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About Joel S. Teig, DMD, FABOMS
Expertise
I am a board certified oral and maxillofacial surgeon 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.

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

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

Education/Credentials
BA DMD

You are here: Experts > Health/Fitness > Surgery > Oral Surgery > wisdom teeth issues

Topic: Oral Surgery

Expert: Joel S. Teig, DMD, FABOMS
Date: 10/12/2008
Subject: wisdom teeth issues

Question
QUESTION: 4 days before my wisdom teeth removal i was put on amoxicillin for 7 days. aug 26 i had my lower and upper wisdom teeth removed from my right side. doctor said bottom one was on nerve and very impacted and during surgery said it was still infected. i then found a small ball that is hard and can be moved and only felt from the outside of my face. it is a little above the jawline. doctor said it was swollen lymph node and that i had a bit of dry socket and to put heating pad on lymph node. when dry socket was healed i still had a nasty taste in my mouth so i called doctor and nurse said the ball was probably an abcess and to come in. doctor said ball on face was normal and only about 2 or 3 cm. but was then put on penicilin for 7 days. then a few days later i wake up with roof of mouth swollen and upper right gums swollen and sore. doctor said that was fine. to use salt water rinses for a week and call if still not improved. so i went backon oct 6th because ball is still there and i have a nasty taste i think coming from the roof of mouth. doctor plugged my nose and had me blow and said pus came out so he told me to take cleocin 4 times a day for 10 days and 12 hr sudafed twice a day for 10 days. i'm on 6th day on medicine and the nasty taste is still there and i never been told what excately is the ball. i'm not in pain which i thought was unusal just sometimes feels like a tooth ache or jaw pain but hardly ever. i also feel like liquid is in my right ear. occasionally pain there. could you please help me understand what is going and where i should go from here. thanks so much for your time

ANSWER: Brandy - It seems that you have what is called an Oral Antral Fistula. That is hole from the mouth into the sinus. That hole comes from the depth of the tooth socket. Very often these fistulas do not self heal with just antibiotics and a surgical sealing is important. With time the sinus can become infected and the nasal cavity inflamed which can clog the eustachian tube from the nose to the inner ear. That may be you ear symptoms.

You do not say what type of doctor removed the teeth, but it is imperative that you get examined by a board certified oral and maxillofacial surgeon. The longer the fistula exists, the hard it is to close the area. It is now about 5-6 weeks and the opening should have been properly addressed before now.

So find a board certified oral and maxillofacial surgeon where you live and get your mouth evaluated. If for some reason you are unable to find a doctor, get back to me, tell me where you live and I'll provide names.

Do not put this off. The sooner it is corrected the less chance of major problems developing. If you have any additional questions, feel free to contact me again.

---------- FOLLOW-UP ----------

QUESTION: thanks again dr. teig. i have been seeing a oral and maxillofacial surgeon. how do i find out if he is board certified. his name his dr. bojrab fort wayne indiana? the test he gave me by plugging my nose and making me blow and the pus came out, is that how you find out i have a oral antral fistula? i see him on the 20th any suggestions on what i should say to him? how do they surgically seal this and the healing process how is that? i also read i should not blow my nose is this true? thanks so much all of this is much appreciated very nervous and want to get this resolved and the more information i know can help. thanks

Answer
Brandy - First of all, Dr. Bojrab is a board certified oral and maxillofacial surgeon. The blowing of the nose is a test to show that an opening exists between the sinus and the mouth.

There are a number of different techniques used to seal this fistula, but the main point to achieve is a watertight seal so no saliva from the mouth gains access to the sinus during the healing period. That is why, now and after the surgery, no blowing of your nose is important to break any developing or surgically created seal. Also, if you sneeze, make sure to keep you mouth open fully to reduce any sinus pressure.

So definitely have Dr. Bojrab help you. I wish you well and hope you can be healed soon. Any additional questions, I am always available.

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