The Cosmetic Dentistry Blog

December 5, 2011

Sinus perforation during tooth extraction – what to do

Filed under: Extractions — Tags: , , , — mesasmiles @ 6:50 pm

My mother had two teeth pulled yesterday, but they pierced her sinus cavity on both teeth and then left a piece of the root behind. What do we do to get this resolved?
- Autumn from Oregon

Autumn,
The roots of upper molar teeth can sometimes be very close to the maxillary sinus, to where there is only a thin layer of bone, or sometimes just a thin membrane and no bone at all between the tip of the root and the sinus. This is one reason a sinus infection can sometimes cause a toothache. So if the sinus cavity was perforated during the extraction, it was probably smart of the dentist to leave the root tip in the bone, as trying to get out that root tip could cause that root tip to be pushed up into the sinus, which would have necessitated sinus surgery to remove it.

Just puncturing the sinus is a rather simple matter to heal. If the dentist suspects that the sinus has been perforated, he or she can ask the patient to blow their nose, and the dentist will see a bubbling of air in the socket. The typical treatment is to pack the tooth socket with a biocompatible resorbable sponge material called gelfoam, which accelerates the growth of tissue to cover the perforation. Or bone grafting material can be carefully placed in the socket. If it’s not too difficult, the dentist can also suture soft tissue over the tooth socket, which also helps accelerate that process. But if it would be too traumatic to move soft tissue to that position, that isn’t necessary. Then the dentist will instruct the patient not to blow their nose for a few days, to give that tissue time to heal without disruption. The opening then heals over with soft tissue, and then gradually over a few months’ time, new bone grows in the socket and the sinus membrane completely heals.

If the dentist has any question about whether any tooth fragments were pushed up into the sinus, he or she may refer the patient to an ear, nose, and throat specialist (otorhinolaryngologist) for an x-ray to check whether or not the sinus is clear.

Leaving a root tip of the tooth in the bone should not cause any problem. There is a tiny risk that it could cause an infection and later need to be removed, but there is a much greater risk, in this situation, associated with trying to remove it now, while there is an opening directly into your sinus.

I hope that is helpful. Anyway, it’s not really a serious situation, but somewhat of an inconvenience. Pretty much all you should have to do is be careful not to create any pressure in your nose and then wait for this to heal itself. I had a couple of these happen when I did tooth extractions, I covered the perforations, and they healed without incident.

Dr. Hall

Links: Please read more about the dangers of tooth extraction and post-operative care on our tooth extraction page.
Read about wisdom teeth removal.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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