Oral Surgery/Complications after apicoectomy
A couple of years ago (2010) I had a root canal that eventually failed due to a crack in the tooth (#3, I think, the second to last molar on my right?). There was an abscess/fistula above the tooth high up where the gums met the cheek and at the request of my sister (a nurse), I went to the ER because it was a Fri night and the dentists were closed for the weekend. I was prescribed 300mg of Clindamycin every 6 hours on a 10 day run. I saw the dentist the following Monday and they referred me to an Endo (the one I went to originally left the area) for a re-treatment. At my first appointment with the Endo, she said that the only two options were Apicoectomy or Extraction. Because I have such a small mouth and was born without several teeth, I have limited chewing teeth and I opted for the apico, hoping to save the tooth. My teeth are not in very good condition as I was informed of gingivitis and A LOT of cavities I need filled and a few more root canals that need to be done. Between my fear of dental procedures and lack of dental attention from a professional over the last few years due to not having insurance (I was unemployed until recently.) and my fear of the dentist. I should mention that I had bronchitis for 6 weeks straight that had only ended about 2 weeks before I noticed the fistula and have been experiencing sinus pain and drainage ever sense the bronchitis (still am a little).
By the day of the Apico, I had finished my run of antibiotics 3 days before and began using a prescription mouth wash 48 hours prior (chlorhexidine?). Needless-to-say, I was terrified of this procedure to the point that when I went to have it done, my blood pressure was so high that they made me wait a little while to start and when they did, my heart started beating so fast and hard that I could see my chest physically moving. The Endo asked if my heart was beating fast and I said, "Yes, but I am very nervous." She proceeded anyway, though I don't think I would've calmed any by waiting. She constantly asked if I was doing okay, though. The procedure took about an hour and a half and I was quite swollen after.
It felt like my cheek was attached to my gums the first couple of days, but I avoided looking at the area or running my tongue or fingers over it as I was told not to do so by the Endo. I was prescribed 150mg of clindamycin every 6 hours for 7 days after the Apico. I was also using the mouthwash a few times a day (specifically after meals) for about 9 days after. When I found a suture on my pillow about 8 days after the procedure, I did not look, but ran my tongue softly over the area. The swelling was mostly gone and it felt like my gums had slid down a little, though the wound felt closed. Some of the sutures were still there, too. I thought nothing of it because I was not in any pain aside from what you might expect this long after the procedure, a little irritation from the stitches scratching and the occasional very slight pain in the teeth around the tooth that had the apico. It was so slight that I had even stopped taking ibuprophen regularly and only took it as needed. By yesterday, most of the sutures had disappeared except for a couple near the front of my mouth that had turned kind of ropey and white. It felt thicker and irritated my gums a little, but beyond that, I was feeling pretty decent aside from the minor leftover sinus issues that I am not sure have anything to do with this situation.
Today, I went in for my follow up, 2 weeks after the procedure. The little bit of stitches were still in and still irritating, but not really painful. I checked them in the morning and saw that it was slightly red around these stitches and nowhere else. There was no swelling that I noticed by this point, but I could still tell that my gums didn't quite line up the way they had before. I was not happy when the Endo said she needed to re-stitch the area because some of my sutures had come out too soon. This took a while and afterwards i was still numb and in too much pain to return to work. I was also a little swollen (very slightly, probably from the cheek retraction?). I came home and iced it for a while and the swelling went down quite a bit. It is now about 6 hours after the new stitching and the numbing has worn off. I have been alternating tylenol and ibuprophen (I have a vicoden prescription, but it makes me SO sick.) I'm not in constant pain currently, but it feels like the roof of my mouth is sore and a little swollen. It also feels like my cheek is stitched to my gums. There is a little pain, dulled by what I've taken to help it. I assume the puffiness is from the new stitches, but I thought it odd to have a little swelling and pain on the roof of my mouth. I was able to shine a light into my mouth (which I can't open all the way due to pain from the stitches and for fear of breaking them again) and the roof of my mouth looks alright, not even discolored in comparison with the left side which is fine. I have been off of my antibiotic for about 5 days and was not prescribed more (thankfully, because I hate the tummy problems that came with them). I was told to use a little of the prescribed mouthwash on a q-tip over the stitched area.
Here are my questions: Is it normal to suture the cheek to the gums after an apicoectomy? I've heard that having dissolving sutures that didn't dissolve for as long as two weeks is bad and could indicate poor healing, does this indicate possible infection? Is the slight pain and puffiness on the roof of my mouth normal? Could this be from stretching of the gums to hold the stitching in place? How will I know if my apico was a failure? Was restitching the area the right thing to do after 2 weeks? Could my sinus trouble indicate further issues from this tooth that didn't get cleared up by the Apico?
I apologize for the bunch of questions and the huge post, I have a difficult time contacting my Endo during the day as I work a job that allows few breaks. Thanks so much for your time and for sharing your knowledge!
Amber - It is, of course, a little difficult for me to fully evaluate what went on or what is going on now. First of all, suturing to the cheek is not usually normal, but if the tissue was tight, suturing to the cheek to close the wound might be appropriate. What does not seem normal is the sinus problem. The dentist might have perforated the sinus from the surgery and an opening of the wound has allowed saliva into the sinus.
As far as sutures not dissolving, that is not bad. The soreness and puffiness of the palate is not normal and indicates that there might still be an opening into the sinus that has not healed. As far as the re-stitching, that is absolutely the wrong this to do. Especially if there is an inflammation or infection, that traps the bacteria and allows it to grow. Your sinus problem is indicative of a problem.
My suggestion is that you immediately have yourself evaluated, not by an endodontist who is really not a trained surgeon, but by a board certified oral and maxillofacial surgeon. So the endodontist sounds like the wrong doctor to properly address the problem. So find a board certified oral and maxillofacial surgeon to evaluate you. If you cannot find one, get back to me, tell me where you live and I will send you names of board certified surgeons near you.