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 possible complications 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 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.
I had a upper tooth pulled out, causing a sinus problems the very next day. I had three catscans, that showed nothing. I would like MRI, but doctors and specialist say no. Do MRI’S show more than catscans? IF so, why can’t I GET ONE! This been going on for more then three years. I live in Simcoe Ontario Canada.
Response by Dr. Hall:
William,
I don’t know enough about what MRIs show to answer your question, but I can tell you that I have never heard of an MRI being used in a dental situation.
You could have very easily had a sinus perforation from the extraction of an upper tooth, and that would cause sinus problems. But if you’re very gentle in blowing your nose, in most cases that will clear up on its own and the bone will fill in. So I’m not sure what you’re saying with “this has been going on for three years.”
I just have a question. I gently had an implant removed. The dentist didn’t put any gelfoam or cadaver bone in the area. Can it still be put in the area of the implant?
Response by Dr. Hall –
Linda, I don’t understand your question. Did you have a sinus perforation when you had an implant removed? And then no gelfoam was used? Is that what you are saying? Placing cadaver bone (basically a bone graft) is another way to help close the hole quickly.
The gelfoam isn’t absolutely essential, it just accelerates the healing. And it doesn’t have to be placed at the time of the original surgery–it can be placed in a follow-up appointment at any time before the perforation has healed. If there is enough soft tissue to stretch over the hole, what I would do is separate some of the overlying soft tissue around the socket from the bone–do that on two sides. Then I would place gelfoam into the socket and stretch the soft tissue over the socket and suture it together. Then I would ask you to not blow your nose for a few days, so it has a chance to heal.
– Dr. Hall
Dear Dr Hall, Thank you for your comments regarding sinus perforation in response to ‘Autumn of Oregon’. I had a tooth out last week which perforated the sinus. I went back to the dentist today as I still have an infection. I shall have the stitches out next week and hopefully it will then just be a matter of time. The information you provided meant that I could understand the implications of what had happened to me and enabled me to systematically question the dentist about it today. Thank you very much!
Kind Regards, from Wales, UK
Response by Dr. Hall,
Thank you, Tim, for your kind words.
I have a question. I had all my teeth pulled upper and lower and ended up with two sinus perforations on right side well had those sewn up by dentist but now about oh about a week later my right nostril has been completely plugged for going on three days and is leaking perfectly clear fluid. I have tried cold, sinus and allergy meds. I have tried steam and salt water rinse but nothing works the only slight relief is when I hold the nostril open but I can’t do that all day. Now my face is starting to hurt there. I also have been taking antibiotics since getting the holes sewn shut too. What is this?
Response by Dr. Hall:
Courtney,
This question is worth a separate post. I’ve answered it here: Complications after a sinus perforation
I started flushing out my sinus with sea salt and baking soda, after 4 weeks of agony and nothing, OTC, worked. Saw immediate relief, continued for 3 days doing 3 flushes a day. Cut down to 1 flush a day but still had yellow/green discharge out of right side. Started flushing out with peroxide on that side and other than a more pronounced burning and pressure around eye, I also had peroxide bubbles coming out of my right eye socket. Note I have on occasion had air bubbles coming from same eye when I blew my nose for at least 10 yrs. Also have sinus issues for the last 15 yrs. Last year I had an abscess from a seemingly healthy molar. Nothing since.
– B Johnson
Comment by Dr. Hall:
So you’re trying to treat a sinus infection with peroxide–not too smart. I’m trying to visualize these peroxide bubbles coming out of your eye socket. Uggh, how awful! Johnson, you’re a great illustration of the value in seeking professional care rather than trying to solve these problems on your own. You need a dentist–though I doubt you’re going to listen to my advice.
Had a tooth pulled in Jan. sinus started draining like crazy accompanied by foul odor. Dentist denies responsibility and says go to ENT. My insurance doesn’t cover ENT visits or MRI’s and that kind of thing. (Thanks Obama) anyway I have been having to live on Claritin D and over the counter nose sprays for 6 months. And as far as I can tell its the same as it was the day it happened. I have had sinus infections, cold chills where I cant warm up, My right eye was swollen shut one day, a steroid shot helped for like 2 days, I have been on 4 different types of antibiotics. Anyway I am running out of money for Doctors visits. If any one has suffered the same thing and then been cured I would like to know what they did and if not how long will it take for the sinus puncture to heal own its own?
– Tim Hebert
Response by Dr. Hall:
This isn’t going to heal until you get the infection under control.
I would want to address your first point, that your dentist denies responsibility. I would get a second opinion on that from another dentist–maybe an oral surgeon. If this sinus infection was caused by the extraction, it may be that this complication was unavoidable, but your dentist would still have an obligation to see that you get proper follow-up care. He or she can’t simply wash their hands of it and say “go to the ENT.” Having said that, the ENT (ear, nose, and throat physician or otorhinolaryngologist) would be the proper specialist for this situation.
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).
Nicole had such a good question that Dr. Hall decided to make it a separate blog post. Read the rest of Nicole’s question and Dr. Hall’s answer here: Sinus infection after tooth extraction.
Hello Dr. Hall,
My mother recently had sinus surgery because her dentist said he would not be able to extract her tooth without this being done. There was some infection in her sinus. But now the dentist says he can’t treat her because the root enters into the sinus. Now my mother is stuck with this horrible tooth ache and has to find someone who can help before the situation worsens. Can you please point us in the right direction and offer your advice on what we should do.
Thank you,
Tony Davis
Comment by Dr. Hall:
Tony,
That’s strange, that the dentist would do that! Sounds kind of like a bait and switch.
I would just call around and ask oral surgeons. They specialize in extractions that have complications, and I’m sure you could find an oral surgeon who would be willing to tackle this.
Dr Hall,
Thank you for your advice. We called and found an oral surgeon who could treat her. My mom had the tooth removed and is still in pain because of the extraction but not as much pain than with the rotten wisdom tooth. I’m pretty sure the extraction pain will go away with time. Thank you so much for your help.
Tony Davis
Hi Dr. Hall,
About 10 days ago I had all 4 wisdom teeth extracted (all bony impacts). 3 days ago I had my recheck where the surgeon explained how to flush the sockets and said all was going well . . . When flushing directly into the socket, I sometimes feel a pressure on the left side of my nose . . .
I felt that this comment by Kayla deserved a blog post of its own. You can read the entire question and Dr. Hall’s answer here: Pressure in my nose after getting my wisdom teeth out.
I had a right molar extraction six months ago, and think I have a perforated sinus; molar area is very tender can’t eat on right side, if I do I get throbbing in all my top teeth . . .
– Cynthia
from Dr. Hall:
I decided to dedicate a separate blog post to Cynthia’s question: Is this allergies or a sinus perforation?
Hello, Dr. Hall. I had a sinus perforation fixed 7 days ago, with a bone graft on an upper middle tooth that was extracted a couple years ago. I’ve had sinus issues on this side for years, so I’m happy the problem is “fixed”. However, I’ve had a condition that makes me very sensitive to pain & I was recently diagnosed with another condition that makes me very sensitive to pain, and prolonged healing times. Seven days out and I still have moderate to intense pain & swelling in most of the left side of my face and jaw. I was back for a re-check on the fifth day, and Dr. said everything looked fine. Is this normal, even with clindamycin & NSAIDs? How long should I expect until the pain reduces by half? Thank you.
– Andy G.
Response by Dr. Hall,
Andy, I wish I could be helpful for you, but there are limitations to what I can diagnose remotely. I don’t know what this condition is that makes you more sensitive to pain—you didn’t say—and am not following what was done to you. I would get back with your treating dentist for answers.
– Dr. Hall
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 my upper wisdom tooth, my sinus was perforated. . . .
Response by Dr. Hall – this question needs its own post, so I’m going to transfer it to the Ask the Dentist form that is designed for that purpose, and then answer it as a blog post, which you can find here.
Dear Dr Hall,
Thank you for this valuable post! My sinus was perforated following my wisdom tooth extraction. The puncture was quite large but it has been plugged with gelfoam and stitched over today. I am due to fly to South Africa in 9 days – does that give me enough time for it to sufficiently heal or would you recommend cancelling the trip?
Cheers
Chris
Response by Dr. Hall:
Chris,
Nine days seems like enough time for this to heal over, so I wouldn’t cancel the trip. Besides, I don’t think traveling would have an impact on this healing.
Dr. Hall, thank you for answering our questions, so glad I found you. I have had 8 teeth pulled on the upper teeth. I have air exchange from all of them. The Dr. called them perforations. I am scared to death, feeling all of this air swishing thru my mouth. Two teeth, it has been 7 weeks, and I still feel the air exchange. I had 6 more pulled, and the same thing for them all. Will this clear up on its own? I have been told very little on what to do for this. I am a diabetic and I worry for this reason also. Is the treatment expensive? I am only on Medicare and no dental insurance. I have my teeth done at a free dental clinic, but they mentioned sending me to a dental surgeon if this persists. Thank you for considering any answers. – Barb Tignor
Barb,
Since you had this done at a free dental clinic, that sounds fair to not expect them to follow up on this for free, and I would agree with their advice. Eventually I would expect this to clear up and it will do so more readily if you avoid blowing your nose. But if it doesn’t, you will need a dental surgeon to help you.
You say it has been seven weeks so far. I would have expected this to heal by now, but maybe the perforations were large. This case goes beyond my experience, but knowing how the body reacts to extractions, it seems reasonable to expect the openings to be gradually closing. Give it as much time as your patience will allow.
– Dr. Hall
Hi Dr. Hall,
My question is about the impact of a sinus perforation, removal of an implant, and antibiotics. . . .
Kelly’s question, I feel, deserves its own blog post, so I created a post about a sinus perforation from a dental implant. Click the link to read it.
Hey! I recently had a broken tooth pulled. It was my upper molar #15. A few days after having it pulled I was having more pain and noticed I could feel air coming through it! I’m following up with the dentist but I’m concerned as how it will be fixed as I am currently 15 weeks pregnant. Also concerned about chance of infection as it will not be good for me or the baby. Is there a safe way they fix this for pregnant women? – Kayti
Response from Dr. Hall:
Kayti – It helps that you’re in your middle trimester when routine dental work is considered the safest for you and the baby. But even so, closing a sinus perforation is a pretty easy, atraumatic procedure that might require only a little novocain in the gum tissue, if that. Much easier than the tooth extraction was in the first place. It could even be left alone and just by avoiding any blowing of your nose it should heal on its own in time. Many dentists want to prescribe decongestants, but those aren’t necessary.
Dr.Hall,
I had a tooth extraction 9 days ago and my sinus was perforated.
My question is how long will it take to heal?
I have no pain just annoying air from my sinus to my mouth.
My dentist packed it with gel foam and 7 sutures.
Thank you Dr.
– Joe
Response from Dr. Hall,
Joe – not enough information here for me to give you an answer. It depends on the size of the perforation, whether or not it was closed with soft tissue, and other factors.
Meanwhile, don’t do anything like blowing your nose that will cause air to pass through the perforation. If you keep doing that, it will never heal.
I am 85 years old. Had a molar removed 4 weeks ago. Dentist said the root was in the sinus cavity. Since then horrible taste and smell. Smells like rotten fish. Going back to see dentist who removed tooth for check up. When you eat the food tastes rotten.
Cheryl had a question that I decided to answer in a separate blog post. She had a sinus perforation about six weeks ago and asked if it was too late for the standard sinus perforation treatment protocol. Click the link to read her question in full and my answer.
I had a molar extracted in and had a sinus perforation.
Nearly 6 months ago I had the furthest back upper tooth on each side extracted by an oral surgeon because both teeth were worn and extremely sensitive, and both sides had roots curled into the sinus cavities.
For the first 3 or 4 months disgusting snot was draining into my mouth on the right side. I was on antibiotics for 60 days – the surgeon suspected a sinus infection’s pressure was forcing the leakage into my mouth, because the hole was tiny. There’s no more excessive drainage- just a bad taste, and the throbbing on the right side of my face, constant congestion, and tenderness between my eye and upper nose. I’m using otc meds, nasal spray, and netti pot maybe 3x/wk. I’ve been back for three followups, and the last time was over 2 months ago when he said if it’s not closed he’ll have to do surgery pulling cheek fat between the sinus and gums. Just the thought freaks me out, and it seems there are other alternatives? I worry about my face visually showing a difference on one side, like not symmetric. Plus I have ptsd about med procedures so I wondered about the surest fix? The last couple months I have been blowing my nose slightly with no change. Whatever comes out of my left side is always clear. The right side is always brown.
– Anne
Response by Dr. Hall:
Anne,
I can’t tell enough from what you’re telling me to know how to advise you. A couple of things, though. The antibiotics, if they’re the right ones, should clear up your sinus infection within a couple of weeks, max. And about the surgery, I can’t imagine that would affect your appearance. I’m having trouble understanding the surgical procedure that is being contemplated. Pulling cheek fat between the sinus and gums??? The sinus isn’t next to the gums, and neither one of those is next to your cheek. So I don’t understand what is going on here at all.
I had my upper teeth extracted a year ago. And I still have a hole in my gum that leads to my sinus it also has a hole. What can I do to fix this? My dentist pulled my teeth and I never wanna go back but I can’t get anyone that will fix the hole in my gum and my sinus because they didn’t do it. Please help.
– Denise
Response by Dr. Hall:
Denise,
I’m not understanding why dentists are telling you that they don’t want to fix this problem because they didn’t cause it. Dentists are always fixing problems that they didn’t cause. Are you asking them to do it for free? Any oral surgeon should be willing to do this for you, and you should expect to pay for it. You need to get this fixed.