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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