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QUESTION: Hello,

Thank you very much for your time.

I had an upper left wisdom tooth removed 17 months ago. It developed a dry socket and although I took 3 lots of antibiotics the area never really settled down. My dentist told me to gargle with salt water, which I did for a year. Eventually the pain spread underneath my top back teeth which became squishy.

The dentist couldn't see an abscess in the tooth socket but it felt as if there was an infection in there somewhere. After some dental treatment in the area (involving an injection) I developed a burning pain deep in my face, which felt as if it was travelling upwards. Eventually a GP diagnosed a sinus infection and I was prescribed antibiotics. I was really ill with a blinding headache and had to take another course of antibiotics.

Since then, I've had post-nasal drip and have been steaming my face several times a day to keep the nasal passages open (for four months). I keep getting pain in the same area - next to the wisdom tooth extraction site and after taking pain killers for a week some yellow mucus finally came out of the left nostril and the pain is better now.

Could this be a chronic inflammation of an area of the maxillary sinus next to the wisdom tooth extraction? I had a CT scan after the second set of antibiotics but it was normal. I asked if there could be an oro-antral fistula but the scan did not show one (could there be a really small one it missed?)

Could the infection also have got into the bone? The gums on that side of the mouth (top and bottom) right at the back, are sore.

Thank you

ANSWER: Jenny - I am so sorry to hear about what you've been through.  it is a little difficult for me to be completely sure what occurred without examining you or at least viewing films of the area, but, if you did truly have a dry socket the dentist did not treat it properly.  The symptoms you have experienced, such as an infection in the sinus, are not indicative of a dry socket.  

An oral antral opening into the sinus can be very small and allow saliva from the mouth to gain entrance into the sinus.  Saliva contains a tremendous amount of bacteria and the smallest perforation of the bone or crack of the bone at the base of the extraction socket can allow bacteria to gain access to the sinus.  

Another possibility is an infection of the bone itself.  This usually will not produce sinus infection and facial swelling is more common.  

You should have yourself examined by and ear, nose and throat doctor.  Sinus symptoms are not usually constant in the production of symptoms.  So sometimes you will feel better and at other times the pain will become worse.  So do yourself a favor and have an ENT doctor evaluate you.  I wish you well and hope you heal soon.

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

QUESTION: Dear Joel,

Thank you so much for your kind response.

The dry socket was intensely painful and the dentist did pack it with dressing on a few occasions. It took ages to heal.

I have a follow up question because a red blister with a white centre has now appeared on the spot where I have been experiencing pain, which is in the palette (roof of the mouth) next to the edge of the upper jaw near the wisdom tooth extraction site.

I also have a sore throat on that side of the mouth with some yellow spots and have had it for ages (several months. My GP has not had a clue why).

If the infection has got into the bone (the cheek on that side is indeed slightly swollen) which diagnostic tool will be best for spotting it? MRI?

Thank you so much.

Answer
Jenny -  The red area with a white spot is a local infection.  Besides needing an antibiotic and cleaning of the area, you should immediately begin warm salt water rinses for about 2-3 minutes, 4-5 times a day.  The rinsing will encourage a drainage of the infection and that should greatly reduce the pain you are enduring.  Once the drainage begins, the soreness of your throat should get better.  Most important is the establishment of drainage.  Well you have been rinsing and the drainage has not occurred.  For that reason an incision and drainage of the infection is probably the best approach for drainage.  It sounds like, from your description of the area, that the incision should be on the palate.  If your dentist is not skilled to do this, see a surgeon.

If you have more questions, feel free to contact me again.

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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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