Hello, I have stumbled across this forum doing some research over last few days. Can I please have some pointers regarding my sinus communication.
I am 48 Male name is David
I have had undiagnossed MCS for 8 years. All the doctors want to do here in the UK is send me to psychiatrist and put me on meds.
I manage my condition by avoidance of triggers though I often push myself and do things that make me sick for days or longer.
Anyhow I was hoping to get some guidance from Bryanna or others (Bryanna seems to pop up all the time on here with great advice for others)
Back to the dentistry problem I am having,

On friday I had Maxillary second molar extracted. There was some cracking noise during extraction.
I remember the dentist saying there was a big gap during clean up and asking assistant for a small probe (i think thats what he said)
He asked me to blow whilst holding my nose.
afterwards I was sitting in the reception room an noticed air coming into my mouth from my nose. I checked by gently do same as what dentist asked me to do. I asked dental assistant but she just said you shouldn't do that. I asked her to have a quick look and she said it was fine.
When rinsing mouth gently water was passing out through my nose.
On sunday water was not coming through nose but I could feel the water trickling out of the cavity when I stood up. An when breathing through nose I could see the water moving up and down on my gum (if that makes sense)
I spoke to my dentist on monday about this and he said he would get some advice. He came back and said if it is a communication he would need to refer me to oral surgeon but he would need to see me on tuesday (yesterday) to confirm the communication first.
After tons of research reading on the net and equipping myself with knowledge, on monday night I didn't notice any water moving around the area and have been really gentle with things, though on that side I have a deviated septum so stuffy normally there giving more pressure to extraction site. I was only noticing some slight fluctuation in the area when I swallow.
When I went to see dentist yesterday I didn't want to just do nose blow test because I felt it would just make it worse and may definately mean referall and I don't know how long that would take, and other concerns, so was hoping it was healing up. He agreed and had a look without probing and only using water to have a quick look.
My questions to him were how big was the gap that he was saying about during extraction and asked him to show me what he meant on a diagram I took with me. He said whilst doing clean up one side was no problem but the other side just stopped as he was cleaning down one side. (meaning end of the bone half way down that side)

Sorry for such an essay!

This morning I woke up with communication back (noticed by flutuance when swallowing and water moving up and down site when I breath through nose after rinsing. Though no water coming into nose)

Should I just see how things go over next few weeks? Dentist still not sure I have a communication though I don't know why he thinks that.
I am still none the wiser as to size of gap.

From what dentist described I think root bone (the bone the root goes in was narrow and root was in sinus) which may mean gap may be a fair size.
Maybe mucus of some sort is stopping the communication but then any pressure is dislodging this.

One thing I couldn't find much information on was is how long would a fistula take to grow where operation is inevitable? I know depending on size of 5-6mm or above operation is the only option but I have no clue of size.

My concerns:

dentist will only refer if communiction is shown to him (hence nose blow test, I suggested probing but he said it would cause a fiscula) We agreed to see how things go as they are as at that time it seemed much better that it was.
I dont know how I would react to drugs needed for surgical procedure due to my mcs, I react to most drugs. I reacted to the composite filling that the dentist put in and this is why I wanted the extraction and I am now wishing I put some research into extractions beforehand.

Any help or suggestions much appreciated please

David

Hello David: I'm not one of the members you want to hear from. Hopefully some of them will see your post & reply soon. I'm simply stopping by to welcome you to NeuroTalk. I trust you will find the time you spend here to be of benefit. Best wishes...

Hi David,

MCS... multiple chemical sensitivities?

I am familiar with MCS. You stated that you try to avoid your triggers, so obviously you know what they are. But do you know why you have MCS? Have you ever thought it could be related to mold sickness?

Based on your description, you have a sinus communication. I am also wondering if the dentist was able to remove the tooth in its entirety? Did he say he broke anything off or did he take a post operative xray to make sure he removed all of the tooth? You mentioned fistula.... there is no way to know a time frame for a fistula to form. It can be something that develops slowly or it can occur within a few days.

Is there any way you could go to a private oral surgeon for a consult and evaluation? They would need the xrays from your original dentist and then they would take one of their own, possibly a panoramic xray, to view the entire arch from a more comprehensive perspective. An xray will show a moderate or larg sinus communication.

Post your thoughts on this when you can a chance.

Bryanna

Thanks Bryanne, I am getting in a bad way right now, I think I may be getting an infection as I am burning up (I know its hot here right now but am not right now) Havent been sleeping much keep waking up as well.
My dentist is private (a mercury free one) when I went back to him I should have got prescription for anti-biotics incase, I forgot to ask him.
He did say tooth came out cleanly. He did take xray after. A tooth next to it was taken out couple months ago.
I have been looking for an oral surgeon private practice online and need to book in today with someone.
(As regards my mcs I have had sensitivities since I was 18 mildly up until 8 years ago) I brought on the mcs by doing liver flushing several times then became really sensitive to all chemicals. I would love to go into this more with you in detail another time. Finding it hard to even type now.

A couple of places I have in mind to see on oral surgeon. Need to call first thing in the morning see if any can see me today. dont really have the finances but cant be waiting on referal to nhs. let it go on the credit card. this is too important to sit around on. I dread to think how I am gonna be on the anti-biotics.
Is ct xray the best one I think both of the practices have them (not 3d ones) with panoramic show all thats needed. is the ct one instance results?

Thank you skeezyks for your warm welcome

David,

Okay, glad to know that you have private dental care.

The fact that you had an adjacent tooth removed just a couple of months ago makes me curious if there is an infection brewing and perhaps both areas are involved.

Can't this dentist give you the name of an oral surgeon in private practice? Not as a formal referral but as an offering to a patient seeking further evaluation?

The panoramic xray is a 2 dimensional xray that shows the upper and lower arches in their entirety, the maxillary sinus cavity, anterior nasal passages, etc. But only in 2 dimensions.

The dental CT scan is a 3 dimensional scan which shows a comprehensive view of the dental and sinus anatomy is slices or cuts, meaning more angles.

Antibiotics may or may not be warranted. I think they should only be given if absolutely necessary. It's best to get a proper diagnosis first and then see what the options are from there.

Bryanna

Thank you,

I norrowed down my search for an oral surgeon to go to see today and decided on this young Portugese oral surgeon. They have a 3D CT Scanner. They were able to book me in 2 hours after I made the phone call.

He was so nice and friendly, very understanding, and gave me so much time.

Down to the nitty gritty.....He had a look in mouth and confirmed the fistula. He said no sign of infection. (relief).

CT Scan showed about one quarter sinus inflammation

Fistula is size 6.6mm x 1.9mm

His opinion to me was to give it 2 weeks to see if it heals itself. If it has not by then to go ahead with procedure to close it. He suggested using PRGF. I am reseaching this right now. Other procedure that he could do is the buccal fat flap, but he preferred the PRGF.

If I need to get it closed, something I read on one of your posts, was debridement to clean up area. Is this something they do anyway or should I ask for it?

I asked him if I do not get any improvement next week to arrange procedure to be done when I return in 2 weeks. I can sometimes be such a worryer.

Am I guessing right that its the repairing of sinus membraine that I am hoping to achieve naturally to stop communication, as it cant be the bone or the gum?

David,

Glad you got in to see the oral surgeon and they took a ct scan.
The term fistula and sinus tract can be interchangeable. In that case it means, yes, there is a definitive opening into the sinus from the extraction site. A fistula of 6.6 mm in diameter is a good size opening. Hopefully it will heal on its own. Did he give you at home instructions of what to do and what not to do between now and next week to try an promote healing of the membrane and reduce the inflammation?

The debridement that I refer to on many posts is correlated with the actual extraction. Every time a tooth is extracted, the dentist is suppose to thoroughly debride the bone socket, remove the periodontal ligament and any disease tissue or bone that is visible clinically or radio graphically. If that debridement is not done immediately and thoroughly after the tooth is extracted, then the dead ligament can prevent or prolong complete healing. Not debriding is like leaving debris in a surgical wound.

When a sinus communication is repaired, the surgeon will debride the surgical site, the sinus and the surrounding area. The degree of that debridement depends on how well the site was debrided at the time of the extraction and if there is infection present.

The hope is that the sinus communication will close on its own. The extraction site, the gum tissue, may or may not close before the sinus opening closes. The bone will not fill in at the area of an open sinus. The sinus needs to be closed for the bone to fill in there.

With or without a sinus opening, the jaw bone normally takes up to one year after a tooth is extracted to solidify. The gum tissue closes over long before the bone solidifies.

The actual surgical repair is of the sinus membrane. However, the gum tissue and bone are involved during the repair surgery.

Bryanna

He told me not to rinse like normal just to hold warm salt water on that side and then repeat. I have been doing things really gentle anyway.
He said if salt water does go up in nose not to worry it wont do any harm.

He never said anything about the inflammation, he just said it may have been there before this all happened. I do have a deviated septum and regularly have stuffiness that side due to my allergies anyway.

I was going to do some research on the inflammation because I think that may hinder healing, do you have any suggestions? Maybe he never suggested anything due to my MCS. I have bought some eucalyptus oil and Alba oil and possibly do some steam inhalation, would that be ok or to harsh.
Any good herbal remedies for this inflammation?

David,

Some suggestions of what NOT to do:
- Blow your nose
- Pinch your nose closed as you did previously to check for air communication
- Drink through a straw
- Rinse with anything other than salt water
- No inhalation of oils as the sinus membrane is very delicate and it's best to avoid disturbing the natural attachment that you are trying to achieve.
- No hard core cardio exercise as this increases the heart rate, elevates the sinus pressure, etc.


Some suggestions of things to do:
- Eat anti inflammatory foods and avoid sugar and processed foods. Avoid dairy and very cold temp liquids or foods as they can increase mucus production.
- Drink plenty of filtered water throughout the day to stay hydrated and flush out toxins, all of which reduce systemic inflammation. Ideally, most people do well with drinking in ounces, half their body weight. Ex: weight 100lbs = 50 oz of water per day.
-Warm herbal teas like white, green, tulsi, or thyme all anti inflammatory. Add some raw local honey (if possible) as this is one of the greatest immune boosting foods you can eat.
-Some supplements that support the immune system and lower inflammation, should be of good quality .... vitamin C, quercetin, and turmeric.
- Massage anti inflammatory essential oils, like eucalyptus, in a carrier oil to the outside of your face over the area above your extraction site. Apply a moist heat over that area for better absorption. Essential oils applied topically are very therapeutic. Remember, a drop of these oils is very potent.
-Take homeopathic remedy, Arnica 30 C or 30 X, 3-5 times a day to promote healing.
-Gentle exercise like stretching or yoga to promote lymph drainage and reduce inflammation.

What do you normally do or take for your sinus allergies? How is your diet? Do you eat organically or .....?

Bryanna