At what point should care be taken over by PCP instead of Dentist?

I am 24 years old, and other than allergies, am in excellent health.  I went to my dentist on 1/13/06 and a large abscess with sinus tract stoma (dentist's terms) was found behind my front upper teeth.  I was referred to an oral surgeon who on 1/17/06 drained the abscess, and then to an endodontist, who did a root canal on that tooth.  He expected that the abscess would spread after the root canal, and was right, so on 1/19/06 I returned and it was once again drained.  I started on Penicillin VK 500mg QID on 1/13/06, but it didn't have an effect on the infection.  I began running a fever consistently, so on 1/23/06 I was put on Clindamycin 300mg QID. After a couple of days, the fever went away, and I assumed things were getting better, however the symptoms are back. I went back to my dentist on friday, and he was concerned about the infection still being present.  I have a "lump" on the hard palate, as well as a fever, which is consistently running in the 100-102 range.  The dentist said that if there was no improvement by friday 2/4/06, that he would refer back to the oral surgeon.  I feel that waiting till friday isn't wise, nor do I wish to have pain and fever that long...I've had enough as it is.  At what point should this all be taken over by my primary care provider?  Do you have any advice that could help?

[Kevin Pho, MD]

This situation clearly needs more than a dentist.  I agree with the oral surgeon overseeing the care - if there is evidence of a spreading abscess, an oral surgeon would be the appropriate referral to help drain this, as well as assess any possible surgical options.  

If the symptoms are worsening, or you do not feel you are receiving appropriate care, then you can discuss this situation with your persoanl physician.  A head and/or sinus CT can be considered to evaluate the spreading of any abscess.  A referral to a second oral surgery opinion can be discussed with your primary care provider.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[AfricanGrey]

I would post this in the dental health forum.

[B_Johnson]

The problem is beyond the scope of a PCP.  I would have him refer you to an ENT.

[higgy]

Ok...you're answer was right on!  I went back to the Oral Surgeon on Monday.  They upped the Clindaymcin to 500mg QID, and scheduled surgery for 2/10 to remove the infected bone/tissue and are sending for a biopsy of it.