Five teeth extraction, two upper molars fused, bone graft, now foul odor
 

Hi,

I found this site from a lot of google searches, I saw Bryanna post on some very similar issues, so I appreciate the attention on this potentially redundant thread.

I have just had five teeth extracted, they came out 12 days ago. I had the top two molars on my right side fused to the bone (my 12 year molar and wisdom tooth) I had a bone graft placed.

It was quite a painful recovery, i took pain meds for over a week (Norco) along with ibuprofen and as much tylenol as i could add without taking too much. I also took a weeks worth of amoxil after the surgery.

A strong smell began in my nose a few days ago, a couple days after i finished the amoxil. It smells like roadkill, and it's disgusting. My boogers (Sorry) look clear if there are any at all. I have no fever.

I did have a lot of pain at the site, the bone grafting area was the most painful part of my recovery, all the other extractions were fairly straightforward with normal 3-5 day recovery.

This has put me through the wringer. I am worrying myself, infection/abscess or some sort of evil. Any ideas?

I have an appointment with my OS day after tomorrow. If it is an infection, will antibiotics alone help?

Hi JenLRhodes,

Given your dental history, surgical experience and antibiotic history, it is very possible that the sudden smell in your nose is indicative of something abnormal (bacterial) in your sinus.

Was there any mention of a sinus exposure or perforation mentioned to your by the oral surgeon? If you press on your face just to the side of your nose on each side, near the lower cheek bone, do you get any pain or tenderness? If you bend your head down towards the floor do you get any pulsating or discomfort in the your sinus or head? Any discomfort or pressure in your ears? Any post nasal drip? Do your nasal passages or sinus feel stuffy?

May I ask... were the extracted teeth root canaled?

Bryanna

Answering your questions
 

He didn't mention any perforation, but I'm not sure I like his communication with me. I asked him about it, and he said if I had a perforation, it would likely heal.

After I went to the oral surgeon again, (the day after my original post) he just gave me augmentin. I don't think it did anything, i didn't notice a change at all. So now i've taken amoxil for seven days immediately post surgery and augmentin for seven days. I'm worried if it is an infection it'll be antibiotic resistant at this point.

I'm worried that i somehow have perforation that didn't close up and is causing an infection somewhere. Or that the bone graft is somehow causing an infection.

If i press on my face on the side of my nose on the affected side (my right) i get tenderness. If I bend my head it becomes more painful. Today i've noticed pressure underneath my eye as well, and i've had a nagging headache on my right temple. My nasal passage on my right side feels stuffy. I'm still blowing green and yellow stuff. my gums sometimes hurt on that side, and my teeth. I can still smell the sickly sweet smell too, and sometimes taste it. And it makes my cheekbone hurt, and my throat on that side a little tender.

I believe there is some post nasal drip because of the taste, and i become nauseous. The teeth were not root canaled, but one of them (the fused twelve year molar) had a cavity.

are there ways to tell if the sinus was perforated? should i seek out an ENT or a different Oral Surgeon for more guidance? The one i went to did not really take my concerns into real consideration. I told him i had a gross smell, he looked at my gums and said they looked fine, took an xray but i don't know what he saw, and gave me augmentin.

JenLRhodes,

Unfortunately, the repetition of antibiotics is commonly and thoughtlessly done but it is not without consequences. Each time you take an antibiotic you upset the balance of your intestinal flora pre disposing you to future inflammatory and bacterial problems. Especially if you already have gut issues or other health problems. So antibiotics should only be given if they are warranted, not just for the sake of giving them.

If the healing were going well, you would not continue to have the same symptoms nor would you be getting additional symptoms. If you feel that this OS is not as concerned as you are about the symptoms and you feel his arrogance takes presidency over his obligation to take care of you, then please consult with another oral surgeon. Someone who is unaffiliated with this one. You would need your pre op and any post op xrays and a copy of the surgical report for that new consultation. It is best to not speak ill of the previous OS to the new office as you do not want to put the them on the defensive or make them leery of taking you on as a patient.

You may also need to consult with an ENT but at this stage the ENT will have limited options of treatment. You need to be evaluated by an OS first.

I hope this info is helpful. Please keep us posted.
Bryanna

I went to see another OS, he looked in my mouth and said my gums look good, like they're healing, and the xray he took didn't seem to concern him.

He recommended an ENT, who looked in my sinuses and identified an infection.

He gave me two weeks of Cipro and scheduled a follow up directly after to ascertain the necessity for further treatment.

As it stands now i don't believe the Cipro is working, but i will be finishing the treatment.

I'll let you know what comes of the follow up. I'm wondering if i'm having some sort of negative reaction to the grafting material?

JenLRhodes,

Please read posts from Angels31. She has a similar problem to yours. You are both on the same family of antibiotics called Fluoroquinolones. These antibiotics are not without systemic consequences. Therefore, they should only be prescribed in dental situations unless a bacterial culture has determined that they are the appropriated medication for this particular species of infectious bacteria.

Please see this video and link by Neurologist Dr Perlmutter.
http://www.drperlmutter.com/fluoroqu...al-neuropathy/

The ENT and the oral surgeon need to collaborate on this infection as it could be that the surgical site is still infected.... the graft may be infected... the sinus may have additional infection. They need to work together.

Bryanna

Thanks
 

Hi Bryanna,

I am going to the ENT for a CT scan tomorrow. I will ask him about that, and follow up with my OS as well to coordinate their collaboration.

Thank you for your help here. I'll keep you posted.

**The ENT and the oral surgeon need to collaborate on this infection as it could be that the surgical site is still infected.... the graft may be infected... the sinus may have additional infection. They need to work together.**


The ENT did the CT scan and has recommended surgery to clear out my sinuses. I'm wondering will that same CT scan have shown him whether my graft or graft site was infected? How do we tell if the graft itself is infected if the inside of my mouth is "fine" The gums are tender...i'm not sure though because we know sinus pressure does this too.

If i have the sinuses surgically cleaned i want to make sure the infection won't recur as a result of it being originated at the graft site.

Since the new OS just referred me to an ENT...how do i convince them i think the infection is in the graft? how can we tell?

JenLRhodes,

ALL of your questions are very valid and to be clear ... the OS should also view the scan and give his opinion as he is the one who performed the oral surgery so he knows what he encountered and he is the one who placed the graft so he knows what he used and where he put it.

You will have to ask both the ENT and the OS all of those questions as they are the ones looking at the scan. Never assume that the "incidental details" are going to be sited or evaluated. It is always wise for the patient to bring up all of their questions to ascertain that these issues and concerns are addressed prior to any further treatment or surgery.

A clinical view of the inside your mouth is limited if we are talking about the sinuses or the bone graft that is in your jaw bone covered by closed gum tissue. So things can look great clinically and be a well hidden problem.

I would not have any surgery done until the OS and the ENT have discussed with each other..... the oral surgery that was done, the graft that was placed, their findings and opinions regarding the scan and what options they think may be a wise approach to helping you. The way to get them to do that.... tell each of them that you want a collaborated effort as you feel that is the best way to cover all the bases and that you won't proceed until this is done.

Bryanna

I've signed the release and the CT results are being sent to me to share with my OS. Meanwhile still dealing with the sinus infection. I've told them no more antibiotics since they aren't doing anything. ENT has agreed, and told me to contact him for antibiotics if I get worse, so that the infection at least doesn't spread. Not sure what "worse" is. Fever, fatigue I imagine.

If it IS in the bone graft, is there a history of bone graft removal to treat infections? What is the necessity of a bone graft, would I need to have another one inserted if they did have to take it out?

I'm also concerned that if they take out the graft it will create a communication in my sinuses. I feel like I was healthier BEFORE i had my wisdom teeth removed, and I don't want to keep doing surgeries and making myself sicker and sicker.

Feeling beaten. So tired of this nonsense.

I'll keep you posted when I meet with the OS and with our action plan..

Thanks for your help.