Anything you put on your gums near that site is going to get into that site via the saliva. That is why I suggested to refrain from using any topical at this time. I would not brush over the wound at this time either.

Sounds like you are doing what you can to keep everything clean... that's good!

How is the site feeling today? Have you had to take a lot of motrin?

I was fine all day long and then in the afternoon the pain returned, and actually it never happened before this way, I was bending down to pickup something from the floor when my gums (first the gums only ) started hurting. I had to take motrin. And sometimes the salt water helps the pain, but not today. Do you think I irritated my gums in the beginning when I used more salt in the rinsing water 4-5 times a day for the first couple of weeks after the extraction ?

nyuszisie,

Sometimes using too much salt will irritate, almost burn, the surgical wound. But if that is the case, then the irritation will heal on it's own.

The fact that you had no pain until you bent down indicates a change in pressure in your head or sinus. That could be indicative of a sinus perforation or communication. A dental periapical x-ray may be able to detect if you have a sinus perforation and how big or small it is. Most perforations heal on their own. Some need surgical intervention but most often within a few weeks they heal on their own.

The pain also can be intermittent and not happen every time you bend down. I would suggest if this happens again, see if it goes away on it's own after a few minutes before you take the motrin as you may not need to take it or may only need to take 200-400 mgs.

I called the general dentist again today because I didn't get the x rays by noon and I was told ( by the guy who was suppose to send them to me, and he is the dentist's husband by the way ) I'll get my pre and post extraction x rays later in the afternoon. And I didn't. I got so mad, because I wanted to post them here for you, but they are not in on Fridays so nothing till Monday. I don't know what was the problem, this is a general dentist who actually referred me to the jerk OS. And this is the general dentist who took the post op x ray ( 3 weeks after the extraction ) and she said everything looks ok on it, she didn't see if there is a sinus perforation or communication.

And sinus CT scan was ok too, so is there still a chance that I have a sinus communication ? even that there is no discharge, etc ? would a dental CT scan show more than a regular sinus CT scan ? Sorry for so many questions, I'm really scared and confused.

I just saw somewhere that a sinus communication can develop 4-6 weeks after the extraction. is that true ?

Incompetence aggravates me too. There is no reason why he could not email your xrays to you ... it only takes a minute or two to do that. I know the office is closed today, friday. However, I would leave a message on their voice mail today telling them that you did not receive the xrays and needed them for monday. Most dental offices call in for their messages or messages get forwarded to their personal phones. Even if they have an answering service, leave the message with that service. Most dental offices can remote into their office software and do transactions like this from home.

A dental CT scan is different than an sinus CT scan. However, I would not subject myself to that radiation again in such a short amount of time.

The symptoms of a sinus perforation vary depending on the inflammation and the size and location of the opening. You do not have to have nasal or oral drainage with a sinus perf. Most of these will resolve on their own.

Yes, a complete perforation can occur or seem to occur a few weeks after the extraction of the tooth. These things are not always picked up right away which could lead to a late diagnosis. Also, the wall of the sinus membrane can be very fragile and close to being perfored after the extraction. Bacteria, inflammation, sneezing, nose blowing... could then cause the fragile membrane to perforate through. Again, this could occur sometime after the extraction during the initial healing phase.

Most of the time sinus perforations heal on their own. Some people have bothersome symptoms for weeks... while others say they have no symptoms. Some people think their symptoms are normal and ignore them...... every one is different. I've already had patients fail to come in for their post op checks.... only to see them a few months later and inform them that their extraction site is still open and they have a sinus perforation. I mean they had no idea it had not healed closed. I know that seems odd.... but I cannot count how many times that has happened and usually these patients are smokers.

I got my x rays but i don't know how to post them here.