Oral Surgery/pain


Ive suffered from chronic pain for about 10 years. Before then I was in general good health. Im male and 38 years old.
I had upper left teeth 8,7,6 extracted due to failed root canals.
One extraction was quite traumatic.
Since then Ive experienced bad headaches pretty much continuously. These happen in the middle of my head and around my eyes and on the top left of my head.
But I have found recently that if I use toothpaste after eating, and if I avoid certain trigger environments where airborne pollutants which trigger headaches, then my pain gets to pretty much zero.
I find now that when I eat, I immediately get some dripping from my left nostril, not a lot, but definitely enough that I need to blow my nose. I also get a kind of painless tightening sensation in the upper left area above the extraction site.
When I use toothpaste after Ive finished eating, my nose stops dripping again and wont start again until the next time I eat.
If I donít use toothpaste, the headache will devlop gradually after about 20 minutes and then I sneeze a lot, and I get a foul smell in my nose and general headaches and I feel ill.
If I feel with my tongue around the extraction site, I can feel a distinct area where there seems to be some sort of crevice in the bone, and no hard bone behind it Ė basically a small hole covered with skin which I can just fit the edge of my tongue into.
It seems pretty obvious to me I have some sort of fistula. Yet the sinus CT scan and MRI scans of the head Ive had done donít indicate anything.
So my question is really about whether its possible these scans could miss such a hole?
Or whether there is anything else that can cause the nose to drip due to eating?
PS Ive also seen a neurologist who specialises in headaches for the last 18 months, but he was baffled by it until I eventually mentioned my dental trauma after which he advised me to go back to the dental hospital. He has given me occipital, maxillary and orbital nerve blocks, which helped the background. Ive also tried every headache tablet under the sun.

ANSWER: Pam - First of all, the sinus does not sit above any of the teeth that were extracted.  So the extractions should not have inflamed the sinus.  This is some difficult situation for me to determine without examining you.  

I don't know what you have tried to calm the area down, but you might just be dealing with an inflammation in the area, as simple as that sounds.  My suggestion is for you to immediately begin a strict regimen of warm salt water rinses in the area of the extractions.  Do the rinsing for about 5 minutes, 4-6 times a day.  If the situation is inflammatory in origin you should notice an improvement 7-10 days after the beginning of the warm salt water rinses.

I wish I could give you a specific answer, but I would need more information.  Let me know the response to the warm salt water after a week or so.

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


You started your reply by calling me Pam, can I just check your response was the correct one for me, Valentine?

Anyway, I've been doing salt washes, after every time I eat, so about 8 times a day being doing this for about 10 days now. I noticed an improvement pretty quickly but it seemed to level off after a few days. Headaches seem a bit better and mouth pain generally better.

Once or twice a day I will combine it with toothpaste to ensure the mouth is completely clean, that seems to help. Its the time after Ive finished eating food that seems to cause trouble, the actual eating itself is not so bad since using the saltwash.

Then I discovered after I ate a meal with a red wine sauce that my pain improved another whole step due to the alchohol it seems.

So now Ive started using Corsodyl a strong mouthwash twice a day on top of everything else. This helps a lot and I seem a more resistant to the things that used to trigger my headaches.

I have two horizontal boney impacted wisom teeth in my lower jaws. Ive been discharged from dental hospital three times over the years, they seem too afraid to do anything. Could they be over-looking something obvious like these teeth being a cause? Should I tell them about the mouth cleaning regiment Ive discovered that helps? Before I started with the saltwash I would find that sometimes when stretching my tongue into the corners of my mouth, I would get a sharp pain in my lower left areas around where my impacted wisdom teeth are. The salt has stopped that.

I had very poor dental hygeine growing up, and have had gingivitis in the past and all my lower back molars have got deep fillings. The endodontist who did the failed root canals on my upper left molars some years ago said he noticed during my operation that my nerves looked stressed and that I should see a periodontist which I never got around to doing.

Right now Im doing a constant mouth cleaning regiment, and dont really want to stop because its helping me get a lot of relief.

What do you think I should do?

Valentine - sorry about the name mistake (very busy and I am not perfect).

I am glad that the warm salt water seems to have helped, but if your problems develop from a situation where you have pockets in the gums where bacteria can collect the problem will recur eventually, even if you continue the warm salt water.  Seeing a periodontist might be a good start.

I question, if you do have wisdom teeth that might be the initiators of the problem that they are not removed.  Ask the periodontist for his opinion about the wisdom teeth when you see him.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired


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.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at 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 Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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