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Hi Dr. Hall;
I really like your clear advice. I had an upper molar on the right removed two weeks ago, and my dentist showed me on the X-rays where the root went into the sinus. (It was an old root canal tooth that was redone two years ago by an endodontist due to infection at the root tip. It was finally so consistently painful that I had it removed). When he removed the tooth my dentist told me there was infection in the root that went into the sinus. He cleaned the sockets and filled the holes with bone graft and used stitches – which have now been removed. He put me on a course of clindamyacin antibiotics 150mg for a week. In this time I have been extremely careful to not blow my nose, rinse gently, and brush gently with a soft tooth brush when I got the okay from my dentist. All was going really well. I’ve been off the antibiotics for a week and this morning I started having sinus drainage on that side, pressure and some pain in my face and gum. I took an oral decongestant, but it hasn’t made any difference in the pressure sensation. Do you think I should call my dentist and ask for more or different antibiotics? Are these kinds of sensations normal in the healing process of a tooth extraction with the root in the sinus? I’m concerned that if there is still infection in the sinus from the tooth, that it might affect the bone graft.
Thanks for your help.
– Nicole L.
It sounds like your dentist did everything right, and I appreciate the clear explanation you have given of your history.
The roots of upper molars can lie very close to the maxillary sinus. Sometimes the only thing separating them from the sinus is a thin membrane which would naturally be ruptured during a tooth extraction, causing a sinus perforation. When this happens, the appropriate treatment is to surgically close the perforation. This can be done with a surgical gelatin sponge material called gelfoam, or with bone grafting material as your dentist did, followed by suturing over the opening. Then you need to be gentle with it for a period of time to allow the body to heal over the opening. You did all that. Antibiotics would be called for if there is any infection present, and clindamycin is an excellent choice in this situation.
You do need to get back to your dentist to see why you are having this relapse of the infection. It could be that you just need to get back onto the clindamycin for a longer period of time, or you may need to switch antibiotics.
It is possible that some bone fragment got pushed up into your sinus and will need to be surgically removed in order for this to completely heal. If you take the antibiotics and it gets completely better and you continue the antibiotics for several days after that, and the infection returns again, I would have your dentist refer you to an otorhinolaryngologist (ear, nose, and throat specialist) for an x-ray to see if there is anything like that going on here.
– Dr. Hall
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.
This is good to know. My sinus lining often is visible in dental X-rays just above my roots.
Something similar happened to my cousin when she had wisdom teeth extracted. Is this common?
Response by Dr. Hall:
It’s not rare, but it’s not common. For the hundreds of upper molar extractions I did over 20-some years in my practice, I think I had a sinus perforation maybe half a dozen times.
Would you have to see an oral surgeon for something like this? Or can any dentist take care of a sinuses?
Response by Dr. Hall:
If it’s a matter of prescribing the antibiotic, many dentists would be fine doing that, though I must say that there are many dentists whose antibiotic repertoire doesn’t extend much past penicillin, amoxicillin, and erythromycin, and they wouldn’t know what to prescribe for a sinus infection.
If a fragment of anything has been displaced into the sinus, I would refer that to an otorhinolaryngologist (ear, nose, and throat physician).
Hi, I had a top molar removed on Wednesday am, 2 days after finishing antibiotic Flagyl for an infection, X-ray showed I have a low lying sinus and during extraction root snapped and was fully removed with bone (had X-ray after to confirm) . Anyhow The sinus was perforated at time, confirmed on nose blowing test. As far as I know it wasn’t packed after, I was given Augmentin and Diclac and advised not to sneeze or blow nose. I am 3 days in and still have air escaping via the hole in gum, it’s a horrible sensation. How long should this last, should I go back to dentist, should it have been packed or stitched. I’m afraid it didn’t clot/block immediately and now won’t.
Was ok when I didn’t speak home alone for day, but then back to square one.
Am I not giving it enough time or should I get it packed.
PS I’m a non smoker.
Response by Dr. Hall
I’m trying to read between the lines here, but I have a hunch that your dentist may not be that good at this sort of thing. I’m basing that on that he didn’t immediately suspect a sinus perforation and test you on the spot. I had some sinus perforations during my practice, but I always knew before the patient was dismissed. The pre-operative x-ray shows the sinus on top of the root. Then, during the extraction, you see bone come out with the root and then you look down in the hole, get suspicious, and ask the patient to plug their nose and try gently to blow out through the nose. The socket bubbles, and you know. They’re still numb then, and it is not that hard to fix it on the spot.
Yes, while I can’t be sure without seeing this myself, it sounds like the natural healing approach isn’t working and the hole should be closed surgically. I would ask your dentist if he/she feels comfortable treating this and if not, if they could refer you to someone who does.