Even my Internist does not know if I have a sinus infection or abscess.

Hi, my problem started Oct 22, 2015 with a sore area above an upper back tooth, near the upper part of the root of the tooth. My tooth did not, and still does not, hurt to chew on. I have not had any sensitivity to hot or cold foods either.

My dentist did an Xray at that time, not seeing any abscess. He did state that I have a slight fracture in that tooth. He prescribed a ZPack in case it was a sinus infection and it improved greatly. Two weeks after that antibiotic, the discomfort began to return, but was again only noticeable when I put pressure on the spot with my finger. My internist called in an antibiotic as I have a history of sinus infections and tooth pain with them. Again, there was improvement.

Fast forward.

Since Oct 22 I have had 4 rounds of antibiotics (ZPack twice, Bactrim, and Avelox). Each time the pain disappeared, only to reappear. It has now reared it's ugly head again and this time my gum area in that spot is swollen. It still does not hurt to chew. But it does hurt to smile, and is more uncomfortable than before. I have begun Bactrim again (14 day supply this time) and my internist has scheduled me for a CT scan of my sinuses. Be he is stumped. It could be my slightly cracked tooth.

I saw my dentist again in early December for semi-annual checkup, cleaning, and xrays. The xray still looked clear. I don't know whether to find a new dentist (an endodontist?), go ahead with the CT scan, or not. I am concerned about the infection spreading into bones. My dentist had said that if the problem turned out to be in the tooth, he would want to pull it. I don't want to lose a tooth! Please advise. Thanks

Reply:

Hi there, I'm sorry you are dealing with this issue. It sounds so frustrating!

I do think a CT scan could be helpful. Dentists use dental CT scans for dental implants. It's amazing what a CT scan shows that regular XRays do not. I have seen CT scans used in cases like yours where there is no sign of an abscess on a regular dental Xray. CT scans sometimes show infection when it wasn't obvious in a regular Xray.

Is the scan you are having one that will also show the teeth? I think that would be best and a good question to ask.

Depending on what the scan shows, seeing an endodontist may also be a good idea. They are experts in this area and see difficult cases like yours routinely. If the tooth is infected an endodontist will be able to advise you on whether you can save the tooth.

If you decide to have the CT scan be sure to get a copy to share with your care providers...internist, dentist and endodontist.

Thanks for writing and good luck,
~Shelly

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