Hi Byanna,

Firstly I must remark on how kind it is of you to help and advise people on this forum.

I'm a male and 36 years old with a life-long history of dental problems. I'll give a timeline of events as it should be quicker and more succinct than writing a load of waffle!......

Approx 4 - 5 years ago: Had toothache in upper left 2nd premolar. It was badly decayed and so dentist extracted it. Around the time I would occasionally wake up with an ear ache on the same side but it would always go away after I got up.

Approx 4 years ago: Upper left first molar was hurting. Dentist took x-ray and said it was fine, but she drilled into it as this would apparently relieve the pain(??). It did seem to work.

Approx three years ago: Small pimple like fistula appears on gum where premolar was extracted. It occasionally formed a yellow head and if I pressed around it, I could burst it and release a small amount of pus. The top of the gum (reaching as I high as I can within my mouth) feels a little fibrous and tender to rub above the first molar.

Approx two and half years ago: Saw dentist re fistula. He said it would be infected root tips from extracted premolar. Prescribed amoxycillin. It does nothing.

Two years ago: Caught a standard cold virus. Blew nose on one occasion and mucus was bright yellow (almost fluorescent!). Stopped after cold went.

About 22 months ago: Bent forward whilst putting out trash. A few bright yellow drops came out of my nose. This became an occurence every now and again, around once every few months and would be more likely if I caught a cold.

Aprox 18 months ago: Strange - the molar starts hurting but only in certain situations. I suffered pain every night when I layed down to go to bed, and that would last around one hour and then subside. I also suffered when drinking anything hot and would soothe it by immediately swigging cold water on the tooth. After about a month, the pain went away again.

Approx 15 months ago: Fistula and tender (ish) gum remains. Palate starts to feel strange behind first molar and forms a yellow hanging pocket which seems to be pus. I visited the dentist (a new one, as my usual had left). Was given antibiotics again and told they would not wish to treat until i'd seen an oral hygienist to improve overall gum health.

Following this, my palate remains permanently swollen although there is no pain. It feels hard and raised behind the first molar with a bony formation which seems to be similar shape and structure to the molar. Just above it, the swelling is soft and of pressed, releases pus out of the front of my gum.

As there was no pain (just a horrible taste if I pressed on the palate), the dental practice advised that they didn't consider it an emergency and so scheduled an appointment for months later. I got fed up at this and (stupidly) ignored it.

Two months ago: Molar (which was filled) breaks whilst eating a cookie. The back, palate side of the molar breaks off at the gum line. The filling came out, leaving just the front, gum side in tact. Fed up of the dental service at my old practice (i'm in the UK and they were NHS funded), I arranged an appointment at a private practice to have my mouth looked at.

The dentist observed the palate swelling and unhealthy gum on the other side. She took an x-ray of the area and advised that the root appears to be communicating with the sinus. With this in mind, she's referring me to a specialist oral surgeon at the hospital for further evaluation and probable extraction. She made a couple of further observations though - that there were no premolar root tips remaining and so the source of infection wasn't known with certainty. She mentioned the possibility of cysts etc but if there were, they would be higher up as there was no such thing on the x-ray.

I have a photo of the x-ray which I can send to you? I have a few questions which I don't know if you can help me with?

1. Can the molar be causing all of these symptoms despite it not hurting anymore?

2. If it isn't the molar and there are no root tips from the premolar, what else is likely to be causing tender gum, palate swelling, and pus discharge?

2. Is it normal for infected molar roots (particularly those within the sinus) to cause chronic palatal swelling?

3. The dentist mentioned having the molar extracted and the hole 'packed' to prevent an oronasal fistula. Is this normally done via local or general anaesthetic? I would prefer local, which shocked her as she said that most people would prefer not to be aware of it.

I'm looking forward to getting this treated but am also nervous that it's something more serious like a hidden tumor or something. I'm also really confused as to what causes this type of thing and what to expect from treatment. I just haven't heard of anyone else getting the same thing - especially with the palate!

Any advice would be much appreciated.

Best wishes and happy new year.

PJ

Hi PJ,

Thanks for the kind words.... :-)

Your description is very complete..... sounds to me like you have an infected molar and the infection may have spread to your sinus. Anytime you get a fistula near a tooth, it is indicative of an abscessed tooth. Eventually the swelling doesn't go down and the area becomes quite uncomfortable. Palatal swelling from an infected sinus is not uncommon.

If you could post an xray here or pm me.... I would be happy to look at it.

Bryanna

I saw the oral surgeon ysterday, and the more I think abbout this the angrier I am. My dentist insisted on deep root cleaning. Since I did not resolve the pocket with my great care, he told me to have surgeryon the gum. He didn't want to crown the tooth without this being done. I said no and asked for referal to the oral surgeon. The oral surgeon said the gum surgery would have been for nothing, as the tooth has an abcess, and is not salvageable even with a RC. He of course didn't recommend the RC for the same reasons you stated. so why was this first dentist recommending all this work around this tooths gum line when the tooth was no good anyway?It seems I waisted my money, and now no longer trust this dentist at all! My mate goes to this same dentist, and now neithor of us trust this dentist since he didn't tell me the true condition of the tooth to begin with. the absess was visable on the xray. My room mate was told she has paradontaldisease, and they wanted to do her whole mouth with deep root cleaning. What kind of dentist should she seek to confirm this diaganosis and get opinion from.?As I said I don't believe now, anything I am told by this origional dentist. I am kinda angry now, as there was a waiste of money as I am on medicare/medicaid, and feel like he was not truthful, did work that would not help. Need advise on what kind of dentist for my house mate, and for us to both have a new regular dentist that we can trust to tell the truth. appreciate you Bryanna very much.

Can't IM you. Let's try the x-ray this way. As you'll see, the area around the tooth is dark and is pretty much in the shape as where the swelling and discharge is coming from.

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Hi PJ,

Without any doubt whatsoever, you have a very large infection in this tooth that appears to have proliferated into your sinus. This tooth is severely decayed and broken down. There is no question about the diagnosis of this tooth.... it is very sick and should be removed as soon as possible. I also want to inform you that the second molar, the tooth behind this one, may also be infected and should be evaluated for extraction at the same time as the first molar.

I do not see any evidence of root tips from the extracted pre molar. However, the infection is long standing.... meaning it has been present and proliferating for a long time. That is evident by the size and circumference of the radiolucent areas on this xray.

Please, do not wait or hesitate about removing this (these) teeth.... this is a very large infection and it will travel past your sinuses if left in your mouth.

I urge you to act on this very soon.

Please keep us posted...
Bryanna

Thanks Bryanna,

So you're sure that it's the tooth that's causing all of this?

It kind of annoys me that in times past the dentists have not acknowledged my concerns of that tooth. The fact that there is no pain appeared to be indicative that nothing serious was going on, but quite clearly infections can present without being in agony. I'm also not feeling ill, which some people would assume with an infection.

I have a dental appointment in due course where my new, much better dentist, will refer me to a specialist surgeon to get this tooth (teeth) out.

May I ask - once the tooth (teeth) are extracted, should this enable the area to heal itself naturally?

Your help is much appreciated and although it doesn't look particularly pleasant, it's kind of reassuring to know that simply removing these teeth could sort everything out.

Best wishes

PJ

My dentist did not tell me the true condition of one of my teeth either. Your dentist didn't address the concerns for your health either. Glad you are getting a new dentist. I am also, from a referal from my new oral surgeon. I have a molar that I was not told was infected. It will be removed this coming week. It would be my guess that the infection will go away when the teeth are removed. I sure would ask him about that, and about antibiotics before and after the extraction. Bryanna led me correctly, have no doubt. She is awsome, helped my health, and got me to the oral surgeon, where the truth was given. I would not have known, and would have spent alot of money unessarily, had I not gone to her for direction. I wish you all the best. ginnie

Thanks Ginnie,

Crazy isn't it, I especially remember the previous dentist who insisted that as the fistula was where the 2nd premolar used to be, it was definitely retained root tips! New dentist advised that sinus tracts (i.e, fistulas, not maxillary sinus) can form anywhere as the infection finds the path of least resistance.

I guess I should be grateful that i'm feeling in general good health and aren't suffering at all, though the swollen palate was really giving me concern.

Glad you found direction on here and got yourself sorted. Makes you wonder how many people out there have underlying infections that they're not even aware of.

I have a feeling there are alot of us who do not know about these infections, and have dentists that are not truthful.. Believe me, I am soooo dissapointed in the dentist I went to. I thought it not moral to require proceedures which would not solve the problem. He did not expect me to say "NO". If I had not come here, I would have done something totally wrong for my condition. This site gave me the "tools" I needed to make the right decision. Aren't we glad we found some help here? I will never again go blindly into a situation, without first asking. Bryanna, has been that resource for truth. ginnie

PJ,

I am positive that the first molar is infected and the second molar is not looking a whole lot healthier. I would be surprised if the infection has not invaded the sinus membrane. This is a long standing infection.... I am guessing from the way it looks.... it is many years old.

One reason why you do not have pain is because the infection is draining from your tooth into your saliva and most likely into your sinuses as well. If the inflammation were to close off the areas of drainage, then you would develop severe pain and quite possible a large swelling. The palatal swelling is indicative of the build up of bacteria.

To be truthful with you about the healing from the oral surgery of these teeth.... it may be complicated depending on how far the infection has spread and may require a long bout of antibiotics. It is imperative that you see an oral surgeon who takes this infection seriously and discusses the extent of the oral surgery with you.

Sometimes a second surgery is needed to remove more necrotic bone and close up the sinus. This is something that is not always determined at the first surgery as it depends on the extent of what is found at the time of the extractions <<as well as how the healing goes because it is difficult to physically remove all of the necrotic tissue and bone when there has been a long standing infection.>>

Sometimes infections like this lead into bone infections that can be difficult to eradicate completely. They can also lead into a brain abscess or worse. It is so important to have a surgeon who treats this properly.

I'm truly sorry if I am scaring you.... my intention is to make it clear that this should not wait.

Bryanna