Question about Tooth Extraction Complication(s)

In My Humble Opinion
1

My spouse broke/cracked a tooth about 20 years ago. The damage was repaired by a root canal. At the time, he was told that it should hold together about 15-20 years.

About three months ago he started having problems with it, culminating in the cap pooping off about two weeks ago. He went to our current dentist who tried to reset the cap. It came off again. Upon closer inspection, and a set of x-rays, the dentist said the tooth could not be saved. An extraction was performed.

At the time, the dentist mentioned that due to the location and what he could see on the x-rays he was concerned about the possibility of sinus damage, basically, a small hole leading into the sinus on that side and cautioned Mr. Broomstick to report any problems/symptoms/bleeding.

A day later, we’re talking bloody snot and yes, bleeding from the tooth socket.

He goes back to the dentist who re-inspects, says yep, that’s the sinus. He made sure everything was cleaned up, re-stitched the hole (a couple sutures had broken, probably due to some swelling), prescribed antibiotics and pain killers, and inserted was he said was “bone graft material”, presumably some sort of filler to promote healing.

Spouse has been back two more times. There are still problems with swelling, sutures, and connection between the mouth and sinus although no obvious signs of infection (like pus), fever, and the like have occurred. The bleeding has stopped. He’s still in pain with a sore jaw and headache.

Obviously, I’ve been feeding him soft stuff that doesn’t require a lot of chewing, if any.

Now, I know complications happen. We do trust this dentist. I have concerns about infection and healing as he is a diabetic, though his diabetes is well controlled at this point. I’m just looking for some reassurance that, though this is a complication, it’s not a bizarro thing and what to expect in the way of healing and time. Spouse does have a follow up appointment for Tuesday, and the dentist is being quite insistent on following up, his office has called a couple times just to check in that he’s doing OK, no new symptoms, and so forth.

I’m just hoping this doesn’t progress to needing actual surgery. Although our health insurance does cover surgery, it doesn’t cover dentistry and I’m concerned this might land in some sort of limbo with him needing it and no one wanting to pay for it.

2

I don’t have experience with a bad extraction like that, but I did have a root canal that took two full years to settle down - sometimes tooth stuff takes forfrickin’ever to work itself out. I also have a friend who is diabetic who has had a foot problem for years now - diabetics can take a long time to heal (which you probably already know).

Here’s hoping someone can reassure you more specifically! :slight_smile:

3

Nothing to add but sympathy and I hope your husband gets it sorted out soon, but I saw this in the mouseover and loled.

4

I don’t have any advice, but I do have lots of sympathy. My SIL recently had a bad experience with an extraction, too. She went to a dentist who extracted two back teeth that were infected–and I mean he extracted them WHILE they were infected. No antibiotics beforehand, nor afterwards. Took her more than a week before she could consume anything more substantive than Boost. And she was in lots of pain–guess what ELSE the dentist failed to prescribe? Then when the pain and swelling went down to bearable levels, she ended up in the ER with sudden onset pharyngitis (scratchy throat in the AM, by 6:00 that evening, had blood and pus pockets in her throat). Doctors speculate the untreated tooth infection spread. She finally got the meds she needed.
Hope your husband is better very soon (and glad he has a more competent dentist than my SIL did)!

5

Doesn’t sound real bad. The rear upper teeth root into the sinuses, and can cause a problem with any extraction. This sounds like it will take a little time to heal. But since there aren’t signs of an extensive infection, he should be fine. If he’s never had any sinus problems before, he’s merely finding out what the true definition of misery is.

6

I had the extraction site for an impacted wisdom tooth get infected. I never had a fever or any real pain, and I left it for a couple of months because it was just swollen and I was in denial that it wouldn’t heal on its own until it started draining copious amounts of pus. That’s when I finally went back to the oral surgeon. It took a Z-pack and 10 days of clindamycin 4x/day to kick it. Even now, 5 months later, the site still doesn’t look the same as the others and I’m planning to ask for an x-ray at my next dentist appointment.

I had the teeth out in July. It is taking a long-ass time to fully heal.

7

i talked to a dentally knowledgeable person. not uncommon complication.

don’t put pressure on sinus so no nose blowing and sneeze with an open mouth. decongestants will help, dentist can prescribe.

root can reach into sinus and be covered by only membrane. tissue growth in sinus and mouth is rapid though be slowed by his diabetes.

swelling and pain after a few days indicate infection. maybe more or different antibiotic might be needed.

bone graft material (bone chips) can get blown out and may need to be reapplied. this might be sandwiched between a resorbable membrane (on the sinus side) bone material then a nonresorbable membrane and sutured, after a week the sutures and nonresorbable membrane are removed.

if an implant would be considered in the future a good bone graft would be needed.

if the dentist might not succeed then it might be referred to an oral surgeon, redoing the bone chips, and that might be medical and not dental.

8

I had a root canal in a tooth that protruded into my sinus (well into it) and it was the most painful thing ever, because the novocaine didn’t numb the sinus tissue. I have a lot of sympathy for your spouse. I’ve had 4 teethe extracted and gotten dry socket on one of them which was agonizing. Mouth pain can be among the worst. Having an actual hole through the sinus into the tooth cavity just sounds miserable. It may be worth stepping up to a specialist rather than your regular dentist (your dentist shouldn’t be offended by this) to see if you can get some more proactive treatment. I don’t know enough about diabetes to know how that complicates the mix, but just reinforces my opinion that going up the chain to a specialist would be a good next step (an Endodontist).

9

I don’t have too much to say except that I think your dentist is doing a good job. My crown took weeks to settle and I was in terrible pain and my dentist was very on top of it.

10

That’s what our guy said, and the Other Half picked up decongestants on the way home from the extraction, so he’s been using them.

More likely it was having to re-do the sutures and bone graft stuff that lead to slightly prolonged swelling, he says it has gone down a little.

Yep, that’s happened once.

Probably not. For one, we just can’t afford it.

Yeah, I just don’t know how or if our insurance would cover that.

Actually, he says dry socket hurts worse. Not that a puncture sinus doesn’t hurt, it does, but he says dry socket was actually worse.

That would be a great idea, if we had the money to pay for it. The Other Half’s medical condition mainly has the effect of prophylactic antibiotics for dentistry, and that has to do with all the titanium and surgical steel in his right leg, not his diabetes. We’ll give it until Tuesday and his next dentist visit. His diabetes is Type II and well controlled. That seems to translate to more watching rather than actual complications, and I’m hoping that trend continues.

11

Even if the Diabetes is well controlled with NO medication, your husband is still DIABETIC. And when the body is stressed through illness or surgery or even tooth extraction, the effect is magnified.

He’s gonna get sicker and take longer to heal than a “normal” person would.

Does the dentist know he’s Diabetic? It is imperative that the dentist know this! And your dental insurance should cover an oral surgeon if necessary. I’d even go as far to say that should he EVER need tooth extraction again, he should go straight to an oral surgeon, because of the Diabetes.

Is your husband testing his blood sugar frequently? With this mess, he should be testing more than he usually does. And a spike in blood sugar or a big drop in blood sugar, even if he feels fine at the time, might mean the beginning of infection.

Once the dentist is sure the opening between the root socket and the sinus have healed over sufficiently, he should be given a plastic syringe with a curved tip. Using warm salt water, the socket needs to be flushed out a couple of times a day. If food gets trapped in that socket, it HURTS.

I’d also check with your husband’s regular doctor about this problem. The doctor might want to change his Diabetes medication or even talk about Insulin temporarily.
~VOW

12

Yes, we know that.

Yes, we know that. Except he is NOT sick. Arguably he is injured but, no he is not “sick” - there is no fever, no pus, no sign of infection. There is some swelling and bleeding, but that’s because of unavoidable trauma to soft tissues when extracting a tooth. He’s on antibiotics to prevent illness.

The extraction was not due to an abscess or other infection, it was a tooth broken years ago whose repair finally failed after 20 years. At the time the repair was done that was the stated “life expectancy” of the root canal and crown, so there was nothing inherently wrong with initial work.

Yes.

We do NOT have dental insurance. At all. All dental costs are completely out of pocket for us.

Why?

Dental extraction is routine, especially without infection present. Explain to me how going to an oral surgeon is really of benefit here? Attitudes such as that drive up the cost of health care, can you justify that? Being diabetic puts him at risk of some things, they are not certainties. This complication has nothing to do with diabetes, it occurs in non-diabetics just as often. The diabetes might complicate recovery… or it might not.

Sure, go to an oral surgeon… who is going to pay for that? He’s unemployed. I am making barely above minimum wage. Where, exactly, do you think the money for that will come from? This is one of the sucky things about the current medical/dental situation in this country - if you don’t have insurance it often doesn’t get done at all.

IF we were referred by our regular doc for a medical reason our medical insurance recognizes yes, it would be covered, but our medical insurance does not take referrals from dentists. His current condition does not meet the criteria for medical referral.

Six times a day at present. He is well aware that a change in those numbers can be significant. One of the reasons we’re reasonably sure there is no infection is that those numbers haven’t changed at all. Because he’s had to change his diet due to problems chewing he’s being more vigilant than usual. So far, he’s doing OK and his numbers are within the parameters they should be.

Given the numbers, the regular doc sees no need for insulin at this point in time. They have already discussed when to make changes in medication and how much. I realize that many diabetics are sloppy about their blood sugar but he is not one of them.

That’s also another reason why we can’t get a referral to a specialist - there is no indication he needs one at this time. No sign of infection. No change in his diabetes. He IS being monitored more than a non-diabetic so that if a problem occurs it will be noticed quickly, at which point if a referral is appropriate I hope it will be made, and I hope our medical insurance will cover it. So far, that’s been the biggest effect of his diabetes - more monitoring, not more complications. Every time he has something medical down the medical people watch him very, very closely - when he was last in the hospital for outpatient procedures they were very careful about that. So far, nothing major has ever cropped up (well, other than the diabetes diagnosis) and his healing rate seems to be on the slow end of normal rather than being explicitly slow.

13

Not having dental insurance SUCKS. I know this well from experience. Have you looked into dental discount plans? They can save you money and might be within your means?

14

Look for a school of dentistry in your area. My husband and I have had excellent work done at a school, the prices are incredibly lower than what a “regular” dentist would charge, and if there are problems, you’ve got the whole faculty available for instruction/advice.
~VOW

15

As it happens, this dentist is open to payment plans, has given us 30% discounts over the past few years as he is aware of our financial situation, and has charged us for neither the actual extraction nor any of the follow up visits for this little episode.

So yeah, think we’re sticking with him for now. (He did charge me full price for my recent cleaning, but that was before all this blew up)

ETA: The Other Half says the soreness and pain are starting to go away as of today. He’s still going to the follow up on Tuesday.

16

I had my wisdom teeth out years ago - no infection, just impacted and I ended up with dry socket.

Yowzers!

The swelling and pain took a month to be fully gone. It wasn’t unbearable the whole time, but it lingered. No diabetes, no infection, it just takes a while sometimes.

17

I’m sorry to hear about your spouse’s teeth trouble, mouth issues really are the worst. I had a wisdom tooth extracted that was buried into my sinus cavity and ripped a big hole on the way out. An oral surgeon sutured it back up. It took almost a month for it to feel better where I could eat solid food, and almost six before I could run my tongue over it without pain. (I drank A LOT of ensure.) So it does take a really long time to heal - even now, years later, I sometimes get twinges of sensitivity.

My insurance actually paid for it even though it doesn’t cover dental because the surgery was on the gums/sinus and not the actual teeth. So you may wish to check with your insurance if it comes to that. Hopefully he’ll keep healing! It sounds like you are staying on top of it, so I’m sure it will work itself out over time.