Hello Dr Hall,
First off I would like to thank you for sharing your time and knowledge. Today I had 12 teeth extracted. Upon removal of an upper molar, my sinus was perforated. The dentist put a compound in to increase blood clotting. Immediately I was able to breath quite easily through the perforation. Will a perforation allowing air through easily heal properly? I was prescribed a 10-day antibiotic to help prevent infection. I am also not currently experiencing any real pain or discomfort. Kinda strange while normal at rest breathing I feel the air in my mouth. I am currently using gauze to apply pressure although I have no bleeding. Any information you can offer will be greatly appreciated. Thank you for your time.
– Robert L.
(see Dr. Hall’s response below)
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I don’t want to paint myself as the country’s greatest expert on sinus perforations, though I’m getting a lot of questions on this. I had only had this happen to my patients a handful of times as I was practicing, and I followed the procedure I was taught. I packed the socket with gelfoam—a resorbable sponge that assisted in the retention of the blood clot and its conversion into replacement bone, and then I pulled some of the tissue around the tooth I had extracted. This tissue becomes loose when the tooth is gone and it was easy to pull that over the extraction site and suture it down to close it over. Then I advised each patient not to blow their noses for a few days. The cases healed in a few days and without complications. Bone grafting materials are now readily accessible to oral surgeons, and they can be used to accelerate the creation of new bone—which is the goal here—to re-create a layer of bone between the teeth socket and the sinus.
What I was taught was to eliminate that air passageway between the mouth and the nose so that the perforation would heal. Now you’re telling me that you have a hole in that perforation that hasn’t really been closed. Will it heal? I’m guessing that eventually it will, but I’m not entirely sure, and it could take quite a long time. But meanwhile you have a situation susceptible to infection and every time air goes through the hole it’s going to want to open that hole a little more—not how I was taught and it seems to me a recipe for very slow healing. Plus what do you do when you’re eating peas and they get up into your nose? :-). I know some kids who would love that, but that can’t be how this is supposed to work.
What to do? I would ask for a referral to an oral surgeon to close this. The future health of your mouth including the ability to plant implants to replace the teeth requires a good thick foundation of bone to work with here and that will be enhanced by proper healing of this sinus perforation.
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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.
Robert L says
I am very pleased to say that my sinus perforation has healed in about 5 days. I avoided anything that could cause pressure. I kept communication to a minimal. I only ate food I could swallow with my mouth open by tilting my head back and allowing majority of the work to be provided by gravity. I am very fortunate that my sinus did not ever feel inflamed or irritated so I didn’t need to use any decongestants. I intend on remaining on the liquid diet and silly method of swallowing for a few days still to give it the best chance possible. I also noticed that I had perceived feeling a little better after waking up from sleep. I was only sleeping a few hours here and there so I made a effort to sleep more. Rest seemed to have the biggest effect on healing things up quickly. I am really quite surprised at the healing rate once I allowed myself time to rest. I did also notice if I added a extra pillow while laying down it reduced the amount of air travel between the sinus and mouth.
Once again I appreciate you taking the time and allowing me the opportunity to share my story. I read quite a few blogs and message boards that had very bad information and/or advice. I read of people using Listerine which seemed like a bad idea to me because of the alcohol content. I even found a post where the individual suggested using a needle to aggregate the tissue to encourage bleeding as to better form a clot! I cannot advise enough that people DO Not ever disturb tissue that it trying to heal. I was terrified about my situation but stay calm, give it time and if it doesn’t heal in the suggested time frame, then consult a professional. Reading through all the material online, I also found that people lost trust in their dentist after having their sinus breached and would take to peer based boards for advice. I would like to add that your dentist is not necessarily a villain who did this to you. These things happen and when they do happen, trust your dentist and follow their advice. If you do feel that your dentist may of given you bad advice, then seek advice from another dentist and not from peer based forums. This blog was a great stone for me because it offers advice from a person qualified to give it. Having a qualified and educated on the matter individual give advice or point you into the right direction is a great asset to help people on their way to seeking true relief and recovery. I know my post and short experience here truly helped me step outside my frantic self so that I could take a realistic look at what I was trying to accomplish and a honest look at what I needed to do. So as a final note, Thank you Dr. Hall for sharing your time and knowledge to help people make better informed decisions.
– Robert L.