Hi Jamm,

I understand that you paid privately.... I often suggest that people take that route because the care is often higher quality and more individualized. I still feel that is usually the best way to go over a dental school or insurance based practitioner.

However, in the case of your first oral surgeon..... to extract a tooth without an xray is a huge NO NO as you cannot possibly know what you are getting into without that xray. That is why the surgery was so quick because he did not debride the area... because he didn't know the full extent of what was there. Secondly, ALL tooth extractions REQUIRE a thorough surgical debridement, there are no exceptions to that rule. Unfortunately, this step is not routinely done as it is suppose to be. The granuloma he referred to was a clear indication that there was more happening in that site which needed further investigation (an xray) and debridement.

What the second oral surgeon is referring to as scar tissue is most likely infection and granulation tissue. Scar tissue does not have the exact appearance as infection, which is pretty obvious on your xray. He may be making that reference to avoid further questions from you about why the first OS didn't do a more thorough debridement.

The concern about having permanent damage is two fold:

1) Without question it is never healthy to have an infection in your jawbone and especially one that has traveled to the sinus cavity. In your case you have at least 4 issues that are contributing to the bacterial problem. One is the root canaled pre molar, the second is the dirty extraction site, the third is the toxic mercury sitting in the surgical site and the fourth is the sinus perforation which is not likely to heal unless the other issues are taken care of.

2) Permanent damage can occur from long term infection (ie root canaled teeth, non debrided extraction sites and chronic sinus involvement). It can also occur from deterioration of the jaw bone due to the proliferation of infectious bacteria. All of which can make the person very ill beyond the original source of the infection.

3) At some point this quadrant of your mouth.... the rc tooth/the infected extraction site/the blob of mercury/ the sinuses.... will have to be addressed. The more deterioration that occurs, the more prolific the infection will become and the more likely it will become a systemic health concern.

Based on all of those things going on and in addition to the length of time that there has been infection in that quadrant (20 years), if the surgery is done now there is a possibility of some damage occurring with the surgical intervention, but no one can tell you if it would be temporary or permanent.
There are also no guarantees that the surgical intervention would be able to cure the infection in it's entirety because the bacteria may be hidden and not yet visible clinically or radio graphically.

The options are....

1) Wait and let it proliferate and be medicated for the pain.
2) Do not wait. Debride and remove the visible sources of the infection and the mercury giving you a better chance of a healthier, more complete recovery.

I know people think they have to just trust their dentist to always do the right or best thing. However, as much as you have no choice but to trust the skills and knowledge of the dentist, it is imperative to remain your own advocate and use your voice to make your concerns and expectations clear.

Again, I hope this info is helpful to you.
Bryanna