Hi Bryanna,

Yay! I am finally getting somewhere!! I just got a call from the ENT and they found inflammation and what they think is osteomyelitis above the implant from the MRI yesterday. I also have sinusitis on the left side. They are sending a copy of the MRI to the oral surgeon. And they are figuring out a plan. The only problem is now I am a little afraid to go to same oral surgeon. Not sure how to handle that.

Angels,

In one of my pm's to you I mentioned the possibility of you having osteomyelitis. This finding is not a surprise at all and it is not a "new" or "recent" occurrence. Irrelevant of whether it is seen or acknowledged by your dentist on previous scans, it was more than likely present not just this past 20 months, but prior to that because osteomyelitis is not an uncommon finding in the jaw bone of teeth that have been root canaled. Conventional dentists do not like to talk about osteomyelitis because it leads to too many questions about long term infection from root canaled teeth or questions about improper surgical debridement during the extraction of teeth. I am sharing this information with you in case your oral surgeon or other dentist seem disinterested or not overly concerned about this diagnosis. Biological dentists see osteomyelitis for exactly what it is ... a serious systemic bone infection.

Osteomyelitis is a bone infection which can happen in any bone of the body. It is a very invasive infection that travels through the bloodstream and therefore easily to the surrounding areas, and beyond, of the original site. This would explain why you have all the on going symptoms that you do with your upper left sinuses, mouth, left ear, left glands in your neck.

The inflammation and sinusitis are not separate from the osteomyelitis. One should not be treated without the other. Meaning antibiotics are not going to cure the inflammation or the sinusitis so long as the osteomyelitis is present.

Did you tell the ENT that you are hesitant to go back to this oral surgeon? If not, then you really should because he may be "glad" to hear that because he will not take it upon himself to refer you elsewhere if he thinks you are comfortable seeing that oral surgeon. Please, don't assume anything this time around and make sure that the ENT knows how you feel. The ENT needs to speak directly to whatever oral surgeon you are going to go to.

I cannot stress enough to go with your gut instinct on this. Don't dismiss the numerous times that oral surgeon dismissed your symptoms or how he scared you into doing the implant or how he didn't diagnose the osteomyelitis before now. If you trust the ENT to take care of you properly, then he needs to know all of these things asap so he can collaborate a treatment plan with a different oral surgeon.

Bryanna

Hi Bryanna,
This is a little more complicated than I thought. The ENT just called me and told me he spoke to the oral surgeon. He said the oral surgeon does not want to take the implant out and thinks we should just treat this with antibiotics. I have been on so many antibiotics and it isn't helping. The ENT is recommending that I have the implant taken out. He said that the oral surgeon is out of his comfort zone with this bone infection. So they are sending me to an infectious disease doctor to take care of the bone infection. But the ENT says that it will be easier to treat without the hardware of the implant. He said if it was him, he would take the implant out. Now I did voice my concern about the oral surgeon and he suggested I stay with the same one because he knows what he did when he put it in. My guess is that the 2nd oral surgeon doesn't want to get involved. This is a giant mess and all I want to do is feel better. Do you have any advise? I have a call into the oral surgeon now.

Angels,

I have been saying from the get go that it's complicated but your oral surgeon kept making it seem like there was nothing wrong. Then to make matters worse he scares you into doing the implant. Even now, he fails to admit the seriousness of the situation. It is not in your best interest to keep the implant and just keep taking antibiotics because you can end up with major health issues as well as intestinal problems that can be very difficult to eradicate.

In my opinion, the oral surgeon is caught between his ego and the money he has been paid and doesn't want to admit his role in this nor lose a dime.

Regarding the removal of the implant ... If "he" removes the implant "now" then without question he should reimburse you and your insurance for all the monies he received pertaining to the implant surgery. He also should not charge you to remove the implant. However, if he can convince you to keep the implant for 6 months to a year and then remove it, even though that is not in your best interest, then he can argue about not being obligated to give any financial reimbursement because of the amount of time that had transpired.

If another oral surgeon removes the implant he will need to have...

ALL of your xrays and scans from the other surgeon.
ALL of your chart notes and surgical reports from the other surgeon.
He will also charge you to remove the implant and perform whatever other surgery needs to be done. Your insurance is not likely to cover any of that cost if there is little to no money left in your yearly allowable budgeted amount.

If the original oral surgeon is not willing to reimburse you and your insurance company, irrelevant of whether he is the one to remove the implant, then you will need to write to your insurance company telling them...

**That the implant was placed in infected bone as confirmed by the recent MRI.
**The oral surgeon refused to remove the implant and you had to seek another oral surgeon to remove it.
**You want the insurance to bill the oral surgeon for reimbursement of the money they paid him for the implant and bone graft surgery. This will put money back into your insurance account to be used for other dental work.
**You then want the insurance to consider paying the fee for the removal of the implant by a different oral surgeon.

The reason the ENT is suggesting that you stay with this oral surgeon is not because he thinks he's going to do right by you, but because he knows that any other surgeon is going to be hesitant to get involved in this case. Why? Because there is a chance you may have to consider taking legal action against the original oral surgeon. Especially if he is not willing to reimburse you and your insurance company.

Another oral surgeon will be able to remove this implant. Having the xrays, scans, charting and surgical reports are all very helpful and necessary as they give the history of what has taken place and the particulars related to the bone graft materials and type and size of the implant that was placed. However, the surgeon will not know the extent of the infection until he gets in there.

An infection disease specialist should get involved as I mentioned to you in a previous note because this is a difficult infection to manage. However, treating the infection while keeping the implant could be detrimental to your health in more ways than you know.

Angels, I would be hesitant to have the original surgeon do any further surgery. He has built a shaky history with you and just does not seem to have your best interests before his own ego or wallet. That's how it looks to me and I've seen it many times before.

Bryanna







QUOTE=Angels31;1220594]Hi Bryanna,
This is a little more complicated than I thought. The ENT just called me and told me he spoke to the oral surgeon. He said the oral surgeon does not want to take the implant out and thinks we should just treat this with antibiotics. I have been on so many antibiotics and it isn't helping. The ENT is recommending that I have the implant taken out. He said that the oral surgeon is out of his comfort zone with this bone infection. So they are sending me to an infectious disease doctor to take care of the bone infection. But the ENT says that it will be easier to treat without the hardware of the implant. He said if it was him, he would take the implant out. Now I did voice my concern about the oral surgeon and he suggested I stay with the same one because he knows what he did when he put it in. My guess is that the 2nd oral surgeon doesn't want to get involved. This is a giant mess and all I want to do is feel better. Do you have any advise? I have a call into the oral surgeon now.[/QUOTE]

Hi Bryanna,
I have a couple of questions. What do they put in when they take the implant out? Do they put another bone graft? Nothing? Also, how come my bone infection didn't show on a CT scan? The second oral surgeon I went to is highly respected and also an MD. You would think he would have seen it? The first oral surgeon has not returned my call. I know you are right about the ego and greed. You have been right about this whole thing all along.

I called the 2nd oral surgeons office and they said absolutely take the implant out. The 1st oral surgeons office called me and the were fighting me on taking it out. The ENT said that if it were him, he would take it out. He didn't say I had to have it taken out. So when I was on the phone with the 1st oral surgeons office they put me on hold and called the ENT. Then came back and said something like he didn't say I had to take it out. I made appt to have it taken out on Thursday, because I told them the ENT said if it was him he would take it out. So now I bet they will still charge me and tell me it was my choice. Meanwhile, the 2nd oral surgeons office told me not to mess around with a bone infection and to get to an infectious disease doc right away. Apparently there are no appointments available until October. I am going to have ENT call to get me in earlier.

Angels,

The implant is removed, the jaw bone and sinus are surgically debrided of all visible infection, necrotic tissue and bone. This surgery NEEDS to be very thorough and meticulously done. It cannot be done quick or carelessly. Sometimes there will be an opening into the sinus which may or may not be able to be repaired during this surgery. That may require a different surgery. It all depends on how extensive the infection is and how thorough the surgeon is able to perform the surgery. Bone grafting is not usually put in at this surgery as there could still be microscopic areas of infection which would hopefully be taken care of with the antibiotics. The antibiotics need to be specific for the type of bacteria that is causing the infection. A clean specimen of the bacteria should be taken at the time of this surgery and sent to a pathologist for culturing to determine the proper antibiotic. This is a CRUCIAL step and should be done.

This bone infection is long standing... it began as far back at the root canal therapy. It may not have shown on the CT scan as definitive infection or the angle of the scan was off... there are a number of reasons why it was not picked up. It could also be that is was visible but misdiagnosed as graft material.

The second oral surgeon is a better option to see for the removal of this implant ..... not the original surgeon. Please, think twice before letting the original surgeon do any further treatment.

Bryanna

Angels,

Who did you talk to at either surgeons office? You should only be talking with the surgeons, no one else.

The ENT obviously feels like he is caught in the middle. His one on one statement about what he would do if it were him was his way of telling you... take it out but he was careful how he phrased it because he didn't want to step on the surgeons toes or make it appear to you that the surgeon misspoke. Now because of your conversation with the surgeons office you have made him look like he spoke over the surgeon, which is what he was trying to avoid.

Angels .... why are you going back to the original oral surgeon?? He has not done right by you over and over again and he's made it clear that he does not want to remove the implant. What makes you think he is going to do a thorough job? He is not on board with doing this and he could care less.

If this were me I would go for a sit down consult with the 2nd oral surgeon and at that meeting have ALL of my stuff from the other surgeon with me .. ... xrays, chart notes, and surgical reports. Discuss a plan on how to properly proceed which would include COLLABORATION between .. the 2nd oral surgeon, the ENT and the infection disease specialist. I would leave out the 1st oral surgeon completely as far as any treatment is concerned.

Do you see clearly what has happened over the last 20 months because there was no collaboration and because you had an oral surgeon who is motivated by ego and $$$? You have a very very serious systemic bone infection. It needs the expertise of a qualified oral surgeon (not the original one), as well as the ENT and the infection disease specialist. Those three will decide together how it is best to proceed. You may need to have a culture done first... or blood work or both. You may need to be on a specific antibiotic prior to and during the surgery and for a length of time afterwards. The ENT may have to be involved in the surgery. These are all important issues that need to be discussed before you go having anyone remove the implant. Going from one to the other on your own is not wise and going back to the original oral surgeon is also not wise... in my opinion.

I know you are anxious to get this done. But please stop and think for a minute about the best way to proceed so that you don't end up in a worse situation.

Bryanna

I would NOT let either of those oral surgeons touch me again. They have already failed to treat you properly! I would suggest legal advise again but you seem hell bent on not needing it!

Hi Bryanna,
Both the ENT and second oral surgeon have told me that I need to have the original oral surgeon take out the implant. He is going to do just that, he isn't going to do a big cleaning and surgery. I am having a heck of a time. The infectious disease doctor can't see me until October and the ENT is not willing to help me get in earlier, they told me that I would need to,go to the ER to get in earlier. I believe this implant is making me sick and I really need it out. The second oral surgeon said it should be easy to take it out because it has only been 2 weeks. I really feel like nobody cares and I am on my own fighting for everything. I am so confused, I have an infection in the bone but I have to wait two months to be seen? This is beyond frustrating and yes I am very uncomfortable having the first oral surgeon take it out especially when he told the ENT this bone infection is out of his comfort zone. He wanted to treat this with antibiotics, but what he doesn't realize is how long I have been on antibiotics. I am bringing a list with me from the pharmacy to show him.