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.

Nicole,
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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