Hi,
I just thought I would update on what is happening with me. I am still battling this sinus issue. Although it feels a little better, these last two days seem to have gotten worse again. I have been to a total of 4 ENT's and two Oral surgeons now. The ENT's are saying my sinuses are beautiful, I do not have a sinus problem. All of them have said that. I have had 4 ct scans and 1 MRI. Both of the oral surgeons say there is no problem with the extractions. They are friends, so I am thinking that the new one didn't want to step on the other one's toes. He didn't do much of a check up. I am going to try to go to the original oral surgeon one more time. But my symptoms are still there, the site still hurts sometimes, I am still getting pieces of bone out, I am still getting the sour taste that seems to be coming from the site. They say the site is completely healed and it wouldn't be coming from there. Also, my post nasal on that side feels like there is stuff in it and I still have a crusty nose. (And they say there is not a sinus problem!) i also have constant ringing in my left ear.it really feels like there is still something wrong. It has been 8 months now. My plan is to go back to the original oral surgeon and if he doesn't find anything than I need to find the very best oral surgeon that is good at figuring out what is going on. I am willing to go anywhere in the country for that. Bryanna, do you know anyone that could help me? I know you have suggested that the doctors talk to each other but how could they talk to each other when they don't think anything is wrong. Also, I am worried about how much radiation I could be having. Would an MRI show more? Isn't that less dangerous? I am sure the ENT would order one for me. I am so tired of living like this. I really want to feel normal again.

Angels,

Please re read all of the posts you wrote on this forum along with my replies regarding your dental situation. There are some discrepancies which leads me to believe that it's possible you may not be asking questions of the doctors and dentists that you see.

In January you had a CT scan and you stated ... <<ENT thinks there may be root tip remnants. Oral surgeon says no.>>
Without question, this oral surgeon and that ENT need to collaborate on your case. The ENT will tell the surgeon of his CT findings, the surgeon will recheck the scan if for no reason other than to cover his own butt, they will discuss your symptoms and complaints, etc.

In May you saw a NEW ENT who acknowledged something is wrong. He also diagnosed you with Klebsiella Oxytoca in your sinus via specimen and culture. The other ENT missed this and in all probability it was not a new infection. It also clearly means you had/have a sinus infection. How did you get that? Likely from the infected teeth. It could also still be lingering if there is a piece of infected root or bone or some other irritant still present in that site. By any chance, did the ENT ever retest you after the antibiotics were done? If so, what were the results?

In June you stated << everyone says there is something in the sinus, maybe it's packing that was placed after the extraction>>
I replied to that statement asking what packing were they referring to. Did you ask them to elaborate on that? Can you understand that "packing" material is not something that should still be present months after a tooth extraction? Were they talking about bone graft material? These are questions that need answers.

Also in June you stated << dental don't see anything, ENT and radiologists do, yet the sinuses are fine>>

So my questions to you are ... Who sees what? How can the sinuses be fine if you still possibly have Klebsiella Oxytoca? What packing are they referring to? How can everything be fine if you still continue to have definitive symptoms of an infection and problems with not just the sinus but the jaw bone as well? Do you still have periodic swelling in your neck?

To be honest with you, at this point any new dentist you go to is going to be reluctant to take your case because given the history it's fairly clear that something is wrong and in all probability it's been wrong from the get go. Anyone new that intervenes with surgical treatment or other will be concerned that they are opening up a can of worms and they don't want to be the one blamed for anything. I know that sounds unfair but can you appreciate why they would be reluctant? Also, there is no logical reason to have had 4 CT scans in addition to an MRI. That is a lot of radiation and you should be mindful about subjecting yourself to anymore of it for several years unless due to an emergency situation. It takes years to clear yourself of radiation that has been accumulated over a short period of time. Your profession subjects you to an abnormal amount of radiation as it is, never mind repeated CT scans of your head. Please do not let anyone talk you into doing another scan.

I would recommend that you choose an oral surgeon, perhaps the original one, along with the ENT that stated something is wrong and diagnosed the Klebsiella and get them to collaborate. If the original oral surgeon is not willing to collaborate with the ENT, then I would recommend that you tell him you want a copy of his surgical report and all notes in your chart. He has to legally give you a copy of both of those. Take those papers to another oral surgeon and have that oral surgeon collaborate with the ENT.

Until you get the ENT who acknowledges a problem and an oral surgeon (irrelevant of his findings) to talk to each other, you are not going to get off this merry go round. It is up to you to get a collaboration going.

Bryanna

Hi Bryanna,
The packing they referred to was the bone graft. This ENT looked at my latest CT scan and said there were roots in my sinus. Then he asked if there was a bone graft and I said yes. He said that is what it is then, he is seeing the bone graft. . The latest test came out with a small amount of Klebsiella. I have been putting antibiotic cream in my nose for that. The ENT said it shouldn't be causing the problems I am having. My symptoms are still pointing to a problem where the teeth are extracted though. I KNOW that there is a problem there, I can feel it. But everyone keeps writing me off. How do they figure that out without scanning the area? That is why I asked about the MRI. It was the MRI that found the dental problem in tooth 15 not the CT scan. I haven't had an MRI since I had 15 removed and that is where I feel the problem.
Yes, I am still having a problem with my neck swelling on the left side and I have thick mucus that seems to originate from above the area where the teeth were removed.
I think that they are looking for sinus infection or sinus disease in the ct scans and I have neither.
So in answer to your question about who sees what is the oral surgeon sees nothing wrong and the ENT thought he saw roots in my sinus but now says it is the bone graft material.
I understand that I am a hard case, but something is really wrong. I am not crazy and I am not a baby. I can take a lot of pain. For many years I had cavities filled without novacane.
I am just so sick of being uncomfortable and have nobody listen to me. I am going to go back to the oral surgeon one last time. He does seem like a very egotistical guy, so I am sure he will say nothing is wrong. Then I will go see the ENT again, I am just not getting anywhere. I honestly don't know where to turn after that. Thanks for your help.

Angels,

Thanks for the clarification.

I completely believe you have an ongoing problem but your case did not have to become this difficult. I also believe if the ENT and the OS had collaborated at the onset, intervention by one or both would have taken place by now. Or the ENT, after speaking to the OS, may have referred you to another surgeon if he felt this guy was not willing to address the problem. Your symptoms, your complaints, are all frequently seen and heard with dental patients who had infected root canaled teeth extracted, especially in cases where there is sinus involvement. So this is NOT an unusual case for them ... it's just been poorly handled in my opinion.

Here's some things that could be contributing factors and if you put them together like a puzzle the situation may make more sense to you.....

1) You had a long term, chronic and active infection in your teeth that spread to the jaw bone, the ligaments, and the sinus. The infection had also become further systemic as indicated by your swollen glands.

2) **Re read this paragraph as you review the others**
Any debris left in the extraction sites, meaning pieces of tooth, infected and/or splintered bone, periodontal ligaments, root canal material, infection in the sinus, that was not removed at the time of the extraction surgery has continued to fester or at least kept the infection alive.

3) If I recall correctly you were prescribed Levaquin by the OS. This drug should only be prescribed very carefully and with caution. The FDA, of which I am not really a big fan of, has issued strict warnings on this drug to be administered with extreme caution. The potential side effects of Fluoroquinolone drugs are to be considered very seriously before prescribing this medication. In spite of taking this medication, you continued to have assorted symptoms of an infection along with swelling in the neck. So the risk of taking it may not have outweighed the benefits. I would urge you to use caution if you are prescribed a Fluoroquinolone drug again.

4) Then the ENT diagnoses a Klebsiella infection in the sinus. So how effective was the Levaquin and did the oral surgeon explore the sinus when he extracted the teeth?

5) Placing bone graft material in a site that still harbors infectious bacteria, whether it be from the "debris" that I mentioned or from a sinus infection, is not going to heal properly. The patient will continue to feel unwell, glands will swell, pain may be present, mucus may discharge from the mouth and/or the sinus, post nasal drip from the nose down the throat, sour or unpleasant taste, etc.

6) When bone graft material is placed in a clean and healthy site of the jaw bone, within a few months the graft material has integrated well enough with the healthy bone that it would not stand out on an xray or a scan as something that resembles a piece of tooth. When grafting does not integrate well with the jaw bone, it can give a radiograhic appearance of a tooth root or resemble a blob rather than bone. These are things that would be discussed between the ENT and the OS.

7) You have had enough scans to detect and diagnose the problem.

In my opinion, I think the oral surgeon figures when he goes in to do the implant he will explore and may debride the site at that time. Or he may not do either of those things and just place the implant and then prescribe more antibiotics. Unfortunately the later is often what is done in cases such as yours and the outcome is often unfavorable. Ideally the surgical site and the sinus should already be free of infection and all irritants "long" before the implant is placed.

Have you asked the ENT to discuss your case with the Oral Surgeon?

Bryanna

Hi Bryanna,
I went to the oral surgeon on Monday. He did a CT Scan, panoramic and X-rays and could not find anything wrong. He says that if I don't do the implant now then I will have many other problems. I am losing bone and the opposing tooth is rising up. If I don't get it I will end up having to have a root canal on the opposing tooth. I am scheduled to get the implant later today because I didn't know what else to do. Meanwhile, I woke up today and am having all sorts of sinus issues on the left side. My left ear is constantly ringing and there is a lot of fluid on that side, not to mention the pain where the teeth were extracted. (Which the second oral surgeon called phantom pain) . I called the oral surgeon that gave me a second opinion because I remember him saying that he disagreed with the first oral surgeon that all sinus issues should be ok before I do it. I thought I could bring my new X-rays to him but he basically just blew me off. So the ENT says nothing is wrong and so does the oral surgeon. But, something is definitely not right to me and nobody will listen. I have been crying all morning because I am really sick of this and I am so frustrated that nobody can find anything. There is something wrong and nobody cares. My appointment is at 2:30 today he said that it won't affect my sinus one way or the other.

Well it has definitely made my sinus problem worse. He showed me where it didn't affect my sinus and showed me on the X-rays where the implant was. I really don't know what to do now. My sinus and nose are really messed up and my left ear is ringing louder than ever. Can this be fixed? Can they take the implant out? I never should have let him talk me into it. He really scared me if I didn't do it. I should have listened to myself. Now I am going to look into going to the Mayo clinic. I really need to get to the bottom of this, I really can't live like this anymore. M
It looks as though the Mayo clinic in Minnesota also has a dental part. I know this is being caused by my teeth but unfortunately nobody in San Diego will listen.

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,

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!

Cleo,

The second oral surgeon has not performed any treatment on Angels. He is reluctant to do so, which any other oral surgeon would be also, as long as she stays under the care of the original oral surgeon.

I don't know her reasons for not seeking legal advise but it just may be because she feels to ill to deal with it right now. If she can let go of the original surgeon and work with the ENT, the second oral surgeon and the infectious disease specialist, once she feels a little better she can then proceed with legal counsel. At least that is how I am interpreting the situation as it stands right now.

Bryanna