Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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.

1 Comment »

  1. I had all my top teeth pulled 2 weeks ago. The extraction of one molar caused a sinus perforation (this was not told to me until the following day, nor did they go over this could happen prior). On day 4 I told them I had popping and cracking on the left side in my nose. I was told to take Sudafed, which I did for several days. That same night I started with a high fever (101-102) & contacted them the next day. They called me in antibiotics which I began immediately. Over the next 3 days my fever didn’t get any better. I also got a really bad pain in my left side to behind my eye. I went back on 7th the day and had a large piece of bone removed and smaller pieces. The infection could be seen in the back 2 sockets as green slime and I felt horrible. I was given a stronger antibiotic. I went back on day 11 because I still had infection. When I gargle with salt water, it makes a foamy green slime come out left nostril only seemingly for days. It smells like it’s burnt and is very disgusting. They finally called an oral surgeon and we’re told I need to see an ENT doctor. I feel like the meds aren’t working and am worried this is a bigger deal than they’re making it.

    Response by Dr. Hall:
    Lyndi,
    I believe, from what you’ve told me, that your dentist made some mistakes here and has been slow to catch on to the seriousness of what has been happening, but referring you to the oral surgeon who is sending you to the ENT specialist was the right thing to do, and it sounds like things are getting on the right track.
    Yes, they should have given you a list of possible complications of the extractions before you ever had anything done, and that list should have included the possibility of a sinus perforation. And then when it happened, they should have told you that on the day of the surgery and done something to begin treating it. I also don’t know what they expected Sudafed to do. I indicated in the original blog post above the proper treatment of a sinus perforation, and that doesn’t include Sudafed. Starting out with the wrong antibiotic is typical of what many dentists do, unfortunately, and if you’re still not on the right antibiotic, the ENT doctor should be able to fix that.
    With the infection that has followed, I suspect that some bone or a tooth fragment was pushed up into the sinus. If that is what happened, the ENT should be able to also fix that.
    I really believe that the original dentist could get in legal trouble from this. I don’t think it’s necessary for you to make any trouble for them, but if I were you, I would definitely insist that he or she cover all your expenses with the oral surgeon and the ENT doctor as a condition for your not making any trouble for them over this.
    Dr. Hall

    Comment by Lyndi — August 6, 2016 @ 8:40 am

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