left nose. The next day I started smell some bad odor from my nose, then the yellow/green discharge).

I switched to another general dentist (holist dentist) in the mid June. He referred me to this OS. I don't know how good this holist dentist is. Before the surgery, I asked him how could oral surgons know the periodontal ligament needs to be removed. The holist dentist said yes they know. Upon my request, the holist dentist wrote on the referral form "extract the tooth and remove the periodontal ligament..."

Should I change to another general dentist? Or I just go ahead to find another oral surgeon by my own?

Before I can get an appointment with another surgeon, do you think Z-pack is a better antibiotic than levaquin. I was on Z-pack for 5 days after the surgery.

Many thanks,

Grace

Grace,

The description of your root canal treatment and the symptoms that you had certainly sounds to me like that dentist may have perforated the apex (root of the tooth) with a file instrument as well as the sinus. That would explain A LOT!!! That occurrence is not uncommon but it sets up house for a nasty long term infection. I'm betting that's what happen!!!

Regarding the note from your holistic dentist...
1) He was verbally trying to reassure you that ALL OS KNOW to remove the periodontal ligament. Unfortunately, he is very aware that not all of them routinely do that. As you have found out :/
2) He agreed to write the note to the OS as a way of "notifying" him to make sure to remove the ligament. This note also made it clear that YOU had been informed of this step. The OS should have performed that step without question.

This holistic dentist needs to be informed of what has happened. I do not see any reason why you should not trust him at this point.

I cannot determine the proper antibiotic for you to take. I can only inform you about the importance of researching the potential harmful affects of Levaquin. I can also inform you about the overuse of antibiotics and that they need to be prescribed carefully and not carelessly to patients. At this point the site may need to be cultured to determine the proper antibiotic. Please think about calling the holistic dentist and tell him what has happened. Let him evaluate it and/or refer you to another oral surgeon.

Bryanna

Thanks Bryanna,
I 've scheduled with an ENT doctor. I Hope this time it is a good one.
I called the hostlist doctor's office and he refused to see me because of this issue. He said everything should be taken care by the oral surgeon. I was too straight forward when I was talking to the office :-(

Thanks again for all your help.
All the best to you, and everyone on this board and myself!
Grace

Grace,

Did you speak directly to the dentist or just the office??
If you are a patient of record at the holistic dentist's office then he cannot legally refuse to speak to you unless he puts the reason in writing and addresses it to you.

The ENT dr cannot be responsible to treat a dental problem. He can however work in conjunction with an oral surgeon.

I know this has been an exhausting ordeal for you. I feel so bad that you are being (mis)treated like this! I so hope you get help and relief soon.

Bryanna

Thanks.

I talked to the front desk (I asked I would like to see the holist dentist asap). The front desk talked to the holistic dentist and passed the word to me. Right now, I don't have energy to hang on with them anymore

Bryanna, could you tell me:
1) From the two X-rays that I posted for 14#, how can I tell the tooth was very infected before the extraction (with a cysts?)? So when I am meeting with a new dentist/oral surgeon, I have a better idea/judgement. I can not be be fooled/abused anymore.

2) If an oral surgeon does Not see a sinus perforation after the extraction, does it mean there is no sinus perforation?

3) A sinus perforation can be spotted by an OS Only if he debride the socket after the extraction. Is that true?

4) If I take new x-rays, what indications should I look for in order to tell the infection in the bone/surrounding tissues?

5) What images/tests will you recommend for sinus infection since I will be meeting with an ENT?

Thanks a lot.

Grace.

Grace,

I feel so bad for you and agree you have not been treated fairly. Chances are your message was not conveyed to the dentist as you would have liked it to be. The person that you spoke to should not have been the go between. So that dentist may not even know what has happened exactly. This situation can create miscommunication between your new dentist and the original dentist if the new one calls him and he doesn't have the correct information. Do you see what I'm saying?

I will try to answer your questions... in bold type.

1) From the two X-rays that I posted for 14#, how can I tell the tooth was very infected before the extraction (with a cysts?)? So when I am meeting with a new dentist/oral surgeon, I have a better idea/judgement. I can not be be fooled/abused anymore.

THE INFECTION WAS EVIDENT ON THE XRAY. THERE WERE AREAS THAT APPEARED TO BE CYSTIC. A EXPERIENCED EYE CAN SEE THOSE THINGS. THE ORAL SURGEON WHO REMOVED THE TOOTH MAY NOT ADMIT WITH THOSE THINGS BECAUSE HE WAS LAX WITH THE SURGERY AS HE TOLD YOU HE DID NOT DEBRIDE THE SOCKET. SO HE MAY WANT TO COVER UP FOR THAT TO SOMEONE WHO QUESTIONS HIM. A "GENERAL DENTIST" MAY NOT VIEW THIS TOOTH SITUATION AS BEING A PROBLEM BECAUSE MOST CONVENTIONAL DENTISTS DO NOT ACKNOWLEDGE THE SEVERITY OF TOOTH INFECTIONS. ORAL SURGEONS TEND TO LOOK AT THIS DIFFERENTLY AS IT IS THERE JOB TO REMOVE THESE MESSES!

2) If an oral surgeon does Not see a sinus perforation after the extraction, does it mean there is no sinus perforation?

NO, NOT NECESSARILY. NOT ALL SINUS PERFS ARE VISIBLE. REMEMBER I WROTE ABOUT THE ORAL SURGEON BEING ABLE TO SEE OR FEEL THE PERF (IF THERE WAS ONE) IF HE HAD DEBRIDED THE SOCKET? UNLESS THE PERF IS LARGE OR IS PICKED UP ON THE XRAY, IT MAY NOT BE VISIBLE TO THE EYE... BUT IT CAN BE FELT DURING THE DEBRIDEMENT AFTER THE TOOTH IS REMOVED. HAVE I EXPLAINED THAT CLEAR ENOUGH?

3) A sinus perforation can be spotted by an OS Only if he debride the socket after the extraction. Is that true?

NO, NOT NECESSARILY. DEPENDS ON HOW LARGE A PERF IT IS AND THE LOCATION OF IT.

4) If I take new x-rays, what indications should I look for in order to tell the infection in the bone/surrounding tissues?

YOU WOULD NOT BE ABLE TO READ NEW XRAYS YOURSELF. IT TAKES A TRAINED EYE TO SEE PATHOLOGY ON AN XRAY. HOWEVER, NEW XRAYS MAY SHOW (TO THE OS) A RESIDUAL INFECTION STILL BREWING.... A SINUS PERF.....THE PERIODONTAL LIGAMENT STILL SITTING THERE... UNHEALTHY BONE STILL PRESENT.

5) What images/tests will you recommend for sinus infection since I will be meeting with an ENT?

SCANS THAT ARE SPECIFICALLY DENTALLY FORMATTED WOULD BE ADVISABLE. THE ENT WOULD BE THE ONE TO DETERMINE WHICH ONE WAS BEST IN YOUR CASE.

Bryanna

Thanks Bryanna.
Grace