Saw this amazing and somewhat terrifying case today during my external rotation at the oral surgeons office. The wisdom tooth can be seen in the X-ray just floating above all the other teeth. Apparently it was pushed up there by an abscess into the maxillary sinus which is why it didn’t cause any pain but just congestion for this poor man. But this doesn’t happen overnight. This man hadn’t seen the dentist until he was 19 and it was an easy spot for his dentist to overlook…although it should have been caught early on before it got this bad. I think the patient was something in his late 30s. The doctor said that the abscess would have a grape-like feel to it as it pushes into the sinus space with epithelial tissue growing inside it with nowhere else for it to go.
About two years ago (wow I can’t believe it’s been that long!) when I was working in another oral surgery office before dental school we saw a case just like this and the oral surgeon went in, drained the abscess, and removed the tooth. It was kind of a mess with black and brownish colored pus coming out of the abscess. Shadowing today was very eventful and reminded me of the days before dental school when I worked in the office. Plus, I’m starting to get to know specialists in the area to whom I may eventually refer patients out to if I ever join a practice in town.
I also asked the doctor what he would suggest in terms of making it easier for the oral surgeon. He said to be proactive. For example, he said many kids who need their wisdom teeth removed don’t get them removed until they have pain or when the surgery would be more drastic due to more developed roots, etc which can lead to a higher risk of complications. He said it’s much better to tell the patient that the surgery could wait rather than telling the patient that it’s too late.