Sinus Perf after Wisdom teeth extraction
 

Hi,

I had all four wisdom teeth out 8 days ago, and 3/4 came out with little issue. The upper right was close to the sinus, and I was told while I was in recovery that there is the possibility a small hole was created, but that they were pretty sure it was fine. I was told to not blow my nose, and that all would be fine.

Fast forward to Day 2, after my first rinse with salt water, I realized really quick that there was a hole, as water came out my right nostril. Based on what I had read, I decided that I would wait out the weekend and call the oral surgeon on the Monday. I got a hold of one of the nurses (Day 5), and was told that it would heal on its own, and not to worry. She said they would take a look when I came in to get my stitches out.

Day 8 (today) came, and I went in to get my stitches out. 3/4 sites healed up nicely, and the stitches were taken out by the nurse. I told her that the upper right site is extremely tender and puffy, and the 3 teeth (and gums) in front are inflamed and super sensitive to touch. In addition, I let her know that I still have an active hole as water and air still travel through it.

Doc comes in, sticks his mirror in my mouth for 15 seconds, says "looks good" and says it will be fine. I kind of gave him a look, and he said "I guess we can see you in 2 to 3 weeks to check on it again, gave me a prescription for more of the same antibiotics and sent me on my way.

Didn't notice until I got back to work, but the prescription is written out:
Clindamycin 300mg
Disp XV
sig 4 hr. prn pain

I might just be a chemist, but I can tell you that you don't dose antibiotics as needed for pain.

I have been wordy...
TL;DR Should the doc have done something for my sinus perf after 8 days? I am just worried it is going to get infected.

and are all oral surgeons this careless with their prescriptions? If anyone has any thoughts I would greatly appreciate it

Hi armstri,

You obviously have a sinus tear or perforation. Whether or not it needs intervention is really up to the oral surgeon. Yes, based on your description it sounds like he was a bit "off" with the rx, etc... perhaps he was rushed? I'm not excusing his demeanor or rx mistake.... it would upset me as it has you.

Sinus tears or perforations often heal on their own unless they are very large and/or there is something preventing them from closing. The healing time varies per individual case.

Smoking, drinking alcohol, poor oral hygiene, poor health, sinus infections/inflammation.... these are all issues that can prevent the perf from closing and/or prolong the healing.

If by Thursday the leaking of water out of your nose has not subsided greatly or it gets worse, then either go back in to see the oral surgeon or seek an evaluation from a different oral surgeon. A periapical xray can sometimes help determine the location and size of the perforation so it may be wise to have one done if the problem does not resolve.

Not all oral surgeons, thank goodness, are that lax about their prescriptions .... I cannot come up with an excuse for him... :/

Bryanna

Thank you so much for the reply Bryanna!

It was the last appointment before lunch, so I guess he could have been rushed. I am trying to keep an open mind, but I tend to worry (maybe a bit too much at times) about my health.

I have been keeping up with the oral hygiene and saltwater rinses, and do not smoke or drink. I guess I am concerned about the inflammation/infection part. The teeth in front of the extraction site are very sensitive with inflamed gums, but I am doing my best to take ibuprofen in an effort to keep that at bay.

I called my dentist today, and she said that she doesn't want to even waste my time coming in, but she would definitely give me a referral to another oral surgeon if I was interested. I will see how it goes through the week and then make a decision.

Thank you so much!

Ian

Hi Ian,

You are very welcome.... !

I don't think you are over worrying about this at all. Are you still leaking water from your nose when you rinse? Are you gargling with the salt water? If so, stop doing that because that can send the water up into your nose.

I am concerned about the soreness and inflammation in the gums in front of the extraction site. Are you able to brush and floss your teeth thoroughly? Are you accumulating plaque along the gum line of those teeth? Plaque is very irritating to the gum tissue and it can cause pain, swelling, discoloration and infection. Do you think plaque could be a contributing problem there?

If you are not building up plaque, not gargling with the salt water and the leaking from the nose has not slowed down .... I then think it may be wise to get that second referral from your dentist and make an appointment with the new oral surgeon. What do you think?

Bryanna

That is comforting to hear. I think the last time I had water leaking from my nose was this past weekend. I think though that it may have been a change in my technique. I never was gargling, or swishing vigorously, just kind of shaking the water around lightly to hit all of the extraction sites. What I have changed is the tilting my head back. I no longer tilt my head back, and I don't end up with water coming out of my nose.

I do still witness water leaking from the extraction site though. It usually is a significant amount that I have run back into my mouth after spitting the first amount out. In addition, it seems as though the amount of air entering my mouth is increased. I have noticed it moreso now even just drinking from a normal glass.

It could be, I have been doing my best to brush those teeth as far back as I can, but the molar closest to the extraction site probably has been a little neglected since it isn't comfortable to brush. I will try and really make sure I clean them well from now on.

I am really considering either calling my oral surgeon and telling them that it is worse, or going for the second opinion. What would be a sound rationale for not taking some sort of action and giving it an extended period of time to heal by itself? Is there one that I wasn't informed of by the oral surgeon?

Im just afraid of getting an infection. I know there are bacteria in your nose/sinuses (staph etc.), that you really don't want in your mouth, and vice versa.

Ian,

Okay so no tilting of the head = no water leaking out of the nose. That is good.

Water should not be leaking out of the extraction site and the air sensation should not be increasing. Were you or are you drinking through a straw? If so, definitely avoid using a straw, just drink from a cup. The suction of using the straw can keep the sinus open or at minimum delay the healing.

Regarding your oral care at home .... it is imperative to clean all of your teeth especially along the gum line to prevent the build up of plaque. It may help if you buy a child's size toothbrush as that may be easier to maneuver back there.

If you feel that the gum inflammation is not plaque related or that the sinus issue has gotten worse, then by all means see one of the surgeons.

Bryanna