Tooth 14 extraction perforated maxillary sinus
 

Hello. I need some advice please. One week ago I had tooth 14 (upper left side second to back tooth) extracted due to fracture. It perforated my maxillary sinus when they extracted it and I knew this, because immediately I had whistling in the surgery site. The whistling went away 6 hours after surgery. Three days after the extraction I got off the pain meds and started just using advil.

That same day in the afternoon I got this horrible pressure in the maxillary sinus above the extracted tooth and in my frontal sinus. It was so painful I began to feel nauseous and got hot flash/clammy feeling. I took 4 advil and a half of a pain med. It took 2 hours for the debilitating pain to subside to a dull ache for the rest of the day. This has since happened everyday since around the same time.

It has now been a week since surgery and they have me on antibiotics 3 times a day, decongestant and saline nasal spray for the past 5 days. Is this pain normal? I have never had a migraine before and the only headaches I ever had could be cured in 20 minutes with 2 advil. Is it normal that when the pressure in my head gets horrible that I feel nauseous and get hot and clammy?? I also would like to say this tooth had 2 root canals performed as well as an apicoectomy.

new symptom
 

After posting this thread last night I woke up this morning with a new symptom. If I smile or touch the maxillary sinus area on my face above the extraction site I get a sharp pain. I am hesitant to call the on call doctor at my oral surgeon's office, because I don't want to bother them on a holiday weekend if I am overreacting. I called them yesterday about the horrible sinus pressure pain and I got the feeling that she thought I was overreacting. Any thoughts or recommendations??
Help!

Hi Radiology chick,

Although I don't think your problem should be ignored by your OS, I think it is somewhat common for those who have had an apicoectomy on an upper molar and that is how it is being "treated".

During the apico surgery, the gum tissue is flapped back and a portion of the upper front area of the jaw bone is removed, exposing the root the tooth and a bit beyond it. Depending on the location of the sinus, that too is often invaded as well. Not only does the procedure itself set up a pool of bacteria and inflammation but after the procedure this opening in the jaw is plugged with either a piece of mercury filling material or something similar. The bone cannot grow back in that space so the patient is left with a diseased area of jaw bone and a blob of foreign material irritating the hell out of it. The area remains inflamed and chronically infected. As if that wasn't injurious enough, the tooth also still remains infected as it is not possible to remove the necrotic tissue from the tiny canals.

Chances are the sinus was already perfed before the extraction from all the infection but the inflammation could have been preventing some otherwise obvious sinus perf symptoms. However, as the tooth was removed the sinus perf became visibly open and obvious. Although the patient is not always informed about it, this situation is commonly found in cases like yours.

Your physical symptoms are indicative of an infection. As the pressure builds up the body sends signals that something is wrong and the pain comes along with feeling ill, then the pressure releases as the bacteria drains and/or the meds kick in.

I would suggest that you consult an Ear Nose and Throat specialist. Bring all (pre and post op) dental xrays or have them emailed to him prior to the appointment. On the health history form and at the consult go into detail about the dental history of this tooth and the time line of your symptoms.

I am so sorry you are going through this... it can be excruciating and debilitating. This may be something that is not going to get better on it's own so please don't take a wait and see approach to this. It is important that you understand that a tooth and/or sinus infection can spread to the brain. Not trying to scare you... just trying to get the point across that even though your dentist is being lax about this... you should not be.

Keep us posted.
Bryanna

Thanks Bryanna for your time and advice!

Do you think this issue should be ok to wait until Tuesday during business hours? Tomorrow is the last day of my antibiotics so I am little concerned that the sinus pressure has not fully resolved yet. I have been taking Clindamycin 3 times a day and tomorrow will be the 7th day of taking it. At times I get a bad/weird taste coming from the cavity where the tooth was. That worries me that the infection is still very active even after taking my antibiotics as prescribed.

Thanks again!

Hi Radiology chick,

First of all the clinda may not be the proper strain of antibiotic for your type of infection. The only sure way to know what antibiotic would be appropriate would be to have a culture done. This is why it is important for specimens to be taken at the time of the extraction. But unfortunately this is rarely done. The ENT could maybe due this by taking a swab of the sinus. You would have to talk with the ENT about that.

Many people are under the impression that as long as they take an antibiotic the infection will be cured. Due to the countless species of bacteria in the body and the fact that the mouth and the sinus also have lots of cross species... it is always a shot in the dark when the antibiotics are prescribed without doing a culture and sensitivity test to determine the proper medication.

I think it is wise to call an ENT on tuesday for an appointment as soon as you can get in there.

In the meantime, it may help to rinse with warm salt water 3 times a day. Do not gargle with it. Also avoid any OTC mouthwash as it is contains nothing but chemicals, preservatives, dyes..... etc.

Bryanna

Bryanna,

Thanks again for your time and concern. I went back to the OS and he removed a bone fragment from the tooth cavity and changed my antibiotic to Z pack (I'm allergic to penicillin). I have been on the Z pack 2 days and I feel sooooo much better already. I think things are rapidly getting better.

Thanks again!!!