Bryanna,

I had my two top wisdom teeth extracted on 6/28. The top right was impacted and reportedly a "tough" extraction. First few days of healing went well and I thought it was going quite well.

Late Sunday into Monday I started to develop a sinus infection. I took some Cefdinir that we had on hand, Monday - Wednesday. On Tuesday and Wednesday night (both times my rinsing was probably too vigorous with too much pressure), I noted leakage of saline rinse before bed into my nostril. I had called Oral Surgeon regarding sinus infection on Wednesday and was prescribed 875 mg, twice daily Amoxicillin. I started taking that on Thursday. Also, after Wednesday's night rinse issue, I contacted Oral Surgeon again about suspected sinus communication.

I saw Oral Surgeon on Friday morning. He did X-Ray and very quick inspection of removal. X-Ray did not show a communication nor did his inspection or nose pinch/mouth breathing test. He suspects it is a very small hole that should spontaneously heal after sinus infection is addressed.

After 3 days of Cefdinir and 3 days of Amoxicillin (starting 4th day today, and have 14 day prescription), I'm still having sinus pain and pressure. Most concerning it seems like I'm having a ton of purulent discharge from either the sinus communication or post-nasal drip. Lots and lots of brown (some with black dots) discharge that I'm spitting out. Occasionally, typically at night I also spit out blood.

A few other notes, I'm taking pseudoephedrine 2-3 per day (since Thursday). Today I started to augment that with Muscinex. I'm taking 4-5 grams of Vitamin C, 8000 IU of Vitamin D3, and 100 mg of Zinc per day. I started using Peridex yesterday, twice daily.

I'm quite concerned with the amount of pus I seem to be dealing with - should I be? Also, I'm scheduled to do a cross-country flight on 7/15 for business - should I be concerned enough to cancel that trip at this point?

Thank you in advance!

Hi Duwath,

Firstly, I hope you are taking a probiotic to help replenish the good intestinal bacteria that the antibiotics are destroying. Also, a pre biotic Saccharomyces Boulardii in addition to the probiotic would be helpful to try and avoid intestinal distress. You can take them both the pre and probiotic together but 2 hours prior or after the antibiotic. You would only need the pre and probiotic 1-2 times a day and then stay on it for another week after the antibiotics are done.

Regarding the peridex rinse... not really necessary and Peridex destroys both the good and bad bacteria and you need good bacteria to heal properly. You're taking plenty of vitamin c to kill bad bacteria and you're on the antibiotic.

The purulent discharge.... yea, that is a bit concerning. I would suggest that you call the oral surgeon and describe what is currently happening and get his opinion on continuing with the pseudo and mucinex. One or both might not be necessary or one or both may be adding or causing the sinus pain and pressure. Sometimes when trying to take care of the symptoms with too many things, we complicate it.


Also mention that you have a cross country flight scheduled for 7/15. Cabin air pressure can be troublesome depending on the problem.... a small sinus perforation is not really a concern so long as there is no infection.

I am wondering if there is a piece of the tooth or root tip still in there. Sometimes a piece of tooth or root tip fractures off during the extraction and gets stuck up there. Sometimes it works its way out, other times it doesn't. Any piece of a remaining tooth can be problematic and it could result in a chronic sinus infection. He may not like the question, but ask him anyway if that is at all possible. You can ask the front desk to email you the xray and post it here if you want and I can take a look. Of course I am not a dentist but well informed on dental radiography. Just be sure to blacken out your name before posting.

Bryanna

Hi Bryanna,

Thank you for your reply!

Yes, I'm taking a daily probiotic and eating at least two servings of greek yogurt per day.

So, I went to see my Oral Surgeon yesterday. They identified the OAC - right behind the "12 year molar". They said it was about the size of ball point pen head. I'm guessing it is certinaly <= 2mm, so a good candidate for self-healing.

They tried to add some material of some sort to the area to help promote closing. That material came out today, and I'm still getting discharge - but it is absolutely way less than what I experiencing on Saturday and Sunday. Yesterday before going to see the Oral Surgeon, I noticed that the discharge was quite a bit less.

They noted the discharge and told me it was normal sinus drainage. Nothing purulent about it. No smell, etc. Therefore no need to culture. They also switched my antibiotic to Penicilin 500mg 4 times daily.

I happened to have an appointment with my ENT today, so I asked her to look at it and evaluate my sinus infection.

She felt like nothing crazy was going, but she did culture for aerobic, anaerobic, and fungal infections. She cultured the general are of the OAC and extraction site. I'm a bit worried the material they had placed my make the culture less effective (the material didn't come out until this afternoon). She also switched me to Augmentin 875 twice daily (my fourth different antibiotic since this fun has started).

At this point, I can definetly say that I feel better than I have throughout this process. I'm just a bit worried that I still have some soreness/pain/pressure in the jaw bone and sinus, and that the OAC hasn't spontaneously healed yet. I'm on day 12.

What do you think? Normal to be sore still after a "rough" extraction (I'm in my mid 40s) and for the OAC to still be open? They did mention it looked like the OAC was trying to close up.

Thanks again for your original reply and thanks for your help!

Hi Duwath,

Glad to hear that they located the OAC. Yes, that is small and likely to heal on it's own.

The reduction in your symptoms is a good sign!

The soreness, pain and pressure in the jaw bone and sinus is normal at this stage and should become less and less with each day.

Just a note... the result of the culture that the ENT took may be a bit skewed due to the antibiotics you've been taking.

Definitely continue with the probiotic daily and for at least 4-6 weeks after the end of this antibiotic. I personally take a probiotic daily just for overall health.

Did you ask about flying across country?

Bryanna



QUOTE=Duwath;1277438]Hi Bryanna,

Thank you for your reply!

Yes, I'm taking a daily probiotic and eating at least two servings of greek yogurt per day.

So, I went to see my Oral Surgeon yesterday. They identified the OAC - right behind the "12 year molar". They said it was about the size of ball point pen head. I'm guessing it is certinaly <= 2mm, so a good candidate for self-healing.

They tried to add some material of some sort to the area to help promote closing. That material came out today, and I'm still getting discharge - but it is absolutely way less than what I experiencing on Saturday and Sunday. Yesterday before going to see the Oral Surgeon, I noticed that the discharge was quite a bit less.

They noted the discharge and told me it was normal sinus drainage. Nothing purulent about it. No smell, etc. Therefore no need to culture. They also switched my antibiotic to Penicilin 500mg 4 times daily.

I happened to have an appointment with my ENT today, so I asked her to look at it and evaluate my sinus infection.

She felt like nothing crazy was going, but she did culture for aerobic, anaerobic, and fungal infections. She cultured the general are of the OAC and extraction site. I'm a bit worried the material they had placed my make the culture less effective (the material didn't come out until this afternoon). She also switched me to Augmentin 875 twice daily (my fourth different antibiotic since this fun has started).

At this point, I can definetly say that I feel better than I have throughout this process. I'm just a bit worried that I still have some soreness/pain/pressure in the jaw bone and sinus, and that the OAC hasn't spontaneously healed yet. I'm on day 12.

What do you think? Normal to be sore still after a "rough" extraction (I'm in my mid 40s) and for the OAC to still be open? They did mention it looked like the OAC was trying to close up.

Thanks again for your original reply and thanks for your help![/QUOTE]

Thanks again for your helpful reply!

Symptoms are again reduced this morning. Feels like I've certainly turned the corner!

I'm glad to hear the soreness, pain, and pressure are normal for this stage of the healing. That was my remaining concern.

Yes, I've got a note excusing me from work through 7/15 and grounding me from flying. My employer was very understanding and had directed me to cancel my trip as soon as I let them know about the situation on Monday. So, no flying next week.

Again, thank you for your time and thoughtful replies. I (and I am sure others over the years here on this forum) found your advice and input a calming influence when dealing with this situation.


[/QUOTE]

Hello again Bryanna,

Another 5 days or so have passed, and I'm still dealing with sinus drainage from the OAC (defintely a little less with each passing day). Also jaw stiffness and soreness is still an issue along with sinus pressure. I'm approaching 2.5 weeks out from surgery.

Do you think I'm still in normal healing phase for this?

Thanks!

Hi again Bryanna,

At 3.5 weeks now. I'm still slowly progressing, I think. Yesterday seemed to be step backward with noticeable increase in drainage from the OAC (and related increase in sinus pressure yesterday). Today seems better. However, I'm concerned that the OAC isn't going to spontaneously heal, as I would have expected that to happen by now.

I also think I'm dealing with a bit of nerve damage that complicates determining if I'm getting sinus pressure or nerve pain (dull ache in 1st and 2nd molars, slight numbness/tingling on that side of my tongue).

Anyway, what do you think - should I be concerned that the OAC is evidently still open?

Thanks!

As an update, at 4.5 weeks the OAC started to heal quite a bit.
As of 5 weeks, it is mostly healed. It has been (what feels to me) a long road with this seemingly minor complication.

I'm still dealing with the nerve issues, but those are progressing, albeit slowly, as well. I'm guessing it maybe 2-3 months before those issues completely resolve. I guess I am optimistically hoping that those will, indeed, heal 100%.