Expert: Lawrence Spindel DDS, www.lspindeldds.com - 12/10/2009

Question
I had a tooth extracted in the emergency room at the local hospital last month.. It was difficult involving cutting into the sinus area and after a dry socket pain it seemed to settle down.Now I have got a severe throbbing pain above the extraction site all around the cheek area which i have been prescribed amoxicillon for which did not work I have seen 3 different dentists but noone seems to want to take responsibility for this. I have phoned the hospital and they told me to see my own dentist, even the notes are not available. I seem to have no one to turn to  and am worried about the possibility of bone infecton or possibly the next tooth causing the pain. can you help?  

Answer
Dear Jane,

It sounds like you may have a sinus infection, but the question is what is causing it. One of the risks in having a maxillary molar removed is developing an oral antral fistula. This happens when the sinus is perforated and doesn't heal. Another possible complication is piece of the root may have been inadvertently pushed into your sinus.

Another possibility is that you may have a bone fragment that needs to work its way out before you have complete healing.  These 'spicules' can cause pain and definitely delay healing.

I think you should follow up your extraction by seeing an Oral Surgeon and not a general dentist. Radiographs should be taken to rule out any root fragments in your sinus. The Oral Surgeon can advise you and may want to clean out the socket up again to remove any bone fragments that may be delaying healing.

Amoxicillin is usually the first line antibiotic that is prescribed for patients who are having post extraction infections, so you should take it as prescribed. If your tooth was extracted was approximately a month ago it should not be hurting if everything is OK, so I would follow this up as I suggested by visiting an Oral Surgeon and getting some advice and treatment.

I hope this information is helpful and please feel free to contact me again with any future dental questions.