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Oral Surgery/suspected hole in gum 7 wks post sinus lift with bone graft

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Question
Dear Dr. Teig,
I had a tooth number 14, the left upper first molar, extracted on Nov 18, 2016.  Afterwards, I had a bone graft to lift the sinus.  I followed the post up instructions.

Not that this matters, but I am an emergency room nurse and have a pretty good skill set of recognizing signs and symptoms of infection.  However, I also don't want to be that annoying patient who freaks out over those little things.  During my time of healing, I had they typical weird taste in my mouth and thick mucus plugs ranging from white to cream.  I did let my doctor know this when I saw him two weeks post op.  He said, it looked like it was healing well and that the thick mucus plugs were nothing to worry about.

Starting in the last week  of December, upon rising in the morning, I would get one small thick, TEXTured GREEN mucus plug that drained from the sinus into my mouth.  After 7 days of these symptoms that gradually increased to sinus pressure, I called my surgeon's office on Dec 31st to let him know that the symptoms were gradually worsening and that I had no fevers or swelling or pain.

I am allergic to amoxicillian and sulfa.  He prescribed me clindamycin 500 TID for 7 days.  I started the med on 12/31 and it is now 1/9/17.   The sinus pressure is gone.  I still get small amounts of the mucus which is creamy with a hint of green.  

There are two other caveats that now bring me concern.
1.  On about January 2, with my tongue, I felt a sharp object in my gum where the tooth was extracted.  I pulled it out and it appeared to be a small bone chip!  I thought, "oh well, you're on antibiotics, so just wait to contact the surgeon until your done with the meds."  

2. On 1/7, I was using my waterpik and when the water was shooting over the area of the tooth extraction, I felt water in my nose and light green mucus came out!  

So, what do you think?  Could there be a small hole in my gums?  Does it sound like he needs to exame the area and suture it shut?  Does it sound like I need another course of antibiotics or a different antibiotic?  

Thank you for your time!

Answer
kristina -  I cannot be completely sure without examining you, but from your description of what you have experience, especially with the water in your mouth causing water into your nose, it sounds like you are suffering from a condition called an oral antral communication.  This communication or hole occurred during the extraction.  The extraction pushed or pulled a hole into your sinus from the socket.  It is important that your doctor, especially if he is an oral and maxillofacial surgeon, close the opening.  That opening cannot be completely closed with just sutures.  The doctor may have to make a gum flap to create a double layer of tissue over the opening to allow it to heal.  

It is important that you doctor place you on an antibiotic and a sinus drying medication.  Most likely it occurred in the attempt to lift the sinus.  This needs to be treated before anything else is attempted.  The doctor you are seeing, I hope, is a board certified oral and maxillofacial surgeon. This opening needs to be closed and the inflammation or infection in the sinus needs to be arrested.  

Get this evaluated and treated as soon as possible.  The sinus will probably need to be cleaned via an antrostomy.  Do not hesitate, get this treated soon.  If you need additional information, please do not hesitate to get back to me.

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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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