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  Discussion on Upper cheek tooth removed, but infection still present
Author Message
New Member:
wilde

Posted on Monday, May 30, 2011 - 7:06 am:

Hi, some advice please.My mare has had a fractured tooth removed ( upper cheek tooth - one at end) she had to have a GA as it was impossible to remove orally. She had a heavy sinus infection prior to removal.She had the op 12 days ago and since then i have been flushing her sinus twice a day with a saline solution, she has a stapled wound on her face where they went in to remove the tooth, this is now discharging a pus like substance and her sinus is still discharging although it is not too smelly now. Where the tube enters her forehead (for flushing) is also discharging pus. She is on antibiotic twice a day & bute twice a day. i am worried that her sinus is still infected & her wounds are now discharging.Why is she still producing pus if on medication & is this normal at this stage after a tooth removal? Many thanks for any info you may be able to give me.
Moderator:
DrO

Posted on Tuesday, May 31, 2011 - 8:33 pm:

Hello wilde,
It certainly is true the sinus remains infected but the question is will this resolve with current treatment or are there predisposing conditions that prevent it from resolving like a oro-nasal fistula or perhaps a aggressive antibiotic resistant infection establishing itself. Nothing in your post helps us decide.

It does sound that at the very least more aggressive therapy is indicated at this point, more frequent flushing perhaps with a antibiotic in the saline that compliments the systemic antibiotic. Best would be a thorough evaluation by your veterinarian including a culture of the infection to determine the best antibiotic.
DrO
Member:
paul303

Posted on Wednesday, Jun 1, 2011 - 12:50 am:

Having spent my working life in human dentistry, my feeling is that you should be seeing some abatement by now, especially if the sinus infection was believed to be connected to the fractured tooth. You might need more than a saline solution for flushing, and, as Dr.O said, it's time for your vet to culture the infection so that an antibiotic specific to the infection can be administered.

You seem to be at the point where you are beginning to doubt your protocol. You're probably right. Go ahead and contact your vet, you're instincts are good.
New Member:
wilde

Posted on Wednesday, Jun 1, 2011 - 5:09 pm:

Hi, many thanks for your replies.Since i posted my message the mare has ripped out her drain and her facial wound has become more swollen and discharging. The vet came yesterday 31/05/2011 and removed staples from face, he was reluctant to restitch in the drain and cleaned & covered the area with a patch.He advised me to clean the face with warm saline daily & keep up with the medication. He says to wait & see how the wound settles down now the staples have been removed and hope that after 12 days of sinus flushing that it has been enough. How would you know if there was a fistula? What should I be looking for or asking my vet to investigate? many thanks
Member:
paul303

Posted on Thursday, Jun 2, 2011 - 12:26 am:

Can you tell us the date that the tooth was removed? Was she on any antibiotic before the surgery? What is the name of the antibiotic that she is on now? How is the vet keeping the "patch" on?

If the bad tooth was the cause of the original sinus infection, it's possible that a pathway (fistula) had already formed to the affected sinus - which means it could be a really tenacious infection. You might need to push your vet to culture the pus. The results could possibly point to a more specific and effective antibiotic if the exact bacteria is identified.

How is she holding up with all this? Is she in any pain? Does she rub the wound on anything? Is she running any temperature? Is she eating and drinking OK?

One thing you should do....call your vet consistently to keep him informed of your horse's progress. Don't let this go for more than a couple of days without checking in with the vet. You have to let him know if it is better, worse, or no change. He needs this information to help formulate his treatment plan.
New Member:
wilde

Posted on Thursday, Jun 2, 2011 - 7:44 am:

Hi, thanks for your reply, she had the tooth removed on 19/05/2011, & she was on norodine antibiotics prior to the op. The patch over the drain is a sticky foam, i put a piece of gauze over the wound & stick this on top & so far it has stayed put. I think prior to the vet removing the staples on tuesday she was in pain due to something building under the incision wound on her face, she was agitated and rubbing her face and generally not herself. Her temp is ok & all through this & prior to having the tooth removed she has eaten & drank. I will ring the vet again today & give him todays update - that the face wound is still oozing and is still swollen and there is pus in the nostril, not running down but there. Thank you for your help.
Member:
paul303

Posted on Friday, Jun 3, 2011 - 1:14 am:

Norodine seems not to be available here in the U.S. What puzzles me is that it has similarities to sulfadiazine which is used for Rheumatic fever and Toxoplasmosis. It also has similarities to trimethoprim which is used to treat bladder infections, otitis ( ear ), and pneumonia.

Dental problems are most always strep in origin. The tendency is to lean toward a Keflex or even Amoxicillan. Common antibiotics for mouth infections and more.

I'm glad you're calling your vet to keep him apprised of the situation. He is powerless without this information.
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