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Medical Forum / General / Dentistry / September 2006Can a fistula develop 17 days after extraction?
My 19 year old daughter had four impacted wisdom teeth extracted 18 days ago by an oral/maxillofacial surgeon who is a faculty member at the Dental School connected to my daughter's college. She seemed to be recovering nicely, so four days later, after moving my daughter into her dorm room, I flew home. The very next day my daughter developed dry sockets. My daughter's doctor was not in for two days. so a dental school student packed her sockets. Two days later she saw the surgeon who said the packing looked good and to come back in two more days. When my daughter returned, the doctor removed the packing and said the mouth would heal faster without packing. My daughter was not in severe pain without the packing, but she wasn't as comfortable either. My daughter also has a "blister" in her mouth that appeared right after surgery. It is not a canker sore, or filled with pus; she describes it as a white hard bump. I'm not sure if this is on the inside of her cheek or on her gum. What could explain something like that? I urged my daugther to call the surgeon, and asked her to point it out last time she was in, but she didn't. I'd like to think an oral surgeon would notice an abscessed tooth during the course of two exams, even if she isn't looking for one. I asked again today about the blister in her mouth, and my daughter told me that she will see the oral surgeon next week because she has a hole in her mouth and can suck in air from her nose! Yikes! My daughter called the emergency number and spoke to her oral surgeon, who sounded surprised. She gave my daughter her personal phone number & told her to call if anything changes, and to come in on Tuesday. What causes a hole like this to develop 17 days post surgery? How is it treated? What do you recommend? Is this something that can get worse quickly? What questions should she and I be asking? HELP!!!!! Thanks for your help. Panicking Mom > My 19 year old daughter had four impacted wisdom teeth extracted 18 days ago > by an oral/maxillofacial surgeon who is a faculty member at the Dental School [quoted text clipped - 15 lines] > didn't. I'd like to think an oral surgeon would notice an abscessed tooth > during the course of two exams, even if she isn't looking for one. An endodontist or general dentist would notice the tooth abscess faster than an oral surgeon. Oral surgeons after years of Jaw and TMJ surgeries tend not to look too closely at abscesses. They most of the time just pull teeth that General Dentists do not want to touch on their instructions no questions asked. > I asked again today about the blister in her mouth, and my daughter told me > that she will see the oral surgeon next week because she has a hole in her [quoted text clipped - 8 lines] > > Thanks for your help. Panicking Mom, Don't panic. This is not a big deal. Sometimes when you take out an upper tooth the roots are in the sinus and you could have a perforation of the sinus resulting in the hole. Your daughter needs to come in have the dry sockets scraped under local anesthesia and allowed to heal this time correctly. She should not drink from a straw or anything else that can cause a pressure change that will cause the clot to dislodge. As fas as the abscess that needs to be looked at could be another tooth or recurrent infection. Drainage and antibiotics will fix that problem. Finally you biggest concern the perforation. That area needs to be packed with special material and bone and the surgical site needs to be sutured shut extremely well. She should be on decongestants antibiotics anti-inflamatories and avoid pressure changes ie no scuba diving no airplanes no hiking mount everest at least 4 months. The hole will eventually heal. This goes to show you having an oral surgeon perform the extractions is no guarantee that there will not be any complications. During these invasive procedures things happen, the good news is that it is not serious and your daughter will be fine. > My 19 year old daughter had four impacted wisdom teeth extracted 18 days ago > by an oral/maxillofacial surgeon who is a faculty member at the Dental School [quoted text clipped - 30 lines] > > Panicking Mom Alex seems to think this is a connection to the sinus, but I didn't notice that you said this was connected to the upper wisdom tooth, and given the dry socket it seemed more likely this was the lower wisdom tooth that is involved. From your description of a "hard white bump" I thought it sounded like the most common cause was the bony edge of the socket. Also, with a dry socket, it is common for small pieces of the bone to die and break off. They usually work their way to the surface, but sometimes take their sweet time doing it. If this is the problem, it is usually a simple matter to grasp any exposed bone with forceps and trim it. Most often it can even be done without numbing the area. Of course I'm just guessing, but if I'm right I'm sure this will all be rectified Tuesday when your daughter is seen. Steve More about the white bump . . . My daughter just told me that it is just below her lip, nowhere near her gum. That doesn't sound like an abscessed tooth to me, but you probably know if abscesses appear that far away from infected teeth. She said that one of those bumps you feel when you run your tongue against the inside of your lip is the offensive bump. We've all bitten one accidentally and suffered for a few days. She describes this as that kind of pain, only the lump is white, the pain has lasted three weeks, and it began immediately after surgery. First, what are those lumps under the lip? And what happens if one is injured or badly damaged? I also have another thought about the fistula that developed 17 days after one of her upper extractions. Does it sound reasonable that she only noticed it on the 18th day because it was swollen closed until then? Thanks for your help again. Slightly Less Panicked Mom > More about the white bump . . . My daughter just told me that it is just > below her lip, nowhere near her gum. That doesn't sound like an abscessed [quoted text clipped - 13 lines] > > Slightly Less Panicked Mom The bumps inside the lip are small mucous glands. If they are bitten and the small duct damaged the secretions build up under the mucosa. This is a mucous retention cyst, or mucocoele. I haven't seen any that are really white there's a chance it's gotten infected. These are generally not really hard, but I can understand not wanting to squeeze it to find out for sure. Some of these mucocoeles can get rather large, and occasionally need to be removed. She should have it checked by the surgeon. It is not related to the extraction per se; but often because of the numbness during and after surgery patients often bite their lips inadvertently, and this could have been the cause. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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