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Dentistry/hole in antral fistula and bone fragments after extraction of tooth 3


Dear Dr. Teig,

on 9-24-12 I had a core build up on tooth 3, right upper. I was still experiencing pain so went back to the dentist. He did a root canal on 10-16-12. i didn't get better and went to him again and again. After several times going back He told me he had broke the tip of the file off in my mouth but, that wouldn't be causing the pain. I had been to the ER and saw ENT because of pain in my ears and eyes and severe headaches and pressure in right temple well really at times everywhere on that right side. ENT thought TMJ was the problem. went back to the dentist he said do another root canal maybe missed canal. things became even worse. alot of antibiotics during this time he prescribed but, never got better. I had  enough so told him to pull the tooth. He did core build ups on teeth 2,4,5.Im confused about that because several years ago the tooth right before 3 was pulled and didn't ever have a crown on it but,anyway, he pulled the tooth on 1-31-13 and placed a temp 4 piece bridge on. He said the tooth root was cracked from base to tip and that was the problem. His assistant said it was probably cracked all along. I tell you it didn't hurt this bad in the beginning. I Didn't think things could get worse but,it did. I was back to ER 4 days later. I was put on yet another antibiotic but, still no relief.a few month I went back to dentist complaining of all the symptoms above and they did several more core build ups on 2,4,5, every time he did them it got worse overtime. It would take weeks for it to calm down even alittle. at this point afraid of the dentist so went back to ENT. I had started having mucus coming out from the bridge at extraction sight.Told ENT of the mucus and severe pain in mouth. He ordered CT scan and found antral fistula hole. referred to oral surgeon who is board certified. I then found out there was also bone fragments/depridement several non-vital bone fragments and granulation tissue. I guess i got a double whammy. I had surgery on 5-8-13. I thought I was on the road to recovery but, into the 3rd week I knew something wasn't right. returned to oral surgeon and he said I fixed your problems go see ENT. Pain unbearable and started having equal libruim problems. went to ER yet again and they did another CT scan and there is some nerve damage and I don't know how to read scan but problems anyway. I'm getting ready to start steroid to get swelling down and maybe help nerve pain too. My new dentist wont put permanent bridge on until I have not been in pain for 2 wks. I know I could lose those surrounding teeth if a bridge is not put on. Do you have any advise for me? I got my records from original dentist and saw some things that weren't true. He claimed he told me about the broken instrument and he didn't disclose that until later. He also said in his records he was going to refer me to Endo. if no 4th canal found but he never said anything like that to me. I appreciate any help you can give me. thank you

Donna -  It is obvious that you have been through the bad dentist mill.  Your dentist, once he broke off the instrument, should have immediately sent you to the Endodontist to clean the canal properly and hopefully stop the problem.  

Now that the fistula is allegedly closed, the sinus is still infected.  One of the main things that must be done prior to closing an oral antral fistula, especially one that sounds like it existed for a while, is to stop any inflammation or infection in the sinus at the time or before closure of the fistula.  The surgeon should have probably cleaned the sinus with an oral and nasal antrostomy prior to closing the fistula or refer you to an ENT doctor to do that.  

Well now that the problem is probably still there and it sounds like a problem or infection is brewing in the sinus.  That sinus needs cleaning.  Equilibrium problem is common from a chronic sinus infection.  So immediately have the original ENT or other one evaluate your sinus.  

I wish you well and hope they help you soon.  If you have additional questions, feel free to contact me again.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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