Infection in both sinus and old root canal
 

I was trying to find information about infections and came across this site. I have read that it is better to extract the tooth (#14) than to do another root canal. The question I have is that pain began monday night with a sinus headache on the left side, and through the night, my tooth began to hurt. I attributed this to sinus pressure, and as the day wore on, the pain lessened. I did hear a slight pop in my left ear, and it felt "clogged". Tuesday night the pain was back, and the tooth hurt more and more. Wednesday night I woke up every 2 hours, percocet did nothing for the pain. I saw my dentist, he said I should see the endodontist, and prescribed penicillin. The endo said there is an infection in the root canal and slight bone loss. The options were remove the tooth, and then bridge or implant, or re-do the root canal. She did not say there was no way to completely remove the infection, though. I started taking 800mg ibuprofen as soon as I left there, then the penicillin an hour later. By friday morning, 95% of the pain was gone, and my tooth felt like "it was back in place". Before, it felt like it was being pushed down from above. My left sinus started draining a clear fluid, as if a faucet had opened up. I am now able to again chew on the left side. There is a lot of swelling in my left cheek still. The root canal was done 33 years ago, and this is the first time there has ever been a problem. What would your recommendation be? I'm not sure if this is caused by sinuses or root canal problems. Thank you for any information.

Hi theprincess.

First of all the antibiotic has only temporarily subsided the symptoms and reduced some of the acute inflammation in the bone. The symptoms will return and with a vengeance. It is best to have this tooth removed while on the antibiotics.

Secondly, although the tooth seems to have been "fine" all of these years.... it really hasn't been. It's been infected for 33 years or longer. The bone loss and bone infection is indicative of a long term infection.

There is no "cure" for this infection inside of this tooth. Re treating it with another root canal or a surgical apicoectomy will do nothing to change the necrotic bacteria inside of the tiny canals that have been infected for 33 yrs.

From your description.... it sounds like the infection may have spread up into your sinus area. It is important for you to know that sinus infections caused by tooth infection are considered very serious, especially if it has been present for a long time, because your brain is only 4 inches from the sinus and the infection has the potential to spread. It is important to know that the longer the infection is present the larger it will become.

To keep this tooth means to keep the infection. To remove this tooth means to remove the source of the infection.

I would suggest that you see an oral surgeon for the extraction as a general dentist most likely will not clean out this area of bone as well as it should be.

You'll be okay.... just please don't wait to get it taken care of.
Keep us posted.

Bryanna

Thank you Bryanna,
I appreciate your replying. It confirms what I was thinking. I'm planning now to coordinate with my dentist here in N.Carolina and an oral surgeon in Miami to remove the tooth and have an implant afterward. I'll know more tomorrow, if it's possible to get an appt for friday to remove the tooth, but if not, what is the maximum length of time to wait to get this done, based on the sinus infection. What is the frequency and duration of Amoxicillan, 500 mg. My dentist prescribed it for 4times a day for 7 days, and the endo for 3 times a day, 7 days. It's been years since I've taken any, but I seem to recall it was usually for 10 days. right now I'm taking the endo prscription. And do you know how long after the extraction that it would be all right to get back on a plane to get back to NC (due to pressurization concerns)? I very much appreciate the help, it's making a bad, painful situation a lot easier!!

Hi theprincess,

The dosage of antibiotic is dependent upon the type of antibiotic prescribed and the infection. I found this on e-notes which uses educational and medical sources to gather their information:

Penicillin VK: an initial dose of 1000 mg followed by 500 mg four times daily for seven days.
Amoxicillin (Augmentin): 250 mg three times daily for ten days.
Erythromycin: 1000 mg first followed by 500 mg four times daily for seven days (for patients allergic to penicillin).
Clindamycin is often prescribed (300 mg daily for seven days).

It is ideal to be on the antibiotic at the time of surgery. So if that doesn't work out, they may prescribe additional antibiotics at the time of surgery.

It is not ideal to fly within a two week period, sometimes longer depending on the individual situation, after an upper tooth is removed. Even flying prior to the removal with this type of infection could cause pain and swelling in the sinus or other complications.

Do you have to travel to Miami to see an oral surgeon?

Bryanna

Thank you Bryanna,
You have been a huge help, and I greatly appreciate it. As of now, I have an appt. in Miami on friday with the oral surgeon to extract the tooth. She saw the xray, and says it will be OK for me to fly home the following wednesday. The impressions were taken this morning of my teeth for the implant later down the road. My health insurance is from Miami, and I have a house there that my daughter lives in with her best friend, who works for the oral surgeon, which is why I'm going there for this procedure. I'm sure there are great oral surgeons here in NC, I just didn't have the luxury of time to find one on short notice. I do have another tooth that had a root canal several years ago, I guess I should think about having that out as well? No problems so far, but now I can see just how fast things can go from being fine to severe in a matter of days. Thank you again for all the information, knowledge definitely IS power!

Hi theprincess,

You are welcome:)

I wish you all the best with your imminent oral surgery. Please keep us posted on how you're doing!

Bryanna