Infection after tooth extraction?
 

Hi Bryanna and all,
My tooth (#14) was infected in earlier May and had root canals done between May 29 and June 8, 2013. Infection was very bad and spread all the way to sinus. The dentist put me on Pennicillin first (got bad allergy reaction) and then Clindamycin (had diarrhea). I was off from any antibiotics for nine days before the extraction.
The tooth was extracted by an oral surgeon on Tuesday morning (July 2). He said the site doesn’t look like infected (at least not serious). I was OK on Tuesday and most time of Wednesday. But this morning (July 4) I started feeling pain around the extraction area. The surgeon did put me on 5 days Z-pack. I started taking Arnica last night but the pain is getting more frequent. Is this normal or does it indicate an infection? Anything I should do now?

I am very concerned now. I don’t have a good tolerance to antibiotics. I’ve lost 15 pounds in a month due to the tooth infection.

Thanks a lot for your inputs

Hi Grace,

Did the oral surgeon say anything about a sinus communciation when he extracted the tooth?

Also, the site had to be infected ... perhaps it wasn't as bad as he anticipated. I wish dentists would inform patients better....:/

An extraction site that starts to hurt or has increased pain on the 3rd to 4th day needs to be seen by the oral surgeon. It could be the onset of a dry socket. If you wake up tomorrow and it feels good, then no need to worry. If it hurts like the dickens, go see him.

You don't have a good tolerance to antibiotics because you don't have a healthy balance of bacteria in your intestines. In addition to that, antibiotics kill off the good and bad bacteria in the intestines. So it is imperative to have an abundant supply good bacteria entering your intestinal tract on a daily basis. You need to supplement with a probiotic twice a day for at least the next few months to try and replace the good bacteria. It is also imperative to cut out all forms of sugar and processed foods in your diet because the bad bacteria thrive on those things.

I am sorry you are going through this. Please see the OS if it does not feel better tomorrow and please do what you can to restore the good bacteria.

Keep us informed on how you're doing!
Bryanna

Update and concern about sinus
 

Hi Bryanna
Thanks a lot for your reply.
The pain is better today, so I didn’t go to see the oral surgeon.

About the sinus.
During the consultation before the extraction (tooth #14), I did ask the OS about the sinus situation. He said the root doesn’t look like growing into the sinus cavity from the panoramic x-ray. He said the infection was not very obvious and at least very localized. I also told him that during the root canal treatment (between May and June, 2013), I got very bad sinus infection . Is there any way to repair the perforation? He mentioned something (I forgot the name) that can be used to repair the perforation.
The extraction was on the next morning (July 2, 2013). Before the extraction, I asked him again about the sinus. He said “we will see”. The extraction was fast (less than 3 minutes). I don’t think he did anything else other than extracting the tooth. After the surgery, I asked him whether any root is in the sinus cavity and he said no. I expressed my worry about the sinus infection again. He put me on Z-pack. This OS is referred by a holistic dentist and supposed to be a reputable one. But I really don’t know now whether he took care of my sinus issue or not.
I still feel some pressure around the sinus area 4 days after the extraction. Sometimes the pain starts from the extraction site and penetrates to the sinus area. I am very concerned now after reading some posts here. I have a follow up appointment with the OS next Tuesday. Is there anything I should ask the OS about? What else should I do? Could you please let me know?
Thank you very much
Grace

Hi Grace,

Hopefully you are feeling better today.

You can get a sinus infection from an infected tooth without a perforation in the sinus membrane. So that may be what had occurred with you if the OS said the sinus was intake when he removed the tooth.

The one thing that concerns me is you said the extraction only took 3 minutes and he didn't do anything else other than remove the tooth. A thorough tooth extraction includes removal of the tooth, removal of the periodontal ligament and debrided of any visible necrotic tissue. Do you recall him doing that?

When you see him on tuesday you might inquire about that. You could ask him something like this .... <<< I was surprised that the extraction went so quick considering that I had an infection that apparently had spread to my sinus. I did some reading on extractions and I want to know if you removed the periodontal ligament and scraped the bone clean of infection??>>

Hopefully he did everything he should have done. In the meantime, keep the area clean with warm salt water rinses. No mouthwash as that will just irritate the surgical wound. Eat soft foods and avoid chewing on that side. It is best to make sure you brush and floss all of your other teeth very well to keep the plaque down.

I do hope you are feeling better today :)
Bryanna

need futher advices
 

Thanks Bryanna,

I really really appreciate your reply.

The OS didn't say the sinus was intact (if that's what you meant). He didn't mention anything after the extraction. Until I asked him, he said that the root is not in the sinus cavity.

I am pretty sure he didn't do anything else other than extracting the tooth. The referral form from the holistic dentist states "extract the tooth and remove the periodontal ligament". During the consultation before the surgery, the OS asked me "what is that"? I briefly explained and he gave me an expression like that's totally non sense. I will ask the OS in the follow up appointment anyways. But I don't have much confidence that he did what should have been done.

Bryanna, what options do I have now? If I did get sinus infection without a perforation in the sinus membrane, do I have any chance to recover on my own (get rid of the infection for both the tooth and sinus)? or Do I have to have the extraction site reopened and cleaned again? The infection around the sinus is still there that I can very much feel.

Thank you very much Bryanna. Fortunately someone like you are willing to share the expertise here......
Grace,

Hi Grace,

I know you do... that's why I'm here ;)

Regarding the attitude of the OS about removing the periodontal ligament...... he may have been taken back a bit by the general dentist stating in writing to remove the ligament. That's an ego thing.... he should have reassured you that he will take care of that instead of being an *** about it. Your GD had every right to give you that note because he is looking out for your best interest and wants to make sure you received the proper treatment as he was the one who referred you there.

The first thing to take care of at this point is to tell the OS about your feeling that you have a sinus infection. Secondly, get a confirmation from the OS that he removed the ligament and any unhealthy bone. If he is vague about answering you, press him for a direct answer. He legally has to disclose what he did and didn't do at the time of the extraction. Request a copy of the surgical report if he's not willing to give you the information verbally. Again you have a legal right to this document. Too bad if his ego is bruised... that's his problem. There is no reason why he should not disclose this to you.... unless he didn't do what he was suppose to do :/

If you leave the OS office feeling unsettled or in doubt, I would suggest that you call your GD and speak to him directly about the situation. First of all your GD and yourself need to know if there is a possibility of residual infection. Secondly, your GD needs to be able to trust the referrals that he gives his patients. If you don't inform him, then he will assume all went well. I hope I have explained that okay....

Please try not to worry. think positive and stay focused on what you feel is important and proceed forward. Please check back tomorrow :)

Bryanna

Thanks.
 

Thanks a lot Bryanna. I will follow up tomorrow after I meet with the OS.

update: panoramic X-Ray
 

Bryanna,

I just got the panoramic X-ray from OS's office. It was taken the day before the extraction (tooth #14). Could you please take a look?

How was the infection at that time? Was sinus around the root?

Many many thanks,
Grace,

Hi Grace,

Thanks for posting the panoramic xray. I have to tell you that the alignment of your jaw with the xray machine was not in the proper position which is an unfortunately common problem seen in many dental offices. If you notice, in the upper arch it looks like you have an upside down smile line indicated by the dark black line that comes across from one corner of your mouth to the other. Anyway, this angle causes the upper maxilllary area to be somewhat skewed (ie: undiagnosable) as you can see it is very black. The posterior maxillary where your molars are is somewhat less affected by this era as far as the teeth are concerned. However, the sinus cavity is not very visible here either.

I can tell you that tooth #14 was very unhealthy/infected and appears to have some cystic activity around the roots. It is possible that this infection spread to your sinus. Whether or not there was a sinus perforation, the bacteria still could have infected the sinus. This area definitely needed to be debrided after the tooth was removed.

It would behoove you to have a periapical xray (this is a single film) of the #14 site to show a better view of the anatomy there. It may tell if there was a sinus correlation with this tooth, if there is residual granulomatous tissue (cysts), and if there is a sinus perforation.

I'm sorry to tell you all of this. I wish I could prevent these stupid mistakes from occurring. Some dentists need to be more strict not only about their own work but about the tasks that their staff perform. UGH :/

I suggest that you ask your OS to take the single xray. If he doesn't then see your GD.

Hope your mouth is feeling a bit better today... even after I gave you this crummy news!!

Bryanna

single X-ray after the root canal was completed
 

Thank you very much Bryanna for your quick reply.
Here is a X-ray taken on June 13, 2013, five days after the root canal treatment was done. The sinus infect was very bad at that time. I don't know whether this X-ray helps or not.

The extraction was on July 2, 2013.

Thank you very much

Grace,

Thanks for posting this xray. It is an excellent shot!
Let me explain about xrays ..... dental xrays are 2 dimensional views and they are meant to be taken straight on as this one is, however, it does limit the viewing field. That's why we sometimes take a different view called a bisecting view. But it is evident that your tooth #14 is directly in line with your sinus. Because the view is 2 dimensional, I cannot be sure if the root is actually into the sinus or directly in front of it. As I said previously, the sinus can become infected even if the root did not perforate the membrane.

If the OS debrided the socket after he removed the tooth he would have been able to tell if this sinus was perforated and/or in communication with this tooth. A new periapical xray like this one may tell the story!

I'm hoping you are feeling better but I get the sense that you're not feeling that well and still having issues with your sinus... yes?

Bryanna




The OS

follow up
 

Thank you very much Bryanna.

I saw the OS this morning. I confirmed two things:

First: He didn’t debride the site after the extraction. He said the site didn’t look infected after the extraction. He also said that if he scraped the bone, some damages could be made to the sinus. I don’t understand it.

Secondly: He didn’t see any sinus perforation after the tooth was removed. He also said that I could get sinus infection without a perforation. Bryanna, if he didn't see a perf after extraction, does it mean there was no perf?

He gave me a prescription for Levaquin and a referral to an ENT. I am at the end of my wisdom. The is the fourth antibiotic given to me within a month (four different ones). Should I take it? Should I go to see another oral surgeon/dentist or ENT?


Have you seen any cases before that the body can heal itself from this infection? Is there any natural way/remedy that I can use? Physically and mentally I am so exhausted. I live in a big metro area, and I couldn't believe finding a doctor who I can trust is so hard.


I have been dragging the dental appointments due to the autoimmune disease (and also afraid of X-rays). I was hit so big this time. Sigh. My last molar on left side (bottom) starts hurting too.

Many thanks,
Grace

Hi Grace,

First of all please consider NOT taking that script for levaquin. That drug can cause some very bad permanent problems. Please google levaquin toxicity and think twice before taking it. He can prescribe something other than in the Fluoroquinolone family.

Please read...
http://articles.mercola.com/sites/ar...e-effects.aspx

Second..... It is irrelevant as to whether he thought the tooth was infected or not.... although the xray is clearer than clear.... ALL extraction sites need to be debrided. It is not okay to leave the periodontal ligament in there. A graphic but perfect example would be .... like leaving the placenta in the uterus after childbirth! The ligament protects and feeds the tooth nutrition.... the placenta works on the same principal.

I urge you to call your dentist, the one who referred you to the OS, and tell him exactly what has (has not!) happened and ask for another referral to a different oral surgeon. Your dentist needs to know that this guy did not follow not only his recommendations but also did not follow the proper surgical protocol.

Infection in the bone does not heal on it's own. Antibiotics can only do so much if the bacteria has overwhelmed the sinus or beyond. I cannot tell you what the outcome will be in your situation.... I just know that you need to get an opinion from a different surgeon asap.

There is nothing "natural" that you can do to eradicate necrotic bone or tissue. You need to have a definitive diagnosis first, get the proper treatment and then there are things you can do to help yourself heal.

You know that stress can cause you to feel more cruddy than usual :/
So I want you to stay focused and think positive ..... be thankful that you are rid of that infected tooth.... that you have met me and ginnie :)...... and that you can and will get through this!!

Look to your general dentist as an ally and let him know that you are seeing him that way. He is (legally) obligated to see this through as you are his patient and he has to either take care of you or release your care to someone else.

It may be a good idea to let him check out that bottom molar too.

Stay strong, stay positive!
Stay in touch with us here....
Bryanna

Bryanna,
Thanks a lot for all the info and the encouragement. I do appreciate I find people like you and others here.

I have no doubt that this tooth was not healthy since it had bothered me for at least two years.

I stopped seeing my original general dentist after his root canal treatments for this #14 (at the begining of June). My gut told me I got this bad sinus infection from his third root canal treatment for this tooth (He was filing and drilling there and all of the suddent, I felt a sharp pain around my left nose. The next day I started smell some bad odor from my nose, then the yellow/green discharge).

I switched to another general dentist (holist dentist) in the mid June. He referred me to this OS. I don't know how good this holist dentist is. Before the surgery, I asked him how could oral surgons know the periodontal ligament needs to be removed. The holist dentist said yes they know. Upon my request, the holist dentist wrote on the referral form "extract the tooth and remove the periodontal ligament..."

Should I change to another general dentist? Or I just go ahead to find another oral surgeon by my own?

Before I can get an appointment with another surgeon, do you think Z-pack is a better antibiotic than levaquin. I was on Z-pack for 5 days after the surgery.

Many thanks,

Grace

Grace,

The description of your root canal treatment and the symptoms that you had certainly sounds to me like that dentist may have perforated the apex (root of the tooth) with a file instrument as well as the sinus. That would explain A LOT!!! That occurrence is not uncommon but it sets up house for a nasty long term infection. I'm betting that's what happen!!!

Regarding the note from your holistic dentist...
1) He was verbally trying to reassure you that ALL OS KNOW to remove the periodontal ligament. Unfortunately, he is very aware that not all of them routinely do that. As you have found out :/
2) He agreed to write the note to the OS as a way of "notifying" him to make sure to remove the ligament. This note also made it clear that YOU had been informed of this step. The OS should have performed that step without question.

This holistic dentist needs to be informed of what has happened. I do not see any reason why you should not trust him at this point.

I cannot determine the proper antibiotic for you to take. I can only inform you about the importance of researching the potential harmful affects of Levaquin. I can also inform you about the overuse of antibiotics and that they need to be prescribed carefully and not carelessly to patients. At this point the site may need to be cultured to determine the proper antibiotic. Please think about calling the holistic dentist and tell him what has happened. Let him evaluate it and/or refer you to another oral surgeon.

Bryanna

Thanks Bryanna,
I 've scheduled with an ENT doctor. I Hope this time it is a good one.
I called the hostlist doctor's office and he refused to see me because of this issue. He said everything should be taken care by the oral surgeon. I was too straight forward when I was talking to the office :-(

Thanks again for all your help.
All the best to you, and everyone on this board and myself!
Grace

Grace,

Did you speak directly to the dentist or just the office??
If you are a patient of record at the holistic dentist's office then he cannot legally refuse to speak to you unless he puts the reason in writing and addresses it to you.

The ENT dr cannot be responsible to treat a dental problem. He can however work in conjunction with an oral surgeon.

I know this has been an exhausting ordeal for you. I feel so bad that you are being (mis)treated like this! I so hope you get help and relief soon.

Bryanna

move on. Need advice.
 

Thanks.

I talked to the front desk (I asked I would like to see the holist dentist asap). The front desk talked to the holistic dentist and passed the word to me. Right now, I don't have energy to hang on with them anymore

Bryanna, could you tell me:
1) From the two X-rays that I posted for 14#, how can I tell the tooth was very infected before the extraction (with a cysts?)? So when I am meeting with a new dentist/oral surgeon, I have a better idea/judgement. I can not be be fooled/abused anymore.

2) If an oral surgeon does Not see a sinus perforation after the extraction, does it mean there is no sinus perforation?

3) A sinus perforation can be spotted by an OS Only if he debride the socket after the extraction. Is that true?

4) If I take new x-rays, what indications should I look for in order to tell the infection in the bone/surrounding tissues?

5) What images/tests will you recommend for sinus infection since I will be meeting with an ENT?

Thanks a lot.

Grace.

Grace,

I feel so bad for you and agree you have not been treated fairly. Chances are your message was not conveyed to the dentist as you would have liked it to be. The person that you spoke to should not have been the go between. So that dentist may not even know what has happened exactly. This situation can create miscommunication between your new dentist and the original dentist if the new one calls him and he doesn't have the correct information. Do you see what I'm saying?

I will try to answer your questions... in bold type.

1) From the two X-rays that I posted for 14#, how can I tell the tooth was very infected before the extraction (with a cysts?)? So when I am meeting with a new dentist/oral surgeon, I have a better idea/judgement. I can not be be fooled/abused anymore.

THE INFECTION WAS EVIDENT ON THE XRAY. THERE WERE AREAS THAT APPEARED TO BE CYSTIC. A EXPERIENCED EYE CAN SEE THOSE THINGS. THE ORAL SURGEON WHO REMOVED THE TOOTH MAY NOT ADMIT WITH THOSE THINGS BECAUSE HE WAS LAX WITH THE SURGERY AS HE TOLD YOU HE DID NOT DEBRIDE THE SOCKET. SO HE MAY WANT TO COVER UP FOR THAT TO SOMEONE WHO QUESTIONS HIM. A "GENERAL DENTIST" MAY NOT VIEW THIS TOOTH SITUATION AS BEING A PROBLEM BECAUSE MOST CONVENTIONAL DENTISTS DO NOT ACKNOWLEDGE THE SEVERITY OF TOOTH INFECTIONS. ORAL SURGEONS TEND TO LOOK AT THIS DIFFERENTLY AS IT IS THERE JOB TO REMOVE THESE MESSES!

2) If an oral surgeon does Not see a sinus perforation after the extraction, does it mean there is no sinus perforation?

NO, NOT NECESSARILY. NOT ALL SINUS PERFS ARE VISIBLE. REMEMBER I WROTE ABOUT THE ORAL SURGEON BEING ABLE TO SEE OR FEEL THE PERF (IF THERE WAS ONE) IF HE HAD DEBRIDED THE SOCKET? UNLESS THE PERF IS LARGE OR IS PICKED UP ON THE XRAY, IT MAY NOT BE VISIBLE TO THE EYE... BUT IT CAN BE FELT DURING THE DEBRIDEMENT AFTER THE TOOTH IS REMOVED. HAVE I EXPLAINED THAT CLEAR ENOUGH?

3) A sinus perforation can be spotted by an OS Only if he debride the socket after the extraction. Is that true?

NO, NOT NECESSARILY. DEPENDS ON HOW LARGE A PERF IT IS AND THE LOCATION OF IT.

4) If I take new x-rays, what indications should I look for in order to tell the infection in the bone/surrounding tissues?

YOU WOULD NOT BE ABLE TO READ NEW XRAYS YOURSELF. IT TAKES A TRAINED EYE TO SEE PATHOLOGY ON AN XRAY. HOWEVER, NEW XRAYS MAY SHOW (TO THE OS) A RESIDUAL INFECTION STILL BREWING.... A SINUS PERF.....THE PERIODONTAL LIGAMENT STILL SITTING THERE... UNHEALTHY BONE STILL PRESENT.

5) What images/tests will you recommend for sinus infection since I will be meeting with an ENT?

SCANS THAT ARE SPECIFICALLY DENTALLY FORMATTED WOULD BE ADVISABLE. THE ENT WOULD BE THE ONE TO DETERMINE WHICH ONE WAS BEST IN YOUR CASE.

Bryanna

Thanks
 

Thanks Bryanna.
Grace

Hi Grace
 

Levaquin is a very powerful antibiotic, in fact on top of the chart. If he gave this medication to you, there is some worry on his part about the site. Bryanna will be here. I am just an observant person who went through some issues that Bryanna helped me with. ginnie

Hi ginnie,

Yes, Levaquin is a powerful antibiotic but it is also in a class of drugs that have a bad track record for neurological problems. There are actually several groups of people who have formed all over the country (possibly beyond) whose goal is to get this class of antibiotics off of the market completely.

Of course not everyone will have a bad reaction to every drug. But there are drugs that should be avoided if at all possible due to the long term if not permanent side effects and these drugs are in that category.

Unfortunately and I say this with a sigh....... some (+) dentists are clueless about drug reactions. Often when a patient reports they had or have a reaction, the dentist refers them to their physician. Dentists rarely delve into the literature on drugs or go to seminars on them and they tend to give out antibiotics and pain meds like they were candy.

If you think back on many of the posts here... people repetitively complain about their dentist putting them on one antibiotic after another sometimes for several weeks or so! Yet they have no idea why or if their dental problem is even responding to the medication. This has been a problem in the dental profession for as long as I can remember and it's not getting any better ... unfortunately :/

But I agree with you that Grace needs to follow up on whether she needs to be on an antibiotic or not.

Thanks for caring so much ginnie.... your concern comes through loud and clear :)
Bryanna

Hi Bryanna
 

That is the reason why I mentioned this drug. I am pretty sure my PN started after I had a six month ear infection with pseudomonias (spelling) Finally gave me levaquin. Followed two surgeries on my ankle and low and behold I have PN. I guess I should count my lucky stars it is not RSD, I worry when people are given so many antibiotics. I sure hope that dear lady gets resolution. Again thank you for all you do on NT. Lord knows we all need the help! ginnie:hug:

Ginnie,

Thank you for all that you do too! We would be lost without you :)
Hope you have a good weekend!!

Bryanna xo

Thanks
 

Bryanna & Ginnie,
Thank you very much! I am grateful at least I find help and care here.

Thanks,
Grace

Hi Grace
 

You found the reason why I stay with Neuro Talk. There are alot of caring people here. This is where I run to when I am in trouble with some medical condition. Glad to meet you through this site. I hope you get all the good dental care you can. I found that this site tells the truth as best people can do. have a good night Grace. ginnie