[Louiske]

Hi Bryanna,

I had sinus lift surgery 1.5 - 2 weeks ago in preparation for two dental implants (2nd & 3rd back molars) schedule for later this year. The dentist has a Bachelor of Dental Surgery and a Postgraduate Diploma of Clinical Dentistry (Oral Implants). Prior to conducting the bone graft surgery it was agreed that he would extract the broken remnant of #3 root canal as well as a broken #2 root remnant apparently remaining from an extraction performed two years earlier whilst traveling in France (I remember the sound of the tooth cracking at the time but had no idea that a broken root remnant had remained!!)

Following the sinus lift surgery I was advised that in addition to the extractions and the bone graft (bovine) that the dentist had also performed an additional surgery: to repair a perforated sinus membrane (using pig membrane). While it hadn't been evident in the X-rays, it was apparently necessary as the root had penetrated the sinus membrane. I was advised that there would be no charge for the sinus membrane surgery (usually an expensive procedure) - suggesting to me that perforation had possibly been caused by human error? I asked if I could see the root remnant but the dental assistant advised that it wouldn't be possible as it had already been thrown out. I was prescribed and completed a course of anti-biotics (Amocycilin).

The following week I caught a cold and have been taking nasal decongestants (Codral) since (as I'm not allowed to blow my nose and there was some serious dripping from my nose :-) When I returned to have the sutures removed 10 days later (two days ago) I was advised that there had apparently also been an abscess which had required quite a lot of scraping. However he seemed pleased with the progress and advised me that things were healing nicely and he also thanked me for the confidence I had placed him. But then suddenly this evening, a bad-tasting discharge has begun oozing from the site. I have been placing cotton wool swabs on the area to soak up the discharge but the smell and yellow/brown color indicates that there is now an infection. I am becoming concerned about the infection but the dental surgery is closed for the weekend and doesn't provide an after-hours number.

Should I look for an after-hours doctor who can prescribe another course of antibiotics this weekend? And should I be seeking a second opinion regarding the surgery and any potential complications associated with the sinus membrane repair and bone graft surgery in the presence of a serious abscess?

Thanks for your help - you seem extremely knowledgeable and I am becoming a little anxious!

[Bryanna]

Hi Louiske,

I am in the dental field and can offer you some information here.

So based on your detailed description this is what appears to be happening.
The retained root tip from the previously extracted root canaled tooth had perforated the sinus and bacteria evidently set up house around that piece of tooth, which is highly likely to occur most of the time especially if the tooth had been root canaled. The dentist who did the recent surgery removed the root tip but in doing so either perforated the sinus further or realized the sinus was more open then he anticipated and very infected as well. If a dental ct scan had been done prior to the surgery the location of the root tip and infection would most likely have been picked up.

By the way, I believe the credentials for this dentist indicate he is a general dentist, not an oral surgeon. Most likely he was surprised at the extent of this problem and not 100% sure how to deal with it and I'm sure did the best he knew how. However, most general dentists have very little education or experience with the extensiveness of this surgery and I think that is why he was thanking you for having so much confidence in him. FYI...It's always good to ask if the dentist is a maxillofacial oral surgeon or a general dentist.

I am not so sure you developed a cold as it could be a draining abscess from the sinus. I suggest you call the dentist office and tell them you need to speak to the dentist as you have a surgical complication. He will either come in and see you or prescribe antibiotics. However, ideally this problem really needs to be evaluated by an oral surgeon who would need your pre and post op xrays for proper evaluation.

Please let me know how you are doing.
Bryanna

Originally Posted by Louiske

Hi Bryanna,

I had sinus lift surgery 1.5 - 2 weeks ago in preparation for two dental implants (2nd & 3rd back molars) schedule for later this year. The dentist has a Bachelor of Dental Surgery and a Postgraduate Diploma of Clinical Dentistry (Oral Implants). Prior to conducting the bone graft surgery it was agreed that he would extract the broken remnant of #3 root canal as well as a broken #2 root remnant apparently remaining from an extraction performed two years earlier whilst traveling in France (I remember the sound of the tooth cracking at the time but had no idea that a broken root remnant had remained!!)

Following the sinus lift surgery I was advised that in addition to the extractions and the bone graft (bovine) that the dentist had also performed an additional surgery: to repair a perforated sinus membrane (using pig membrane). While it hadn't been evident in the X-rays, it was apparently necessary as the root had penetrated the sinus membrane. I was advised that there would be no charge for the sinus membrane surgery (usually an expensive procedure) - suggesting to me that perforation had possibly been caused by human error? I asked if I could see the root remnant but the dental assistant advised that it wouldn't be possible as it had already been thrown out. I was prescribed and completed a course of anti-biotics (Amocycilin).

The following week I caught a cold and have been taking nasal decongestants (Codral) since (as I'm not allowed to blow my nose and there was some serious dripping from my nose :-) When I returned to have the sutures removed 10 days later (two days ago) I was advised that there had apparently also been an abscess which had required quite a lot of scraping. However he seemed pleased with the progress and advised me that things were healing nicely and he also thanked me for the confidence I had placed him. But then suddenly this evening, a bad-tasting discharge has begun oozing from the site. I have been placing cotton wool swabs on the area to soak up the discharge but the smell and yellow/brown color indicates that there is now an infection. I am becoming concerned about the infection but the dental surgery is closed for the weekend and doesn't provide an after-hours number.

Should I look for an after-hours doctor who can prescribe another course of antibiotics this weekend? And should I be seeking a second opinion regarding the surgery and any potential complications associated with the sinus membrane repair and bone graft surgery in the presence of a serious abscess?

Thanks for your help - you seem extremely knowledgeable and I am becoming a little anxious!