Your leading source for cosmetic dentistry
information and referrals.

Is it too late to treat my sinus perforation?

Posted on by .

Hi, Dr. Hall,
I had a tooth removed about 6 weeks ago. My dentist told me that he could see right into my sinuses. Rt upper sinus perforation. He put me on a week’s worth of antibiotics. That was all. Nothing more than general post-extraction protocol. I also had 2 other teeth pulled. They have healed fine. But this one with the sinus perforation has not even closed yet. It feels like there is still a deep hole there. I have had several rounds of antibiotics from my GP for sinus infection. It didn’t help that I have a horrible headache everyday and a fever, not too high around 99.2 to 99.8. My question is … is it too late for him to follow the preferred sinus perforation protocol to fix this or am I headed to an oral surgeon or the ENT? Thanks so much,
Cheryl
 


We thank our advertisers who help fund this site.

Cheryl
It sounds like you have had a persistent sinus infection ever since this extraction with the sinus perforation. With this extraction being six weeks ago, the perforation should have healed. The fact that it hasn’t makes me worried that there is a root tip of the tooth or a bone fragment or some other foreign object pushed up into your sinus. Have you had an x-ray of your sinus to see what is going on there? If I were in your shoes, I would seek a referral to an otorhinolaryngologist (ear, nose, and throat physician) to check for that possibility and to provide proper care for this perforation. Had your dentist known how to take care of this incident, you wouldn’t be in your current situation. The sinus should be checked for any foreign objects. If present, they should be removed. That’s the tricky part of this. Then the hole should be closed. That’s the simpler part. After that, a course of antibiotics of about ten days should clear this up for you.
If there is indeed a tooth or bone fragment in your sinus, you are probably better off that your dentist didn’t close the hole.

Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

Is this allergies or a perforated sinus?

Posted on by .


We thank our advertisers who help fund this site.

Dr. Hall,
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, I can smile the after taste of my food, sinus headaches, my nose feels like water went into it in a bad way, burning my nose and I have some leaking out of my right nostril. All this time I just thought it was allergies, but when I drink or eat someone with a lot of liquid, it goes up my nose causing burning and draining in my right mistral. I was thinking that yes by now the perforation should be closed. It’s such a discomfort. I do have allergies and get sinus infection but this is very different?
Can this still be fixed?
– Cynthia

Cynthia,
I really doubt that this could be a sinus perforation, after all this time. Surely the socket has healed over by now. I’m not saying it’s impossible, but it seems highly unlikely to me. The liquid getting into your nose could be through the back of your mouth where there is a passageway from your windpipe up to your nose.

I would check you for a garden variety sinus infection–or it could be allergies as you have suspected. As we have said, the roots of your upper back teeth can be very close to the sinus wall, so any pressure in the sinus may manifest itself as pain in the teeth.

I would have it checked, and, since I think it is more likely that it is just a sinus problem, I would go to an ear, nose, and throat physician (otorhinolaryngologist). One thing you could do at home: close your mouth and try to blow through your mouth, puffing out your cheeks. If you can do that and hold the air in your mouth, there is no perforation. If there’s a perforation, air will bubble up through your nose.
– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

Sinus infection after extraction

Posted on by .


We thank our advertisers who help fund this site.

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

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

Complications following a sinus perforation

Posted on by .


We thank our advertisers who help fund this site.

Dr. Hall,
I have a question. I had all my teeth pulled upper and lower and ended up with two sinus perforations on right side. My dentist sewed those up but now 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?
– Courtney K.

Courtney,
I would go back to your dentist and ask for a referral to an ear, nose, and throat specialist (otorhinolaryngologist). There are several things that could be going wrong here. There is some lingering infection in your sinus. It could be that you just have some antibiotic-resistant bacteria involved and you just need to change antibiotics. It could be that with the sinus perforation a piece of bone or a tooth fragment got pushed up into the sinus and needs to be removed. Or it could be something else. I would get this addressed promptly, as it sounds like the infection is progressing.

From the sounds of what you are telling me, your dentist has done the right thing so far. A sinus perforation can happen very easily after a tooth extraction and can sometimes be unavoidable. If it can be closed surgically, which is what it sounds like your dentist did, that is helpful, and antibiotics are appropriate. But you’re at the boundary here between dentistry and medicine when you get up into the nasal sinuses, and I think the added expertise of a medical doctor specializing in this area of the body is what you need when your infection hasn’t resolved.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

Categories

Follow this blog

Get every new post delivered right to your inbox.