Much less commonly w canines bc they rarely approximate the maxillary sinus floor (though is possible). I think the incisors probably never approximate the sinus floor, but then again, I try to never say never :)
Absolutely. Have you seen our international consensus on diagnosis published in IFAR? It's summarized in this video: y2u.be/BfdQkrZgSsQ I definitely agree patients should be evaluated first by dental specialist before considering treatment options, but then the treatment should be individualized to the patient based on symptom burden and their financial state with regard to dental and medical insurance coverage. We have published multiple papers on various aspects of ODS, and the issue of whether to treat teeth or sinuses first will continue to be controversial until more evidence accumulates. Thanks for your comment.
What in case blocked osteomeatal complex, just odontogenic sinomucosal thickening along with concha bullosa, inferior turbinate hypertrophy. Still you prefer prior dental treatment or vice versa Dr. YL
Enjoyed your video, Dr. Craig! I have just finished a 10 day course of Cefuroxime for sinusitis which has lasted 2 1/2 months. I'm somewhat better. The day before I saw my family doctor, I saw my dentist BECAUSE at one point I had previously suffered pain when pressing above my lip under right nostril AND I also have a dental abscess, a small swelling at the emminence above my right incisor. OK, so my dentist pounded my upper teeth in that area and there was no tooth pain. So therefore he concluded that the bump was a "nothing." He did not do xrays thinking that my doctor might do this and would be covered under my insurance. Well, there were no xrays done at all. So now I am taking a wait and see approach. But then I read about bad things that can happen from dental abscess .... bone being eaten away, sepsis, even an infection of the brain!!! Oh my! And for the last 2-3 months I'm also suffering from anosmia. It has not resolved post antibiotic. My sinus condition is better but by no means great.
Have you sought out a rhinologist in your area (fellowship trained ENT surgeon)? Your condition might not be odontogenic sinusitis, but if you have persistent nasal symptoms, I would look for someone so they can take a history and scope you. Good luck!
@@JohnCraigNose No, not yet. I'm just getting familiar with the vocabulary. I will look for one because now I'm getting worse. Oh and thank you for your thoughtful response.
Sorry to hear. Not my area of expertise, but if it's a parotid cyst, mainly you need to talk to an ENT or head and neck cancer surgeon to evaluate the appearance on MRI to make sure they feel it's truly a cyst and not perhaps a tumor. Also good to assess for any salivary duct stone. Type of surgery will depend on these variables. Hope that helps.
Thanks sir for early and valuable reply. You already told it's not your area of expertise but still like to tell you that its neither tumor nor stone as this swelling developed after I had an road accident a month before and got facial injury. Was sutured in emergency for the same.
Oh I see. Symptomatic? I would definitely establish care with an ENT surgeon to see if you require intervention. If the duct is narrowed or scarred off, that's a trickier scenario and I would not want to give you misinformation. You'll do well as long as you get to an experienced surgeon for these things.
Sir Thanks again and as you suggested I will definitely consult to ENT Surgeon and will not disturb you more as you have already given me your valuable time and suggestions. Sir the whole MR Sialography reports is given below. MR findings are suggestive of prominent right parotid duct in its entire course terminating at an oval shaped cystic swelling in the right cheek region superficial to the buccinator muscle. No filling defect or calculus seen within the parotid duct. The parotid gland appears normal in size and signal. Parotid duct is prominent in calibre in its entire course extending from superficial lobe of parotid gland coursing along the masseter and terminating into cystic swelling. The duct measures approx 1.7 mm within the parotid gland and 2.0 mm along the masseter muscle. There is also mild dilatation of side branches within the parotid gland. Oval shape swelling measuring 2.6(AP) x 1.9 (TR) x 3.8(cc) with the volume of approx. 10 CC in the right cheek region just superficial to the buccinator muscle.
A very interesting and informative video. I have had FESS but still have ongoing maxillary sinusitis with fishy smelling discharge from both sinuses. My ent suspects odondogenic infection as my CT scan shows molar protrusion into the right and left maxillary sinuses, I've had root canal treatment on my left side but still have recurrent sinusitis, my dentist has suggested extraction as a final treatment as he can't rule out periodontal infection. Is this the correct course of action given my history? Once again thank you for your video and your research, definitely an area that needs more attention and study.
This is a tricky scenario. Did your sinus surgeon obtain sinus cultures? We published a paper recently on differences in culture results between odontogenic and typical sinusitis, and this sometimes help you in deciding whether a tooth is the source. But to answer your question, presuming the sinus surgery was optimal with having a nice patent opening, and the root canal was completed properly, then dental extraction may be the next step. If I were you, I would first get a maxillary sinus culture to test for aerobic and anaerobic bacteria and see what it shows. Will make you feel better about removing your tooth. I have done this for 3 patients before and i can say it worked for sure in 2, and the 3rd I'm hopeful but the it's only been 2 months and the patient still has sinusitis (but less, so I'm hoping it resolved). There's no literature currently to drive this decision but there will be in the next 2 yrs, but it likely won't be a high level of evidence due to the rarity of the scenario. Best of luck!
Hi doc I have bilateral sinuses with chronic mastoiditis..mucosal thickening of bilateral maxillary sinus and concha bolusa left. Pls help doc what would be the best treatment for me i suspect my maxillary sinus is of dental origin what would be my first thing to do what do u think is the best treat ment for me..
Have you seen an ENT surgeon? Def need an evaluation. The findings you describe are not typical of odontogenic sinusitis but there are many more questions to answer and exam findings to analyze. I strongly recommend you see an ENT surgeon near you if possible.
Do you have colored or foul smelling drainage from your nose on the side of a treated upper molar tooth? If so, get to see an ENT surgeon or rhinologist and inquire about possible sinusitis or odontogenic sinusitis.
While there may be rare instances where patient respond to antibiotics, most of the time patients need either dental treatment, sinus surgery, or both. I personally have never seen a patient resolve on antibiotics.
@@JohnCraigNose I just had a tooth extraction due to infection and have what my dentist described to me as a small nasal communication. I can suck air through the hole where the tooth was. I also started an implant and we are waiting to see if the hole is going to heal and close on it's own. She said if it doesn't heal, we may have to do a procedure called a nasal lift?
@@ronin2167 yes sounds like you have an 'oroantral communication' and most heal. But if not, then first I believe you'd need to have it closed, THEN consider implant, for which many require a sinus lift which is just a bone graft at the tooth socket area so the implant has enough bone to integrate long-term. Hope that helps.
Dr.Craig I have oroantral fistula and my sinus was perforated about 8mm during molar tooth extraction..Since then i am suffering from chronic sinusitis..I have a green mucus foul smell that came out from my nose and fistula,my left nose is always clogged ,post nasal drip,blurry vision,suffocation, i developed polyps from both nostrils because of this.My cbct result says my maxillary sinus is completely blocked and have root tooth .im completely loss of getting an answer to cure this.It was all happen year 2019. What kind of doctor or surgery should i have?please help me
Hello. Sorry to hear. In what country do you live? You should try to see a rhinologist to address the sinus disease, and then if you still have an oroantral fistula, you will need an oral surgeon which could be an oral surgeon or periodontist. This is curable though.
@@JohnCraigNose im from philippines..Does the oral surgeon can do the surgery alone? Or i need an ENT to perform the FESS and the Oral surgeon to close the oroantral fistula?
@@JohnCraigNose im afraid if i proceed to fess surgery there's a lot of risk that i read after the surgery like CSF,meningitis,empty nose syndrome and brain damage because our nose is very close to our brain.
Dr. Craig - I was so relieved to come across your video today, and I was hoping you could possibly offer some referral advice. I am a 46-year-old woman, on IL Medicaid, and I'm on day 2 of my 6TH severe dry-sinus infection in less than 2-years. And I say severe, because 5 of those times I ended up in the ER because the pain had pushed into the 9-10 range and I could not bear it. This coming from someone who has had chronic pain from fibro, arthritis and bursitis since I was 14, and who lives most of her day at 6-7 on the pain scale. I was referred to an ENT last February, and all I was told was to try harder to keep hydrated, to keep a humidifier running when the weather is dry and to use a steroid nasal spray 1-2 times a day (on Flonase presently). She couldn't identify what might be causing these things to constantly recur. Which tells me that she wasn't familiar with Odontogenic sinusitis, because I'm not a gambler, but I'd put down good money on that being my problem. I didn't have regular dental care most of my life, and I drank too much Mt. Dew when I was young (no longer drink any soda or carbonated beverages). Chunks of my teeth have been breaking off for a number of years, particularly my molars. I tried to get partial dentures a few years ago, because nearly half of my teeth are still salvageable, but then I learned that Medicaid will never pay for partial dentures, only removing all the remaining teeth and getting full dentures - which I hesitant to do. The these sinus infections began happening, and their pattern is identical every time. I wake up with pain throughout the right side of my face, including the jaw line and teeth. I'm already on Lyrica, Metaxalone and 600mg of Ibuprofen 3 times a day, so usually my morning meds will ease the pain. But as the day progresses, they become less useful. At no point do I have mucus, draining or sinus pressure of the congestion sort - my sinus are completely dried out and it's inflammation causing the pain & pressure, not congestion. Day 2 I wake up and the pain is is becoming more difficult to take and a low-grade fever starts. My regular pain meds no longer stop the pain at all, they only reduce it a little. The rest of my symptoms are still identical to the day before - dried out and inflamed. I will try to use careful sinus massage and hot compresses to reduce the pain, but the problem is that once I start using heat and pressure I cannot stop. By the evening I'll be in agony unless I keep a heat pad directly on my face every minute. From past doctor's recommendations, I have started adding two acetaminophen to my regimen on day 2, and using saline sprays and my nettie pot regularly - it'll ease symptoms momentarily, but even that efficacy will disappear by dinner time. At that point, no OTC med does anything to ease the pain and the heat pad just keeps the pain at 8-9, so that I'm crying and struggling but not yet moaning or sobbing in agony. That's also when I start feeling constant jolts of electricity throughout my body, that make my muscles twitch and spasm, leaving me jittery and struggling to articulate myself, focus, or do anything remotely productive. I'm guessing it's some kind of pain-overload or fibro-flare triggered by the infection. In the beginning I tried to wait it out overnight, hoping that things would be better by the morning of Day 3 - but each time I end up in the emergency room at some point in the night, with the entire right side of my head pulsing and the pain breaking past 9. More recently, I start making desperate calls on the morning of Day 2, trying to see my GP, or the ENT - no one is ever available. I end up being told to go to an express care clinic - who I have been to and who does diagnose it as a sinus infection. They will prescribe me a z-pack or similar anti-biotic to stop the infection, maybe throw in something for the inflammation. But it never works fast enough on the infection to keep me out of the ER that night. And none of our express care clinics will prescribe any kind of real pain meds - not even Tylenol3. The last time I asked for 800mg Ibuprofens, hoping that would be enough to keep me out of the ER - it wasn't. As a chronic pain patient and disability advocate, I avoid asking for any kind of opioid unless I am seriously desperate - because I get so frustrated with the anti-dependency hysteria that's going on in the medical community right now. I get why it's going on, and I'm not oblivious to the opioid crisis they are trying to manage, but the presumptions and stigma are leaving people like myself in a lot of pain these days. But by the time I end up in the ER, and the doctor confirms the infection/inflammation and sees how non-functional I am from the pain, they will give me something at the ER (if I didn't drive myself) and prescribe 2-3 days of Tylenol3 or something in that ballpark - the first doctor gave me Vicodin, which did work faster and longer, but if I suggest it to anyone else they start looking at me like a drug-seeker again. So this morning, in amongst my desperate phone calls to try and see one of my docs today, I started doing more research on what could be causing this - and I found your video. Once again, my GP and ENT can't see me before next week, so I called my sister and made plans to go to the ER when she gets off of work. By that point, the pain will probably only be around an 8, but it's better than having to wake her up to take me to the ER at 3AM again. I hate making plans to go to the emergency room for something that a quick appointment with my existing medical team could get under control - but that's the position I'm left in. But I'm hoping you can give me some advice on finding a doctor in IL that will be familiar with odontogenic sinusitis and will be willing to pursue sinus surgery as a first solution, since clearly it has a better chance of stopping these from recurring. And distance is no object - I already drive 2-3 hours, each way, to see my rheumatologist and neurologist. If referral suggestions are not viable, are there some resources I can direct my current ENT towards, beyond just this video, that might give her the info she needs to diagnose and treat this issue herself? Thanks for ANY suggestions or input you can offer. I would normally not put such a lengthy YT comment up like this, soliciting help, but I am getting quite desperate to make sure this never happens again. It's not just the 6th in 2 years, it's also the 3rd time in 5 months. If I had the means to pay out of pocket, I'd have already booked an appointment with you and been researching cheap hotel options in Detroit. :D And if reaching me directly would be easier than replying to this message, you can email me at yli.shopping1 at gmail. Thanks again! Kat
Hello, sorry to hear about your misery. So, I think you really need to see a headache specialist within neurology next. Really important to get a thorough evaluation of your pain because you have a very complex pain history and it sounds out of proportion to what we see from any sinusitis. Also, without nasty colored or smelling mucus, it makes odontogenic sinusitis much less likely. Can't stress it enough how important it is to get a thorough headache and facial pain eval, and I find headache specialists to be be excellent for this due to their extra training. Universities def have them in your area but you can search online for private doctors w those credentials. Good luck!
I think it would be reasonable to see your dentist for the cavity, to determine if a filling or other procedure is necessary. If that fails to resolve the burning feeling in left cheek, may have to see ENT surgeon to evaluate, though often you could require a facial pain specialist as well (neurologist who is trained in headache management)
Extraction related OAF lead to sinus infection. Bad taste in mouth (probably pus leakage from extraction site), foul smell in right nose, twice headache per week which can go away with a painkiller. Congestion in the right nose, No other symptoms. Does nose drips and antibiotics alone fix this with the closing the OAF? Or sinus surgery is must? Thank you.
It’s crazy, I’ve been to an ENT twice, and dentist, and I needed google/UA-cam to find out what I probably have!
I feel you my story is identical!
Glad you enjoyed it. More to come
Thank you for the video Dr. Craig! I wonder how many people were in the mentioned groups!? 🙏
@JohnCraigNose how many people were in the groups?
Does this only occur with molars and premolars or can this also happen with canine or incisors?
Much less commonly w canines bc they rarely approximate the maxillary sinus floor (though is possible). I think the incisors probably never approximate the sinus floor, but then again, I try to never say never :)
@@JohnCraigNose Do you feel that it’s possible for receding gum tooth pain in upper molars to cause dizziness or is it only related to an infection?
As an ENT, thorough dental treatment should precede FESS, in my opinion with collobaration with dental specialist.
Absolutely. Have you seen our international consensus on diagnosis published in IFAR? It's summarized in this video:
y2u.be/BfdQkrZgSsQ
I definitely agree patients should be evaluated first by dental specialist before considering treatment options, but then the treatment should be individualized to the patient based on symptom burden and their financial state with regard to dental and medical insurance coverage. We have published multiple papers on various aspects of ODS, and the issue of whether to treat teeth or sinuses first will continue to be controversial until more evidence accumulates. Thanks for your comment.
What in case blocked osteomeatal complex, just odontogenic sinomucosal thickening along with concha bullosa, inferior turbinate hypertrophy. Still you prefer prior dental treatment or vice versa
Dr. YL
Enjoyed your video, Dr. Craig! I have just finished a 10 day course of Cefuroxime for sinusitis which has lasted 2 1/2 months. I'm somewhat better. The day before I saw my family doctor, I saw my dentist BECAUSE at one point I had previously suffered pain when pressing above my lip under right nostril AND I also have a dental abscess, a small swelling at the emminence above my right incisor. OK, so my dentist pounded my upper teeth in that area and there was no tooth pain. So therefore he concluded that the bump was a "nothing." He did not do xrays thinking that my doctor might do this and would be covered under my insurance. Well, there were no xrays done at all.
So now I am taking a wait and see approach.
But then I read about bad things that can happen from dental abscess .... bone being eaten away, sepsis, even an infection of the brain!!! Oh my! And for the last 2-3 months I'm also suffering from anosmia. It has not resolved post antibiotic. My sinus condition is better but by no means great.
Have you sought out a rhinologist in your area (fellowship trained ENT surgeon)? Your condition might not be odontogenic sinusitis, but if you have persistent nasal symptoms, I would look for someone so they can take a history and scope you. Good luck!
@@JohnCraigNose No, not yet. I'm just getting familiar with the vocabulary. I will look for one because now I'm getting worse. Oh and thank you for your thoughtful response.
Dr. My MR Sialography suggest parotid duct terminating to cystic swelling. Do I need parotidectomy or Just repair of parotid duct. Please suggest.
Sorry to hear. Not my area of expertise, but if it's a parotid cyst, mainly you need to talk to an ENT or head and neck cancer surgeon to evaluate the appearance on MRI to make sure they feel it's truly a cyst and not perhaps a tumor. Also good to assess for any salivary duct stone. Type of surgery will depend on these variables. Hope that helps.
Thanks sir for early and valuable reply. You already told it's not your area of expertise but still like to tell you that its neither tumor nor stone as this swelling developed after I had an road accident a month before and got facial injury. Was sutured in emergency for the same.
Oh I see. Symptomatic? I would definitely establish care with an ENT surgeon to see if you require intervention. If the duct is narrowed or scarred off, that's a trickier scenario and I would not want to give you misinformation. You'll do well as long as you get to an experienced surgeon for these things.
Sir Thanks again and as you suggested I will definitely consult to ENT Surgeon and will not disturb you more as you have already given me your valuable time and suggestions. Sir the whole MR Sialography reports is given below. MR findings are suggestive of prominent right parotid duct in its entire course terminating at an oval shaped cystic swelling in the right cheek region superficial to the buccinator muscle. No filling defect or calculus seen within the parotid duct. The parotid gland appears normal in size and signal. Parotid duct is prominent in calibre in its entire course extending from superficial lobe of parotid gland coursing along the masseter and terminating into cystic swelling. The duct measures approx 1.7 mm within the parotid gland and 2.0 mm along the masseter muscle. There is also mild dilatation of side branches within the parotid gland. Oval shape swelling measuring 2.6(AP) x 1.9 (TR) x 3.8(cc) with the volume of approx. 10 CC in the right cheek region just superficial to the buccinator muscle.
Hi doc is bilateral maxillary sinusitis possibly the cause of teeth I suspect my RCT tooth hope u reply doc
A very interesting and informative video. I have had FESS but still have ongoing maxillary sinusitis with fishy smelling discharge from both sinuses. My ent suspects odondogenic infection as my CT scan shows molar protrusion into the right and left maxillary sinuses, I've had root canal treatment on my left side but still have recurrent sinusitis, my dentist has suggested extraction as a final treatment as he can't rule out periodontal infection. Is this the correct course of action given my history? Once again thank you for your video and your research, definitely an area that needs more attention and study.
This is a tricky scenario. Did your sinus surgeon obtain sinus cultures? We published a paper recently on differences in culture results between odontogenic and typical sinusitis, and this sometimes help you in deciding whether a tooth is the source. But to answer your question, presuming the sinus surgery was optimal with having a nice patent opening, and the root canal was completed properly, then dental extraction may be the next step. If I were you, I would first get a maxillary sinus culture to test for aerobic and anaerobic bacteria and see what it shows. Will make you feel better about removing your tooth. I have done this for 3 patients before and i can say it worked for sure in 2, and the 3rd I'm hopeful but the it's only been 2 months and the patient still has sinusitis (but less, so I'm hoping it resolved). There's no literature currently to drive this decision but there will be in the next 2 yrs, but it likely won't be a high level of evidence due to the rarity of the scenario. Best of luck!
Hi doc I have bilateral sinuses with chronic mastoiditis..mucosal thickening of bilateral maxillary sinus and concha bolusa left. Pls help doc what would be the best treatment for me i suspect my maxillary sinus is of dental origin what would be my first thing to do what do u think is the best treat ment for me..
Have you seen an ENT surgeon? Def need an evaluation. The findings you describe are not typical of odontogenic sinusitis but there are many more questions to answer and exam findings to analyze. I strongly recommend you see an ENT surgeon near you if possible.
as usual Excellent quality presentations and videos. Thank you Dr Craig for sharing.
Hi doc I suspect I have dental sinusitis on my RCT tooth I have maxillary sinusitis is these possible?
Do you have colored or foul smelling drainage from your nose on the side of a treated upper molar tooth? If so, get to see an ENT surgeon or rhinologist and inquire about possible sinusitis or odontogenic sinusitis.
Ok doc can x-ray detecti these
CT best. Often gets missed on regular X-rays. In dental office that's a cone beam CT. If seeing ENT, it's probably a CT sinus
Ok doc thanks for you're reply greatly appreciated..
Is there a medicine to treat this
While there may be rare instances where patient respond to antibiotics, most of the time patients need either dental treatment, sinus surgery, or both. I personally have never seen a patient resolve on antibiotics.
@@JohnCraigNose I just had a tooth extraction due to infection and have what my dentist described to me as a small nasal communication. I can suck air through the hole where the tooth was. I also started an implant and we are waiting to see if the hole is going to heal and close on it's own. She said if it doesn't heal, we may have to do a procedure called a nasal lift?
@@ronin2167 yes sounds like you have an 'oroantral communication' and most heal. But if not, then first I believe you'd need to have it closed, THEN consider implant, for which many require a sinus lift which is just a bone graft at the tooth socket area so the implant has enough bone to integrate long-term. Hope that helps.
Dr.Craig I have oroantral fistula and my sinus was perforated about 8mm during molar tooth extraction..Since then i am suffering from chronic sinusitis..I have a green mucus foul smell that came out from my nose and fistula,my left nose is always clogged ,post nasal drip,blurry vision,suffocation, i developed polyps from both nostrils because of this.My cbct result says my maxillary sinus is completely blocked and have root tooth
.im completely loss of getting an answer to cure this.It was all happen year 2019.
What kind of doctor or surgery should i have?please help me
Hello. Sorry to hear. In what country do you live? You should try to see a rhinologist to address the sinus disease, and then if you still have an oroantral fistula, you will need an oral surgeon which could be an oral surgeon or periodontist. This is curable though.
@@JohnCraigNose im from philippines..Does the oral surgeon can do the surgery alone? Or i need an ENT to perform the FESS and the Oral surgeon to close the oroantral fistula?
I still have oroantral fistula.
For me, it's ENT/rhinologist to do the sinus surgery and oral surgeon to close the fistula. Some ENTs close their own so would depend on the surgeon.
@@JohnCraigNose im afraid if i proceed to fess surgery there's a lot of risk that i read after the surgery like CSF,meningitis,empty nose syndrome and brain damage because our nose is very close to our brain.
Dr. Craig - I was so relieved to come across your video today, and I was hoping you could possibly offer some referral advice.
I am a 46-year-old woman, on IL Medicaid, and I'm on day 2 of my 6TH severe dry-sinus infection in less than 2-years. And I say severe, because 5 of those times I ended up in the ER because the pain had pushed into the 9-10 range and I could not bear it. This coming from someone who has had chronic pain from fibro, arthritis and bursitis since I was 14, and who lives most of her day at 6-7 on the pain scale.
I was referred to an ENT last February, and all I was told was to try harder to keep hydrated, to keep a humidifier running when the weather is dry and to use a steroid nasal spray 1-2 times a day (on Flonase presently). She couldn't identify what might be causing these things to constantly recur.
Which tells me that she wasn't familiar with Odontogenic sinusitis, because I'm not a gambler, but I'd put down good money on that being my problem. I didn't have regular dental care most of my life, and I drank too much Mt. Dew when I was young (no longer drink any soda or carbonated beverages). Chunks of my teeth have been breaking off for a number of years, particularly my molars. I tried to get partial dentures a few years ago, because nearly half of my teeth are still salvageable, but then I learned that Medicaid will never pay for partial dentures, only removing all the remaining teeth and getting full dentures - which I hesitant to do.
The these sinus infections began happening, and their pattern is identical every time. I wake up with pain throughout the right side of my face, including the jaw line and teeth. I'm already on Lyrica, Metaxalone and 600mg of Ibuprofen 3 times a day, so usually my morning meds will ease the pain. But as the day progresses, they become less useful. At no point do I have mucus, draining or sinus pressure of the congestion sort - my sinus are completely dried out and it's inflammation causing the pain & pressure, not congestion.
Day 2 I wake up and the pain is is becoming more difficult to take and a low-grade fever starts. My regular pain meds no longer stop the pain at all, they only reduce it a little. The rest of my symptoms are still identical to the day before - dried out and inflamed. I will try to use careful sinus massage and hot compresses to reduce the pain, but the problem is that once I start using heat and pressure I cannot stop. By the evening I'll be in agony unless I keep a heat pad directly on my face every minute. From past doctor's recommendations, I have started adding two acetaminophen to my regimen on day 2, and using saline sprays and my nettie pot regularly - it'll ease symptoms momentarily, but even that efficacy will disappear by dinner time. At that point, no OTC med does anything to ease the pain and the heat pad just keeps the pain at 8-9, so that I'm crying and struggling but not yet moaning or sobbing in agony.
That's also when I start feeling constant jolts of electricity throughout my body, that make my muscles twitch and spasm, leaving me jittery and struggling to articulate myself, focus, or do anything remotely productive. I'm guessing it's some kind of pain-overload or fibro-flare triggered by the infection.
In the beginning I tried to wait it out overnight, hoping that things would be better by the morning of Day 3 - but each time I end up in the emergency room at some point in the night, with the entire right side of my head pulsing and the pain breaking past 9. More recently, I start making desperate calls on the morning of Day 2, trying to see my GP, or the ENT - no one is ever available. I end up being told to go to an express care clinic - who I have been to and who does diagnose it as a sinus infection. They will prescribe me a z-pack or similar anti-biotic to stop the infection, maybe throw in something for the inflammation. But it never works fast enough on the infection to keep me out of the ER that night. And none of our express care clinics will prescribe any kind of real pain meds - not even Tylenol3. The last time I asked for 800mg Ibuprofens, hoping that would be enough to keep me out of the ER - it wasn't.
As a chronic pain patient and disability advocate, I avoid asking for any kind of opioid unless I am seriously desperate - because I get so frustrated with the anti-dependency hysteria that's going on in the medical community right now. I get why it's going on, and I'm not oblivious to the opioid crisis they are trying to manage, but the presumptions and stigma are leaving people like myself in a lot of pain these days. But by the time I end up in the ER, and the doctor confirms the infection/inflammation and sees how non-functional I am from the pain, they will give me something at the ER (if I didn't drive myself) and prescribe 2-3 days of Tylenol3 or something in that ballpark - the first doctor gave me Vicodin, which did work faster and longer, but if I suggest it to anyone else they start looking at me like a drug-seeker again.
So this morning, in amongst my desperate phone calls to try and see one of my docs today, I started doing more research on what could be causing this - and I found your video. Once again, my GP and ENT can't see me before next week, so I called my sister and made plans to go to the ER when she gets off of work. By that point, the pain will probably only be around an 8, but it's better than having to wake her up to take me to the ER at 3AM again. I hate making plans to go to the emergency room for something that a quick appointment with my existing medical team could get under control - but that's the position I'm left in.
But I'm hoping you can give me some advice on finding a doctor in IL that will be familiar with odontogenic sinusitis and will be willing to pursue sinus surgery as a first solution, since clearly it has a better chance of stopping these from recurring. And distance is no object - I already drive 2-3 hours, each way, to see my rheumatologist and neurologist. If referral suggestions are not viable, are there some resources I can direct my current ENT towards, beyond just this video, that might give her the info she needs to diagnose and treat this issue herself?
Thanks for ANY suggestions or input you can offer. I would normally not put such a lengthy YT comment up like this, soliciting help, but I am getting quite desperate to make sure this never happens again. It's not just the 6th in 2 years, it's also the 3rd time in 5 months. If I had the means to pay out of pocket, I'd have already booked an appointment with you and been researching cheap hotel options in Detroit. :D
And if reaching me directly would be easier than replying to this message, you can email me at yli.shopping1 at gmail.
Thanks again!
Kat
Hello, sorry to hear about your misery. So, I think you really need to see a headache specialist within neurology next. Really important to get a thorough evaluation of your pain because you have a very complex pain history and it sounds out of proportion to what we see from any sinusitis. Also, without nasty colored or smelling mucus, it makes odontogenic sinusitis much less likely. Can't stress it enough how important it is to get a thorough headache and facial pain eval, and I find headache specialists to be be excellent for this due to their extra training. Universities def have them in your area but you can search online for private doctors w those credentials. Good luck!
Thank you for sharing this video Dr. Craig!!!
great vid, doc. thanks.
Thankful
Do I see a oral surgeon for this I have pain in my left sinus almost burns when I breath I also have a cavity on my left side top tooth on the back
I think it would be reasonable to see your dentist for the cavity, to determine if a filling or other procedure is necessary. If that fails to resolve the burning feeling in left cheek, may have to see ENT surgeon to evaluate, though often you could require a facial pain specialist as well (neurologist who is trained in headache management)
Extraction related OAF lead to sinus infection. Bad taste in mouth (probably pus leakage from extraction site), foul smell in right nose, twice headache per week which can go away with a painkiller. Congestion in the right nose, No other symptoms. Does nose drips and antibiotics alone fix this with the closing the OAF? Or sinus surgery is must?
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