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Oral Surgery/Facial Pain after Extraction

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QUESTION: Hi Dr. Teig,

Iím a 24 year old female. In May I had tooth # 14 extracted by an oral & maxillofacial surgeon. During the extraction the surgeon had to go back into my mouth to retrieve a root tip and ended up removing part of my maxillary sinus bone in the process.  I had a sinus communication, which healed nicely according to the oral surgeon and ENT.

Iím still feeling a lot of pain. It feels like a burning sensation and pressure in and around the extraction site. The pain is affecting the left side of my face up to the bridge of my nose.  I have seen my primary care doctor, an ENT, orthodontist, and the oral surgeon.  I have had numerous CT scans done, which all came back clear. I have also been on antibiotics, decongestants, and allergy medicine.  

The orthodontist thinks I could be suffering from atypical facial pain. In addition to the pain on the left side of my face my bottom wisdom teeth have began to cause me pain. My three questions are:

1)On average, how long does it take the maxillary sinus bone to heal completely? Iím curious to know if bone or scar tissue will fill in the missing part of the maxillary sinus bone since I was given different answers from multiple doctors.

2)How would I go upon looking for a doctor who specializes in atypical facial pain and can you help me find a specialist in my area? I live in the Denver metro area.

3)Would you recommend that I have my wisdom teeth removed now or wait until the pain on the left side of my face is not as severe?

Thank you for your help.

-M

ANSWER: M - Before I answer your question, I have to tell you that from the picture of the xray you sent me, there appears to be a difference within the sinus from the right to the left.  If you look at the xray, the sinus on the right side appears darker than the left.  A lighter color usually indicates a thickening of the tissues.  In sinuses with thickening, it could be from inflammation to the sinus lining or the presence of fluid within the sinus or between the sinus lining and the bone.  This indicates that something is happening to create the inflammation that shows up on the xray. I wonder what method was used to create a water tight seal between the mouth and the sinus through the extraction socket.

Maxillary sinus bone heals at a regular speed of healing like anywhere else, unless there is a continuation of inflammation.  I cannot determine if the hole created between the sinus and the mouth still exists, but you stated that the doctors who examined you said it was closed.  There can be a microscopic opening that could potentially exist that cannot be determined by just viewing the area.  Usually, if there was an opening from an extraction, the surgeon does a "belt and suspender" treatment to insure healing.  That would insuring that there is a water tight seal to allow healing.  I see on the xray where the root was and it was touching the sinus.  

I would not have your wisdom teeth extracted until all your symptoms have resolved.  It might be a good idea to have the area evaluated by a board certified oral and maxillofacial surgeon not near where you live.   Hopefully a doctor can identify the continued inflammation showing on the xray.

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

QUESTION: Hi Dr. Teig,

Thank you for the informative and knowledgeable answer. I was wondering if you could please recommend a few names of board certified oral & maxillofacial surgeons or suggest a few places where I should start to seek proper treatment.

Can you explain the process or procedure that has to be done to diagnose a microscopic opening?  

-M

Answer
M -  I have found a doctor that must recommend, but he is in Denver.  I know that I told you previously I would find a doctor a distance from you, but the doctor I am going to recommend is located in Denver and at the Denver Health Medical Center.  Dr. Mark Glasgow is the program director for the oral and maxillofacial surgery residency program at the Denver Medical Center.  The following is the number for you to call: (303) 602-8236.

I suggest that you call and request an appointment with Dr. Glasgow. Make sure to see him first and not a resident at the program.  The individual answering the phone might tell you to see a resident first, but request Dr. Glasgow.  You can tell them, if you need to, that Dr. Joel Teig, a board certified oral and maxillofacial surgeon in New York requested that he examine you.

I wish you well and hope Dr. Glasgow can help you.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

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- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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