Hi Suzqwalk,

Thank you for sharing pertinent information and being honest about the smoking. Yes, it sounds like you have a perforated sinus. The smoking irrelevant of placing the gauze or not, is preventing the sinus membrane from closing.

The smoking... it does not matter if you smoke one cigarette or 20 cigarettes a day.... with each drag you reopen the membrane and inhale chemicals up into the sinus. You should also know that the sinus is only 3-4 inches away from your brain. Everyone knows that smoking is bad for your health but did you know that cigarette smoke contains over 4000 chemicals, 43 or more of those are carcinogenic (cause cancer) and 400 additional ones are known toxins? Cigarettes contain nicotine, tar, carbon monoxide, formaldehyde, ammonia, hydrogen cyanide, arsenic and DDT to name just a few. Please consider the health risks of smoking and please take measures to stop.

The gauze.... covering the site with gauze when you smoke is not preventing the smoke or chemicals from entering the socket or the sinus. The gauze actually holds onto all of that and bathes the area in it. So the gauze is not acting preventatively as I think you assume it is. This is not a lecture, this is me offering you honest information that I guess no one else has.

The attitude of your dentist is unacceptable and I am not giving him an excuse for acting like that. But most likely the reason he may have this attitude is because you smoke and he knows he cannot help you if you continue to smoke. He should be educating you about it like I am rather than patronizing you. FYI.... even if you didn't tell him you smoke, he knows by the odor of your breath, the stain on your teeth, palate and tongue and the discoloration of the gum tissue. All of which may not be evident to you but it is clinically.

If you continue to smoke either the sinus will not close or it can take months to close or it might just partially close. Usually in people who smoke the gum tissue doesn't close completely either and all there has to be is a pin hole size opening in the gum tissue and bacteria from the mouth will continually get up into the sinus which can cause chronic sinus infections and worse. If you stop smoking, you will get a healthy mad rush of red blood cells as the oxygen comes back to the oral tissue and the area will start to heal on its own. You may find that your gums bleed when you stop smoking, this is due to the influx of red blood cells. It is imperative to keep your mouth clean with thorough tooth brushing and flossing to keep the plaque to a minimum.

Just for clarification.... Do you have regular dental care? Or do you only see a dentist when you have a problem?