Thanks for the detailed reply.
I think his ongoing dental issue is intricately connected to his systemic health.
How many doctors/practitioners is he seeing? Are some conventional and some integrative? Are any of them collaborating with each other about his case or is he seeing them independently with no collaboration? Is the dentist a general dentist ... and is he biological, holistic, conventional??
Are you familiar with Functional Medicine and how different that type of health care compared to conventional healthcare?
The dental aspect:
Did he have or does he have:
*Other root canaled teeth? This would affest his adrenal and gut health.
*Periodontal disease? This too affects adrenal and gut health.
*Mercury dental fillings, now or when he was younger? Again adrenals and gut.
*Did he have mercury fillings removed without the proper safety removal protocol?
*Placing the bone graft into an infected jaw bone can result in surgical complications and poor post operative prognosis. When the graft is placed too soon into infected bone, the body looks for ways to reject the graft which often results in a bursting of the inflamed tissue to encourage infectious bacteria to pour out. A fistula forms for the same reason and this is another way for the body to forcefully drain the infectious bacteria.
*When the dentist extracted the tooth, did he at that time take specimens to ....send to an oral pathologist... for a comprehensive microbiological diagnosis and culture sensitivity? That specimen usually includes a piece of the extracted tooth, the bone and infected tissue. That was the ideal time to do that and sending it to an oral pathologist was imperative. Doing an in house culture is not adequate in these types of cases.
Cubicin is Daptomycin and it is fairly common to be given intravenously for bone infections, like osteomyelitis. So it sounds like the physician was suspecting he has osteomyeltitis. Why his dentist and oral surgeon are not, baffles me.
Of course then the augmentin.... ugh... was bound to cause holy havoc on his already compromised digestive system. This is like putting gas on a burning fire! :/
Here's one common problem in dentistry and antibiotic therapy in cases of jaw bone infection. When the microbiology of the infection is not clearly known, any antibiotic that is prescribed is going to be nothing more than a crap shoot. It is never wise to do that because the infection will linger and the patient can end up so ill.
Given the fact that he's already had 2 round of antibiotics.... taking specimens during that time and even for a time after taking them, the microbiology may be skewed affecting the actual bacterial diagnosis. However, I would bring up this testing to the oral surgeon or the dentist that did the extractions. I can also tell you.... it is not unusual for an oral surgeon to be hesitant to intervene too greatly on a patient's care pertaining to oral surgery done by another dentist. They don't want to be blamed for anything that might occur while under their care, that could be due to the original surgery.
To sum up the dental .... Without any doubt, he had a 10+ year infection in that molar via the findings of the severe bone deterioration and also because ALL root canaled teeth are a source of infectious bacteria. This type of infection is very progressive and not self limiting to just the tooth, thus the findings of bone deterioration. Given those facts and his long term poor digestive health, the likelihood of the sinus being affected and infected would not be uncommon. It is also not uncommon for cases like this to find a bone infection known as osteomyeltitis (infection and inflammation of the bone) and/or NICO (Neuralgia-Inducing Cavitational Osteonecrosis). Both of which are commonly associated with infected teeth, root canaled teeth, people with poor immune health, and people who take steroids and/or bisphosphonate drugs. The usual bacteria that is often, but not always found with that infection is in the Staphylococcus bacteria family. This is why it is imperative for the "specimens" to be sent out to an oral pathologist for the most comprehensive microbiology testing and culture.
The Medical aspect....
His systemic problems are widespread but all health problems have some, usually more than some, gut health component to them. So that area needs to be focused on. Functional Medicine is different than conventional medicine as it seeks to find the root causes of disease... and gut health is thought to be at the root cause of most, if not all illnesses because that is primarily where our immune system resides.
His overproduction of mucus....
The formation of mucus is a bodily function that occurs in an attempt to protect against infectious pathogens like bacteria, viruses and fungi. When mucus is in abundance and on a daily basis, other than just with an acute illness like a cold or upper respiratory infection, that is a pretty clear indication that the body is overwhelmed with unfriendly pathogens. In his case, the ongoing mucus problem may be directly correlated with his gut dybiosis. Many people think mucus is just a sinus issue ... but it is so much more involved than that. His gut health needs to be diagnosed and treated properly in order for his immune system to be able to deal with anything else.
Re the ozone ear insufflation and IV vitamin C therapy...
I'm not very familiar with the ear insufflation ... however, I think in his case it may just be a band-ade if anything because the problems with his infection are likely in his jaw bone and possibly sinus. Ozone injections can be very therapeutic but again, may not be appropriate in this case, at this time.
IV Vitamin C therapy can be very beneficial. But again because it doesn't sound like his dental problem or medical issues have been fully disclosed yet .... the C may not be very beneficial for the long term.
I've thrown a lot at you, Jennifer. I hope you will read it through and make notes of what you think could pertain to your husband. Then speak to the dentist and/or oral surgeon about the oral pathology and microbiology testing. If you haven't already, look into Functional Medicine.org and see if you can locate a practitioner to consult with for his systemic health issues.
Originally Posted by jrs2831
Hi Bryanna. I will reply with asterisks prior to my answers.
I am going to re post your post and reply in CAPS.
<<My husband had a root canal removed on tooth #2 (upper back right tooth) on February 15. The infection was large, included the cavitation behind where the old wisdom tooth was, and the removal caused a large sinus exposure. This Huggins trained dentist created tissue from my husband's blood and sewed that in, filling the socket with plugs created from his blood.>>
IN ALL PROBABILITY, THE INFECTED ROOT CANALED TOOTH AND BACTERIA FROM THE CAVITATION HAD ALREADY PERFORATED THE SINUS, PRIOR TO THE EXTRACTION. I MENTION THIS BECAUSE THIS TYPE OF INFECTION CAUSES THE JAW BONE TO CRUMBLE LEAVING THE SINUS UNPROTECTED.
THE ROOT CANALED TOOTH HAS BEEN INFECTED SINCE ON OR BEFORE IT WAS ROOT CANALED AND THE CAVITATION MAY HAVE DEVELOPED SHORTLY AFTER THE EXTRACTION, IF IT WAS NOT ALREADY PRESENT PRIOR TO THE WISDOM TOOTH BEING REMOVED. I MENTION THIS BECAUSE IT WILL GIVE YOU AN APPROXIMATE TIME LINE AS TO HOW LONG THE INFECTION HAS BEEN BREWING.
****When he pressed on the nub of a tooth (crown was removed prior to the toot removal) and the jaw behind it, they flexed and the dentist said the infected bone was soft so it sounds like the infection was extensive. For the 10+ year since the root canal the chain of lymph nodes on that side has been swollen, but never a problem to the doctors he asked about it. He just said yesterday his tonsils have never been so small.
THE BLOOD PROCEDURE YOU MENTIONED IS CALLED PLATELET-RICH PLASMA AND IT IS USED AFTER THE SURGERY TO PROMOTE BONE GROWTH AND HEALING.
DID THE DENTIST PLACE BONE GRAFT MATERIAL AT THE TIME OF THE EXTRACTION?
****Yes the graft material and the plugs were placed at the time of the tooth removal and removal of the dead/infected bone.
<<He developed an infection, had a 2nd procedure to "clean up" the site so to speak and stitch up the split where the infection came out, received antibiotics. He now has a fistula on his gum plus the sinus perforation has not fully healed so he can feel air passing through.>>
WAS HE PLACED ON ANTIBIOTICS FOR THE FIRST SURGERY? IF SO, DID HE TAKE THEM?
****One week after the tooth removal he woke at 4am with severe pain in the socket that felt like nerve pain. He took hydrocodone prescribed but not yet taken for the surgery, which helped tremedously. He saw the dentist later that day and nothing yet looked out of sorts so he did his scheduled Vitamin C and Ozone therapy (ear insufflation and injection in the mouth area). That night the socket started to pulse and drop out lumps of what looked like pus (in hindsight maybe these were plugs being rejected?); 2 lumps that evening. We went back to the dentist the next day and more "pus" lumps were dropping intermittently out of the bottom of socket; 3 lumps while at the dentist for 8 hours. There now was the hole on the side of the gum too, the same socket where the tooth was removed. That day (day 8 post surgery) the dentist cleaned up the site (but did not do a culture), removed the plugs that had not taken, put more plugs in and stitched up the hole on the side of the gum. At that point it appeared the new sinus membrane was still intact. That night the whitish fluid started seeping out through the stitches on the side. He developed a fever of 101 and chills. He is on hydrocortisone 20mg per day for adrenal fatigue (more on his health problems below) so his regular doctor was concerned about infection and with the fever and chills prescribed 7 days of IV Cubicin, trying to limit the GI issues from antibiotics. He saw the dentist again the next day for more IV Vitamin C and at that point my husband thinks the ozone injection disturbed the sinus "membrane" due to the pressure from all the fluid injected near the surgical site. He received the IV Cubicin then saw and ENT and oral surgeon the next week. The oral surgeon said Cubicin was not the right drug and started him on Augmentin plus Allegra and chlorhexadine oral rinse. The ENT cultured the fluid that was still seeping out the hole on the side that remained after the stitches dissolved and that was negative. My husband took 7 of the 10 days of Augmentin, stopping early due to GI side effects and severe electrosensitivity (see below on health problems).
THE SPLIT TISSUE WHERE THE INFECTION DRAINED OUT OF .... WAS THIS THE SAME SITE AS THE INITIAL INCISION OR A DIFFERENT AREA? HOW LONG AFTER THE EXTRACTION SURGERY DID THIS HAPPEN?
****Initial incision was on the bottom where the tooth came out and this split is on the side of the gum of that same tooth. Occurred 1 week after the surgery.
WHEN THE DENTIST PERFORMED THE SECOND DEBRIDEMENT OF THE SURGICAL SITE, DID HE DO ANOTHER PLATELET-RICH PLASMA PROCEDURE OR PUT IN BONE GRAFT MATERIAL?
****He believed the sinus membrane was fine so only put more plugs into the socket.
HAD HE DEVELOPED A FISTULA NEAR OR ABOVE TOOTH #2 PRIOR TO THE EXTRACTION? IF SO, IS THIS NEW FISTULA AT THAT SAME LOCATION OR A DIFFERENT AREA?
****No problems prior to the surgery, just the hidden/undetected infection.
HAS HE BEEN BACK TO THE DENTIST WHO PERFORMED THE 2 SURGERIES TO EVALUATE THE FISTULA? IF NOT, HE NEEDS TO HAVE IT EVALUATED.
****The dentist is not sure what it is (seems my husband's situation post-surgery is like none he's seen) and wants to "let the body do it's thing" supporting with Vitamin C and ozone. The oral surgeon and ENT also said nothing about it, also want to take the wait and see approach, but his regular doctor labeled it a fistula.
<<First question is the ENT said it can take 3-4 months for the sinus to heal and just to wait it out taking Allegra, Flonase and mucinex. He has just been taking allegra which keeps him from having any mucus so the other two have
not seemed necessary.>>
A SEVERE SINUS PERFORATION, ESPECIALLY WITH THE SEVERITY OF THE INFECTION THAT WAS, IS, PRESENT, CAN TAKE MONTHS TO HEAL CLOSED AND IT WILL ONLY CLOSE IF THE INFECTION IS CURED.
I AM NOT A BIG PROPONENT OF DRUGS AND THIS SEEMS LIKE AN OVERKILL TO ME.
****My husband produces an excessive amount of mucus and thinks he would have been better off if he'd started Allegra from the get go (he as careful not so sneeze or spit but still had to sort of hack out this excessive mucus post-surgery) because it's dried up the mucus. He does have saline nasal spray (ENT and oral surgeon recommended) but has not felt dry so has not used it.
....THE ALLEGRA IS AN ANTIHISTAMINE WHICH REDUCES THE EFFECTS OF HISTAMINE WHICH BASICALLY REDUCE MUCUS SECRETIONS AND SINUS SWELLING. HOWEVER, ANTIHISTAMINES CAN DRY OUT THE NASAL MUCUS MEMBRANES AND PROLONG THE INFECTION.
....FLONASE IS A CORTICOSTEROID AND DECONGESTANT WHICH DRIES UP THE MEMBRANE AND REDUCES INFLAMMATION. HE MAY BE ABLE TO USE JUST SALINE SPRAY INSTEAD OF FLONASE.
...THE MUCINEX THINS MUCUS AND IS OFTEN PRESCRIBED FOR UPPER RESPIRATORY ISSUES. I'M NOT SO SURE HE NEEDS THIS.
ALL OF THESE MEDS SEEM A BIT MUCH. BUT JUST USING THE ALLEGRA CAN CAUSE OVER DRYNESS IN THE NASAL MEMBRANES WHICH CAUSE IRRITATION AND FURTHER PROBLEMS. PERHAPS A PURE SALINE SPRAY WOULD PREVENT THAT DRYNESS FROM OCCURRING. HE SHOULD ALSO STAY WELL HYDRATED THROUGHOUT THE DAY WITH FILTERED WATER. IDEALLY, MOST PEOPLE SHOULD CONSUME HALF THEIR BODY WEIGHT IN WATER OUNCES. MEANING SOMEONE WEIGHING 150 LBS = 75 OUNCES OF WATER PER DAY.
****He is drinking a lot but i will make sure it's enough and warn him about the concerns with Allegra. He has not felt he needed Flonase or Mucinex. The ENT stopped the chlorhexadine rinse so he only used that for a week.
<< He is a slow healer so it's no surprise it's not healed yet. Does waiting it out seem right? The ENT said a gum flap procedure is what they do to fix it.>>
I THINK THE DENTIST SHOULD SEE THE FISTULA. HE SHOULD DO A TRACT TEST WITH A GUTTA PERCHA POINT AND A PERIAPICAL XRAY TO SEE WHERE THE TRACT OF INFECTION GOES FROM THE FISTULA.
****No one seems to think there is an infection with the negative culture. Is it possible this is lymph fluid or the plugs dissolving?
WHY DOES YOUR HUSBAND HEAL SLOWLY? DOES HE HAVE MEDICAL PROBLEMS?
****He has mercury (and lead) toxicity which was inadvertently re-distributed last summer, resulting in a acute toxicity which caused his adrenal glands to reduce function, necessitating the hydrocortisone therapy. His health issues are now explained to a large degree, which include severe tinnitus and hearing loss from a young age, extreme irritability, ADD-type symptoms, poor nutrient absorption, which is likely part of why he has had very slow wound healing over his whole life, terribly digestion and almost no gut motility. He thinks his excessive mucus could be related to candida (which he has been diagnosed with in his gut), which he has been trying to address since this all began last summer taking antimicrobial tinctures recommended by Dietrich Klinghardt but he took a break from them prior to the surgery and in hindsight maybe that was a bad idea because the mucus production increased when he stopped them. I could go on if you would like me to; not sure how much you need to know. The acute mercury event from last summer caused him to be sensitive to EMF and that got worse on the antibiotics. The ENT wants a CT scan of the sinus but we are waiting until his electrosensitivy is better. He is working with a mercury specialist and has tried chelating the mercury but this tooth infection was potentially a big issue and we prioritized getting it out as soon as his regular doctor though he was well enough, hoping he could go back to work when his 6 months of disability runs out but the recovery not going well has set him back.
YES, A FLAP SURGERY CAN BE DONE. IT ALL DEPENDS ON THE SIZE AND LOCATION OF THE OPENING.
<<Second question is about the fistula. It continues to weep a whitish salty fluid that is stimulated to come out the gum by pressing on the lymph nodes in his neck or face when he feels pressure building up. It now twice has swelled then sort of popped like a blister. The fluid has been cultured and does no show any infection. It seems to fluid has been less over the past few days. Does he just wait this out, hoping it will eventually heal?>>
WAS THE CULTURE TAKEN FROM THE FISTULA OR TAKEN AT THE TIME OF THE SURGERY? IS THE LYMPH NODE SORE OR SWOLLEN? WAS THE LYMPH NODE SORE OR SWOLLEN ANYTIME PRIOR?
****Culture was taken from fluid coming out of the fistula (good sized sample), one week after the fistula developed, which was one week after the initial surgery. Lymph nodes are not as swollen as they were before the surgery and no longer sore (which they were for years). He says he more feels some pressure in his face/sinus/socket and then when he presses on his neck nodes, the fluid seeps out the side and bottom of the socket. He is now doing lymph draining massage (down to his clavicle) and exercises with his calves to try to get the fluid to go down, not up into his sinus.
****I hope I've answered all your questions and thank you thank you for your help. Let me know if I've left anything out or not been clear.