CWMB,

I'm glad that we are on the same page about the longevity of that infection. I was concerned when your dentist only removed the wisdom tooth as he had to have some inclination that the molar was infected too. I mean I knew it and I'm only going by the descriptions that you are giving me!

I also agree with you in that the sinus infection is connected to the infections in those teeth. Which means that the infection was brewing for a long time before you had the teeth removed. The antibiotic could not eradicate the infection because the multiplying bacteria was kept alive by the infected teeth.

I don't know if this antibiotic is going to eradicate the infection or not. It depends on whether or not the bacteria is sensitive to that medication. The only way to know for sure what antibiotic to prescribe is to take a specimen of the bacteria and have it cultured. This could be done if the surgeon goes in and debrides that area. I would bring this up when you see the ENT on monday. The ENT may be able to do a nasal or throat swab. I would inquire about that if it were me.

A deviated septum can cause a chronic nasal blockage. But a chronic sinus infection can too. Be sure to tell the ENT about your dental issues with those two teeth. In fact, it would be helpful to get any pre and post op xrays sent to him so he can see the history of the infection.

The coated tongue could be from the bacterial infection but it could also be thrush from the antibiotics. Make sure the ENT looks at your tongue.

A panoramic xray will show the TMJ on both sides in less detail than the MRI, but it will show the alignment of the joint. Most oral surgeons take that type of xray.

I suggest that you make a list of all of the issues pertaining to these two teeth, what has happened, the symptoms you have (congestion, coated tongue, pressure in extraction site), the meds you have been and are currently on and another list of your questions and concerns. There is far too much going on, which is most likely all connected, to remember all the details. Write them down and bring them with you at every appointment. It's obvious there is a long term problem going on and it's most important that it be diagnosed.. Your input and tenacity could have a huge impact on getting the proper diagnosis.

I know you are not feeling well and this is truly difficult to be dealing with for so long. But you've got to muster up the strength to see this through. Make it easier by writing everything down... keeping a journal will keep your thoughts straight

Bryanna

Thank you for your encouragement. This forum has been so important to me throughout this process. I saw the periodontist this morning and he said the extraction socket seems to be continuing to be healing well. He doesn't even want to look into doing dental implants until well beyond when it fully heals… maybe into the summer months or beyond. It was nice that he was on the same page as me. I saw the ENT this afternoon. He agreed that all of my sinus issues probably stemmed from the dental issues and the initial infection. He thinks I do have an ongoing sinus infection… not a major one, but nonetheless, he didn't think another course of antibiotics would do much until the sinus perforation closes up. Both he and the periodontist felt that I should wait 2 weeks to see if it closes on its own and if it hasn't by then, the periodontist can do a procedure to close it. He showed me on the CT scan that the communication is very small, although he said even a small communication can cause the leakage that I'm tasting in my mouth. The ENT essentially described the leakage as "pus from your sinuses." Yuck. The ENT also said that once it closes, he can put me on antibiotics at that point if I'm still experiencing sinus issues, and if they continue to persist, then he may need to do a surgery to open up … I think he said the passage from my nose to my sinuses… that could be gummed up from the chronic sinus infection? Does that make sense? And can you tell me - do you think it is wise for me to wait 2 weeks to see if this sinus communication closes on its own? Would this normally happen with a small communication?
Thanks so much!

Hi CWMB,

A small sinus perforation into the oral cavity from an (extracted) infected tooth can cause the drainage symptoms that you have. Sometimes the perf will close over time, sometimes it won't. It really all depends on "why" it is still open. The pus indicates that the infection, to some degree, is still present so that is one reason why it has not closed. Another reason could be that due to the longevity of the infection, the various bacterias that have developed over time could have become resistant to the antibiotics that you have taken. When that happens the infection is not able to clear without further intervention. Perhaps you recall me mentioning the only way to know what meds to prescribe is for the surgeon or ENT to take a sample of the bacteria and have it cultured? Sometimes oral antibiotics are not adequate and some patients are put on IV antibiotics. These infections can become very virulent and stubborn to eradicate.

Your case is not unusual in that a long standing infection that involves a dead and/or infected tooth can infect the sinus or elsewhere pretty severely. It is unfortunate that infections like yours involving more than one tooth, one being root canaled, are often undiagnosed or misdiagnosed for a long period of time. The dentist and the ENT know that if this does not heal on it's own, it may be difficult to eradicate completely. So it needs to be monitored even if your symptoms subside completely.

I cannot tell you if it's okay to wait 2 weeks.... you will have to rely on the judgement of your doctors with that as they have seen you clinically and reviewed your radio-graphs and scans.

Did you talk to the ENT about using your current nasal sprays, etc? Did he suggest that you take any precautions or have any other suggestions for you?

Bryanna


QUOTE=CWMB;1119226]Thank you for your encouragement. This forum has been so important to me throughout this process. I saw the periodontist this morning and he said the extraction socket seems to be continuing to be healing well. He doesn't even want to look into doing dental implants until well beyond when it fully heals… maybe into the summer months or beyond. It was nice that he was on the same page as me. I saw the ENT this afternoon. He agreed that all of my sinus issues probably stemmed from the dental issues and the initial infection. He thinks I do have an ongoing sinus infection… not a major one, but nonetheless, he didn't think another course of antibiotics would do much until the sinus perforation closes up. Both he and the periodontist felt that I should wait 2 weeks to see if it closes on its own and if it hasn't by then, the periodontist can do a procedure to close it. He showed me on the CT scan that the communication is very small, although he said even a small communication can cause the leakage that I'm tasting in my mouth. The ENT essentially described the leakage as "pus from your sinuses." Yuck. The ENT also said that once it closes, he can put me on antibiotics at that point if I'm still experiencing sinus issues, and if they continue to persist, then he may need to do a surgery to open up … I think he said the passage from my nose to my sinuses… that could be gummed up from the chronic sinus infection? Does that make sense? And can you tell me - do you think it is wise for me to wait 2 weeks to see if this sinus communication closes on its own? Would this normally happen with a small communication?
Thanks so much![/QUOTE]

Thank you! The drainage seems to have stopped!! Phew! And the sinus pressure seems to be getting better day by day. I could actually breathe through my right nostril for a portion of yesterday! Amazing. The ENT prescribed another nasal spray and essentially just said wait till the socket heals and call him if I still am experiencing sinus issues thereafter. I wasn't overly impressed by him… or his curt bedside manner. My periodontist on the other hand, has the most amazing bedside manner and told me to call him and come in if anything feels even slightly not right. I do feel like things are getting better. My TMJ has also seen major improvement now that I've been going for cranial sacral massage. The extraction socket isn't too sore now… although I am still very aware of it… it feel like my cheek is resting on the socket bone… I suppose my mouth is just getting used to there being no tooth there? It occasionally is a bit achey and the periodontist said I do have a piece of bone that is a bit pointy and that it will essentially be reabsorbed as it heals. It is tender and occasionally bothers me, but nothing major at this point. I will keep you posted as this process continues.

Bryanna,
I can't even believe i'm writing this, but i'm having another tooth issue. This is truly a nightmare. So, I didn't mention it previously because I was dealing with the other issue I had… but about 6 weeks ago I had to have a root canal on a lower tooth. The tooth was extremely sensitive to hot foods. It was very sore after the root canal and about 2 weeks after, the endodontist redid it. Now, it is a month later and I've been to him about the pain I'm in and am scheduled to see him tonight. I have deep pain under the root canal. The tissue surrounding it is very sore. There isn't extreme biting pressure but occasionally slight sensitivity to biting. And the pain beneath the root canal seems to be radiating into my chin and as of today, making my face feel tingly. This is, of course, scary. I am scheduled to see him in 3 hours. I'm assuming this tooth needs to come out. He thinks we will open it up again, I'm thinking probably put in medicine again, and let it sit and see what happens. Do you think there is any worth in doing this? I know your feelings on root canals, but please also understand how anxiety causing it is to think about having another tooth removed… especially because it is on the other side and I'm still not really eating using my right side. My best guess is either that there is a root crack that has gone unseen, or that I have an infection that is putting pressure on a nerve in my face. I've also been clenching a lot (due to the stress of all of this I'm sure) and my endodontist seemed to think last week that's why I was having facial pain. I don't think so though… I've experienced muscular pain from clenching and TMJ and this feels very different. Ugh. I am once again at a loss. Any advice is very much appreciated.

Hi CWMB,

I am very sorry you are dealing with another infected tooth. I do know how upsetting it is to have teeth extracted and how you want to do something to make them better to avoid extractions. However, I have explained many times that there is unfortunately no way to make an infected tooth or a dead tooth (rc tooth) healthy again. It doesn't matter what is done to the tooth.... or how many times it is done ... or if the tooth is fractured ... or if you take a ton of antibiotics.... once the nerves are infected and/or the rc procedure is done, the tooth will chronically ill. The acute symptoms may subside, stay the same, become intermittent, or become chronic. Absence of symptoms does not mean that the infected or dead tooth has gotten better or become well. The absence just means that the bacteria has found an outlet and is moving elsewhere. I know that is very difficult to read and understand, but unfortunately that is the pathology that occurs when the nerves of the tooth become infected or when the tooth becomes non vital.

I think you realize what is going on with this lower tooth and are fearful of it turning into a situation like the upper one. Only you can make a decision based on the information you have acquired, the experiences that you have already had and what you feel is in your best interest.

I wish I could give you better news :/
Bryanna