I had an upper wisdom tooth extracted 3 weeks ago. My cheek was very swollen and I started getting a yellow smelly discharge out of my nose and the tooth socket three days after the extraction. Turns out I have a sinus perforation (small according to my oral surgeon). I was put on Augmentin for seven days. That took care of the swelling. I got a CT scan which showed my one sinus was full of infection. Then I was started on Azythromycin for 5 days for the sinus infection. I’m finished with the course but I still have yellow drainage out of the hole. It’s not as much as it used to be and it doesn’t taste as bad as before. The gums have healed except for that 3-4 mm hole. I still feel slight pain and pressure in my one sinus. My surgeon instructed me to irrigate the site with the prescription blue rinse 2-3 times a day. I have also been doing salt water rinses as well. And I use Flonase for the sinus. I’m almost never congested any more but still feel the pain and pressure in the sinus. Does it sound like I am on the right track? I was wondering if I need to see ENT specialist. I follow the sinus precautions and I will see my surgeon in a week.
(See Dr. Hall’s answer below.)
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Thanks for providing good information about what is going on.
I’m at a disadvantage, not being there to see things first-hand. There are some things that are unusual about your case. One is the post-operative infection you had. A sinus perforation doesn’t usually lead to an infection. So it seems to me that the tooth must have been badly infected before you had it taken out. I don’t really know. I wish I could know about that part of what happened. And you actually had two infections which were treated with two different antibiotics. The Augmentin was given to control the infection in your face that was causing the swelling. And then they discovered that you also had an infection in your sinus, and the Azythromycin was given to eradicate that. Having an infection in your sinus suggests to me that during the course of the extraction something was pushed up into your sinus. Your CT scan should have answered whether or not anything needed to be retrieved from your sinus.
It does sound like the right things have been done for you to treat your infections and that you’re healing. You didn’t say anything about the perforation being closed. If it’s a small perforation, it shouldn’t take much to close it up. If the sinus infection is draining through the perforation, the infection would need to be eliminated before it can be closed.
One caution, if you will. You say that you are done with the Azythromycin, but there is still some pain and pressure in your sinus and some drainage through the hole. That would indicate to me that you need a refill of the Azythromycin. When an antibiotic is used to treat an infection, the antibiotic should be continued until the infection is completely gone. Otherwise it will relapse and will be even tougher to control the second time. The bacteria left that weren’t killed will have a tendency to be resistant to the antibiotic—not a situation you want.
The Flonase is a corticosteroid that is given to reduce the sinus inflammation, and is often used in situations like this.
While I don’t have all the facts about your case, from all I can tell it looks like you are in good hands and you don’t need to go to the ENT physician. You do need to be sure your oral surgeon knows that the sinus infection isn’t all gone yet and he or she may want to extend your antibiotic prescription. I wish you a smooth and continued recovery.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.