Know How Our iCliniq Doctor Helped a Patient With Systemic Inflammation

A patient consulted our iCliniq doctor with a complaint of systemic inflammation and a CRP (C-reactive protein) of 200, which, he mentioned, had shot up from his previous test reports. He gave a history of undergoing a tooth extraction and a bone graft placement following it. He then mentioned that he was advised antibiotics post-extraction, following which his CRP had reduced to 2. He also told our doctor that he had a fever, sore throat, and nasal discharge at night. He added that the CAT (computed tomography) scan he underwent showed tooth inflammation and a polyp. Regarding the symptoms, he only mentioned feeling tenderness on the extraction site and no symptoms otherwise. He expressed his concerns regarding the CAT scan report results and asked whether there was any infection in the teeth or the extraction socket and the cause of the polyp. He also enquired whether the implant adjacent to the extraction site was infected and if there were signs of bone loss. He further informed our doctor about getting diagnosed with osteomyelitis and taking medications. He concluded his query by enclosing his most recent CRP value, which was 250.

Our iCliniq doctor, after a keen assessment of the patient’s symptoms and reports, confirmed his condition to be osteomyelitis. He explained to the patient that symptoms like fever, sore throat, nasal discharge, or tooth pain were common in osteomyelitis and polyps of the facial sinuses. He further said that the reports suggested alveolar polyps of the sinus and asked the patient to continue the same medication his doctor had prescribed. He further assured the patient that there was no infection in his tooth but that he could be at higher risk of infections because of the polyp. He also said that the inflammatory alveolar polyps could be treated surgically by endoscopic sinus surgery or non-surgically with antibiotics. He suggested the patient take an in-clinic opinion from a maxillofacial surgeon for close examination as he suspected infection in the sinus cavity, per the details provided. He then asked the patient if he experienced pain or shakiness in the implant.

The patient reverted and thanked our iCliniq doctor for his quick response. He answered our doctor’s question saying his upper right implant was sore, and expressed his concerns about noticing the tip of the implant into the sinus cavity in the scan. He was also worried that the tooth behind the implant was infected. He doubted if the root canal he underwent for the upper molar had failed and questioned if our doctor had detected any bone loss. He also mentioned that his dentist suspected neuralgia-inducing cavitational osteonecrosis (NICO) and an abscess in the lower left tooth caused by a failed filling. He then requested our doctor for a second opinion about the diagnosis made by his previous dentist.

Our iCliniq doctor assured the patient that the implant and the root canals were proper and that the slight dip of the implant into the sinus cavity was normal. Our doctor also informed the patient that the alveolar fossa polyp mentioned in the report was expected because of the maxillary sinus infection around the dental implant, as the patient was suffering from osteomyelitis or high CRP. Our iCliniq doctor advised the patient to continue taking his medications and consult a maxillofacial surgeon for an in-clinic opinion regarding the treatment choice. He also informed the patient that a secondary infection due to systemic inflammation seemed to be the reason for the jaw infection rather than neuralgia-induced osteonecrosis. He also mentioned that the lower left tooth filling was close to the root canal, and the cause of the abscess was because the filling was close to the nerve and advised the root canal of the lower left last molar. He further assured the patient the prognosis of his condition was good.

The patient replied and thanked our iCliniq doctor for explaining everything in detail.