Dear Bryanna,

Thank you so much for checking the x-ray.
This is unbelievable. I spent the past 5-8 years trying to convince dentists (at least 10) and ENT that there is something going on in my face. Numerous X-rays, nothing.
Once in a while I woke up with a weird feeling on my left side, a little swelling.
Because I was attacked 10 years ago (broken eardrum, upper teeths on the left side) a few dentists blamed it on that. ENT checked my sinuses last time a year ago and gave me the all clear.

Noone ever mentioned of a visible ongoing infection. To be fair, had no other symptoms at all. No pain, running nose, facial pressure, nothing.
In fact last week on Thursday I saw a dentist who said he would re-fill the RC tooth on the left side and it will be ok. Not the roots, that I already had done less than a year ago. He was very convincing. I went back the next day and had them pulled by another dentist. After the extractions the dentist said nothing about sinus perforation and when I called them on my way home that something is wrong I was told that it heals by itself, not to worry.

Sorry, back to the unfortunate present .

Now I think the right side (with the one tooth deep in the sinus) despite the second operation is still open. Or open again, and hat was the noise yesterday morning, no idea. Still swollen, much less though. I have been sleeping in a semi-sitting position since the extraction. Pressure in the face or rather head is bad. Nothing comes from my nose.

The affected first molar: if the hole does not close on its own than while having the operation I will have that removed too. If the hole closes by any chance and the tooth is affected still will have to have it pulled in the close future, resulting in another sinus opening. Now I rather wish it would not close this time.
I rather remove all teeth that might have a negative effect on my health, also the ones that are likely to become a problem source soon. Will do it all within a year whatever it takes and be all clear after that, with some nice dentures.


Yes please please would you tell me what else of concern can you see on the X-ray?
It would help a lot in solving these issues and in finding a doctor who is more likely to take on complicated problems.
For example the tooth before the first molar might also be affected you think?

Thank you. Thank you.
Elna

Hi ELna,

It is not unusual, as you may have read on many occasions on this forum, for people to see several dentists/doctors about chronic symptoms and be told everything was fine. Sometimes dentists zero in on one particular area rather than the whole picture because they either don't want to inform the patient of everything that is going on for fear that the patient will be overwhelmed and not come back OR they get the impression that the patient only wants them to zero in on one thing at a time. I am not justifying this as a proper way of doing things, but it is often what happens.

I am going to assume that the xray you posted is a mirror image of your mouth. Which is what it should be if you did not flip the xray over before you copied it. In other words YOUR right side, which is marked with a large "R" is on the left side of this photo when looking at it.

The panoramic xray is very diagnostic if you want a view of the upper and lower jaw in their entirety. However, for better detection of decay and certain pathology, it is wise to have a full series of xrays, this is 18-20 small xrays, done in addition to this panoramic xray. Those xrays would give a close up view of each tooth and be more diagnostic at detecting cavities.

With that said...........
On this panoramic xray, your left side has a wisdom tooth, #16, that may have extensive decay on the back portion and even under the existing filling. The rc molar tooth next to that, #15, that you just had removed showed radio graphic pathology surrounding that tooth which appears to be in communication with your sinus. You are missing teeth #13 and 14. Tooth #12 has a large filling with possible decay around the filling and possible pathology around the root surface. The vitality of that tooth may be questionable because the central nerve chambers are only partially visible. Which could indicate calcification of the canals and/or infection. This could also be caused by the injury that you sustained to that side of your face.

Across the upper arch over to the wisdom tooth #1, this tooth may have decay on the mesial (next to #2) near the gum line. Tooth #2 which you recently had removed, appeared to be in communication with the sinus and had many things going on with it. The next tooth #3 is possibly non vital and appears in communication with the sinus. Most of the upper portion of this tooth is surrounded by a large radio-lucent (dark) area which could be infection. Teeth #4 and 5 should be evaluated for decay with those small xrays I mentioned.

Your lower right side, you are missing a molar and then tooth #29 has a cavity on the distal (back) portion of the tooth high up near the occlusal (biting) surface. Going over to tooth #20 the lower left root canaled tooth there may be decay on the distal (back) portion along the gum line underneath the filling.

The small xrays, called periapical and bitewings, would be very helpful in diagnosing decay and pathology in the areas that I mentioned and would give a clearer view of the other teeth as well. Without those xrays, it is easy to miss certain areas of decay or pathology.

How are you feeling today.... how is the swelling and the air sounds??

Dear Bryanna,

Thank you very much for all this information. It is priceless and will help me a lot in trying to solve all problems. Now to find a dentist in London who is willing to take the time you did to analyse the situation and also has the expertise to see it as it is plus willing to actually fix things. Good luck to me but thanks to you I have something to measure by. I'll ask about the first molar, whoever is honest about it might be the ONE.

The series of small x-rays is what I'll start with once this is over.
Swelling is gone as of yesterday (there was a hard lump on the right side that worried me but gone :-)), left side feels normal, the right one felt better until yesterday evening when after a week of silence and liquids I raised my voice for one word (for safety), felt pressure and now it's more tender and funny again. I didn't feel it rip or anything so I'm hoping it's just been stretched. Very frustrated, I was so careful. But I am not testing it until after the stitches are removed. The weird air-sound didn't repeat.

I hope that it will close for now, I can have a break, find a dentist to fill all cavities one by one, take the last root-canaled out and meanwhile I can find an oral surgeon to deal with the first molar. Maybe a good dentist knows a good OS. I'll probably have the top wisdom teeth removed together with that one if necessary.

I have one more week now before the stitches are removed. I'm thinking of going somewhere else for that too.

Thank you. I'm sorry, this is a not-so-good day. The last dentist before this I saw in December, he was keen on making a crown and told me nothing about molars either.

Thank you so much.
Elna

It did break yesterday. It would have healed. I have not been using nasal spray for 2 days, now I decided to give it a go and I could feel a sucking (and pain) on the right side I have not felt when using it previously.
(not crying, can't blow my nose)

Is there any chance for it to heal on its own now? Had no problem with the nasal spray before at all.
Thank you

Dear Bryanna,
Hope you are well.
I am going back to see the 1st OS tomorrow as figured he can't do much damage removing the stitches but made an appointment to an apparently really good delntist to proceed with the rest next week. She is young and a dentist but with excellent reviews and willingness to help plus works one day a week on the OS ward in a hospital.
Also made an appointment to my GP and will ask him to refer me to OS to check the damage. This will take weeks / months but in that case the doctor will see the end result and can advise on the first molar.

The OS I'm seeing tomorrow said he will remove both stitches. The left side will be two weeks on Saturday and feels ok, but the right side is only 10 days since surgery by then and does not feel right - I just started to have a better feeling yesterday.
I'm worried he'll insist on removing it tomorrow. That's not his work and he's not here next week. In general, should I keep myself to the two weeks the operating surgeon said (he won't be here either but someone else can remove it next week)?
Do a few days make a difference at this stage if it's not closed yet or anyhow?
Can I wait until Monday and have them both removed then?

Thank you so much again.
Elna

Hi ELna,

All of the answers to your questions depend on what is going on clinically. Meaning, your situation needs to be evaluated clinically, visually and perhaps radio graphically as well. There is no standard remedy or standard time frame for a sinus perforation because there are various contributing factors as to why the sinus is perforated, how large of a perforation it is, and what is causing it to stay perforated. Those all require clinical evaluation.

Any general dentist, unless they have extensive training in oral surgery, will most likely not be able to address your sinus situation. They are just not educated on how to deal with it. If they are a new general dentist then they have little to no experience dealing with complicated sinus perforations. I just want you to be aware of that. When you see the OS to remove the stitches, tell him all of the symptoms that you have been having. Sometimes just one xray will show whether or not the sinus is still open and it can show pathology indicating infection. So please don't be shy about telling them to take an xray of that area.

Hopefully this visit will be better than the past. Keep in touch........

Thank you Bryanna, for all the answers. Had the stitches removed from the left side and going back to have the ones from the right side removed on Tuesday.
Can I have one last question please?
I was taking Amoxicillin 500 for 2 weeks which ran out yesterday. The OS said the one with the stitches still in is a bit infected what he thinks due to the stitches themselves now AND there is still an opening there. I asked him whether I should carry on with the antibiotics until the stitches are out but he said 'not for now'.
I feel something new and not good on my right side this evening.
Do you think people with sinus perforation should stay on antibiotics at least until the stitches are out? An infection now straight walks up to the sinus doesn't it? I can't have another lingering condition really.

Thank you. This was the last one really. Thank you!
Elna

Hi ELna,

I don't mind your questions, really. Feel free to ask them here

Staying on the antibiotic does not necessarily need to be done for all types of infections. In your case, to not renew the prescription is a judgement call by the oral surgeon. However, the ongoing symptoms and now new symptoms with your right side seem to indicate a chronic infection. As I stated to you previously after you posted the panoramic xray, there appears to be a large radiolucent (black) area in the bone/sinus above the first molar and recently extracted second molar. I do not know why your dentist is not reviewing that pathology with you.

If the symptoms on the right side are not better or gone by Monday, please call the oral surgeon and report your symptoms to him. I wish there was more I could offer you about this, but your dental problem requires a thorough clinical evaluation and additional radiographs.

Did the OS instruct you to continue using a nasal spray? Did you ask him about using saline spray instead of the other? Did he suggest that you rinse your mouth with warm salt water rinses a few times a day?

Dear Bryanna,

Thank you.
I tried the saline nasal spray but as I can't blow the nose it did not do any good yet - I'm keeping it for later. I used the decongestant spray for the first week then took Sudafed for the second week and now I'm going with nothing for a few days, returning to the spray for a couple of days if needed. Even though I feel a bit wet after drinking or brushing the teeth, its not uncomfortably blocked.

Had the last stitches removed yesterday. Booked an appointment at a hospital a month from now to check the sinuses.

I know it is still open, but feels a lot better and I really hope it will heal on its own now.
I have another problem though, one I wasn't paying attention to because I thought it was caused by the stitches. Where the operation was more severe, on the right side, things are not moving as they should. It has nothing to do with RHS, it is something caused by either the injections or the sutures. For a good week I had a hard lump that slowly went away. I was scared to move my mouth too much, didn't eat talk or do much at all. The lump is gone, I was told there is no infection.
But I can't smile all the way, it feels like the inside of my cheek is smaller or something. My eye is pulling too a bit. I'm scared of trying to push it in case I break the healing membrane but I'm very concerned.
If the injection in the cheek from the inside hit a nerve or sg will this feeling go away? Have you heard of anything like this? Please, I do know it's not RHS, that I know inside out. But it would kill me to lose movement now because of dental work after having recovered (facially) from RHS.

Thank you so much.
Elna

ELna,

I really don't know what is going on with the right side. The pulling of your eye is a bit concerning. Did the dentist know about this yesterday when he removed the stitches? What are you afraid to push in? Is the lump still there or what feels like it needs to be pushed in?

Bryanna