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Oral Surgery/never ending third molar extraction complications

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Question
Hi Dr. Teig,

I'm hoping you can see the thread of ?s since I started asking you back in July when my daughter was diagnosed with a sub periosteal abscess. I took her to our oral surgeon 11 days ago just to make sure she was all healed before I took her for a cleaning that she was supposed to have in August. On September 4, she got the "all clear" and looked good. He said there still was an "opening" ( I forgot the exact word he used), but no sign of infection. He recommended continued self irrigation at bedtime. Then two days ago, she said her mouth hurt AGAIN! I took her in this AM. He said the area looked cleaned and he took a cone beam CT of her mouth which showed nothing. The area is tender to touch and he said it is inflamed. He put her on Levaquin 750 mg QD for ten days and she is to follow up next week. I know you haven't seen her, but I'm just reaching out for an educated guess. I mentioned to you that our oral surgeon has been around a long time and he says this type of thing happens so rarely. I think he's getting frustrated and was a little sad to see us again this AM.  He had a resident working with him and I mentioned what a good teaching case my daughter would be! I apologize for bothering you again, but am very curious to your thoughts. Thank you again, Julie

Answer
Julie -  I am a little concerned with her surgeon's apparent lack of concern for a continuation of, what I think you are indicating, as a fistula (a site of drainage from infection).  If that fistula still exists after the length of time she has endured, then the source of the problem has not been completely addressed.  The surgeon needs to be more attentive or if he is unable to arrive at a cause of the continuation of the fistula, then he should arrange for her evaluation by a different oral and maxillofacial surgeon, who might be more knowledgeable, or have evaluated by a oral surgical program at a local hospital.  Just allowing a continuation leaves her vulnerable and that is not appropriate.  

I am sorry that I cannot be more specific, but not directly examining your daughter, xrays or tests leaves me a little be without information necessary to better answer your question.

Oral Surgery

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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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