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Oral Surgery/sub periosteal abscess part 2

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Question
QUESTION: HI Dr. Teig,
My daughter went for her follow up and had the drain removed. She is healing nicely. When I asked if she should be doing the salt water rinses, the doctor said, "Sure, she can if she wants to." Can you please tell me how long you would recommend doing the rinses?  She had the I and D five days ago and has approx. five days left of the Clindamycin. Also, I've heard that this is a rare complication after having third molar surgery and I've heard that this happens all the time! Can you please share your professional opinion and what causes this?  Thank you so very much again!

ANSWER: Julie -  First of all, this is not a common problem.  Yes is does occur, but in most cases is does not occur.  The cause is usually due to an entrapment of oral bacteria into the healing area.  Once there, the bacteria begin to grow and invade further into the area and cause inflammation and infection.  

I am so glad that she seems to be doing better and healing.  I would have her continue the warm salt water rinses 3-4 times a day, especially after meals.  Have her do the rinsing for 1-2 minutes.  

Any more questions, I am available.

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QUESTION: Dr. Teig,
I promise this will be my last ?!! Sorry if I wasn't clear...how long do you recommend doing the salt water rinses after surgery, for one week? ten days? two weeks? She has an appt on August 14 with our local oral surgeon when she returns from camp.
Thank you again!
Julie

ANSWER: Julie - sorry I didn't understand your question.  Not viewing the surgical area makes it is a little difficult to say how long she should rinse.  In general, I suggest she continues to rinse about 5-7 days after the drain is removed.  Speak with the surgeon to get his opinion, but have her continue rinsing for another few days after the drain is removed and she will definitely get better then.

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

QUESTION: Hi again Dr. Teig,
I am sorry I lied and said my last ? would be the last one. My daughter went for a follow up today after having her sub periosteal abscess at camp. I took her to our local oral surgeon who performed the extraction of all four impacted wisdom teeth on July 1st. I took her just to make sure she was alright.  She had her drain removed two weeks ago and got the " all clear" at that visit. Today, our oral surgeon didn't like what he saw. He said the area was very swollen and removed some debris and irrigated. He took an xray which didn't show anything obvious to him. He said that the only way to know for sure what's going on is to open up the area AGAIN! He proceeded to do that and said there was some debris and a lot of granulation tissue. He put packing in and she needs to return tomorrow(Fri.) and again on Monday. He put her on another course of Clindamycin 300mg TID. Our oral surgeon has been around a LONG time and kept saying. "This is so rare." I have faith in him as he has a reputation of putting accident victims' faces back together and has trained many younger oral surgeons.   I know you haven't examined my daughter, but I'm just wondering your thoughts on  why the I and D didn't work the first time. Is my daughter unintentionally doing something wrong? We followed the post op directions meticulously after the extractions. She took 5 days of Amoxil per the doctor's instructions.   Once again, I really appreciate you taking the time to answer. Thank you so much, Julie

Answer
Julie - I wish I could give you a more specific answer as to why your daughter has had a recurrence of the infection.  The most common cause is debris remaining after the initial I&D.  I hope this treatment works, but my recommendation is the same as I initially stated - warm salt water rinses to insure drainage.  This should heal within a few days if all the source of the infection is removed.

I hope she does well.

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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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