I have found a lot of online health forums but have never encountered one with a member like Bryanna who is so helpful, clear, and straightforward. Wow!

I am posting here, though, because I'd like some advice from her, or anyone, on what to do for my dental and sinus issues that seem to be progressively worse, especially what seems to be a sinus issue directly related to my upper teeth problems.

As a kid, my parents taught me to brush at night and that was it. Everything seemed fine until my late twenties (I am 28 now) when lots of problems came up, probably from the accumulated poor hygiene. I have had a couple cavities filled, and one root canal performed on a lower left molar. I also just recently had two root canals done on one upper and one lower right molar. I have changed my habits and now brush after each big meal and floss.

The upper left side of my teeth is much worse though, as tooth 15 has a quarter of the side cracked off. Tooth 14 has significant deep decay where more than half of the tooth has decayed or cracked off. The roots are still there, but the missing tooth structure also includes a little below the gumline. My dentist says that #15 needs a root canal and a crown, while #14 needs to be removed.

I am hesitant to get tooth 14 removed because of fears of bone loss at that area and the adjacent teeth shifting. The biggest concern though is that the roots of the teeth are very close to my sinuses, and I fear that an extraction would result in additional sinus issues or surgery.

For a few weeks now, when I gently blow my nose, every once in a few days, there will be a small speck or streak of dried blood in the mucus blown out. It doesn't happen every time, but once a week or so.

Yesterday, I had sinus allergy sypmtoms (runny nose, sneezing, itchy eyes). When I blow my nose, I can feel pressure in my ears and sounds of clicking or motion. My ears felt moist, so I used a Q-tip to gently clean my left ear. The Q-tip had a small patch of blood, a little dried, as well.

I have an appointment with my dentist in about two weeks.

I suspect what is happening now is that the root or infection from the root of my upper left teeth has penetrated or perforated my sinuses and caused the sinus problems I've been having. Or problems in my upper left teeth are irritating the sinuses. Does this sound about right? Does this explain the blood when blowing my nose and in my ear? Do I need antiobiotics in the meantime? Should I go see my primary care physician as well to get a blood test to test for blood infection?
Will an Xray at my dentist see what's going on with the sinuses?

Thanks very much!

Hi dknight,

Thank you for the kind words! My intention is to give as much information as possible to help others become better informed.

Many people do not realize that tooth decay is actually an infection. Lingering tooth infections can progress into the gum, jawbone and/or the sinuses. Sometimes a tooth infection will be very painful and become very swollen. Other times a piece of the tooth breaks creating an opening for the release of pressure from the infection. Both situations require attention as soon as possible.

Infections of the sinus can become chronic, especially if the infected tooth remains in the mouth. Root canals do not cure infection for many reasons, one being the inability to gain access to the microscopic canals which will continue to harbor infected, necrotic tissue. The longer an infected tooth is present, the more bone loss will occur which can make replacement options for that tooth very limited.

The blood in your nasal mucus can be attributed to a sinus infection and/or dry nasal passages caused by allergies. The blood from your ear can be from an infection or even a scratch in your ear. An ENT dr may be able to evaluate and diagnose the origin of the blood.

A dental xray called a panorex as well as a digital periapical xray can show to some degree, the extent of the tooth infection and if it has penetrated the sinus.

It is always wise to review your treatment options with your dentist before having a root canal on any tooth. All root canal teeth harbor necrotic bacteria which can cause or contribute to systemic health problems. With regard to tooth replacement options, it is always advantageous to remove the infected tooth before the jawbone or sinus becomes infected.

I hope this information helps....let me know if you have any other questions.

Bryanna

Thanks Bryanna!

Last week, I went to the my dentist appointment, and my dentist said he wanted to take a closer look at tooth #14, which is the one that is very decayed and with more than half of the tooth decayed down to the root canals. He used a waterlase to remove gum tissue around the tooth because he said gum tissue had grown thick around it. After removing the gum tissue and looking at the tooth, he said that he might be able to save it with a root canal and crown, but that the diagnosis would be "guarded". Since I always want to save a tooth if possible, I agreed that we should do the root canal and crown for tooth #14.

Yesterday, I had the root canal done on both #15 and #14, but had a strange experience with tooth #14 during the root canal. Both teeth were very numb and I did not feel any of the drilling or other work on the teeth. However, when the dentist got to tooth #14 and used the files to shape and clean out the canals, I "felt" the poking of the file in sinuses. It was a very strange feeling since I was already numb there and the pain seemed like it was in the sinuses.

Also, in my previous post, I described severe sinus infections which I felt were directly caused by an infection in the #14 and #15 teeth. This make me wonder:

Is it possible that the roots of my #14 tooth are practically in the sinus, causing the pain and weird feeling during the root canal? Also, the root canal has been finished and the gutta percha has been placed inside the root canal. For just tooth #14, it feels like something is stuck inside the tooth and poking into the sinus (a strange feeling), whereas tooth #15 doesn't have this feeling.

On the xray right after the root canal, it shows the gutta percha right up to the end of the roots' end.

If it indeed the root of the tooth has pushed into the sinus, would the sinus heal around the root canal and "stablize"?

Or perhaps infection at the end of the roots of tooth #14 is causing this weird feeling during and after the root canal?

Thanks!

I have also been reading the other NeuroTalk thread titled "tooth extraction when root is in sinus cavity" which Bryanna has provided a ton of information and may be closely related to what I'm experiencing.

Any additional thoughts on what I described earlier is also appreciated!

Hi dknight,

It is not surprising or unusual for you to be having a problem with tooth #14 after the root canal procedure. The reason being is number one, this tooth from your own description was in very bad condition and would still remain in "guarded" condition even after the crown lenghthening, the root canal and crown were done. Which unfortunately means the only thing you are trying to save is a chronically sick tooth. Perhaps your dentist should have made that fact clearer to you. Secondly, from your description of the root canal procedure, the apex (end of the root) was perforated during the procedure with one of the sharp files. When that occurs, it doesn't matter if the gutta percha material was then pushed through this opening or not because once the apex is perforated, the bacteria on the file as well as the medicaments used to debride the interior of the canals exit this opening into the jawbone (and possibly the sinus in your case) which causes the area surrounding the root tip to become inflamed. Eventually a secondary infection develops and depending on the individual, you may not have definitive symptoms from the infection until you develop a fistula (pimple on the gum above the tooth acts as a pressure release) or a large swelling.

From your description of the condition of these two teeth as well as your chronic sinus infections, I believe that your teeth may have infected your sinuses in the first place. Since root canal therapy does not "cure" or remove the infection within the dentin tubules, both teeth remain infected. So as I said earlier, the only thing you have "saved" is two infected teeth.

It is very unfair to the patient for any dentist to misuse the words "cure" or "save" as in "making well" when describing root canal therapy since the procedure is not capable of doing either of those things. BOTH of those words in dental terms simply mean "retain".

The end of the root of #14 has not moved. It is exactly where it was prior to the root canal procedure. So that is not your case at all. If it was near your sinuses to begin with, it is still that way ... however, if the sinus wall was in close proximity, then it could have been perforated as I explained earlier.

Please understand.... it is not just the root of the tooth is not infected. It is the tooth/teeth in their entirety. The infection grows from the bacteria inside the tooth proliferating through the apex into the jawbone. A cyst eventually forms at the end of the apex in the jaw which can be seen on an xray.

I know this is not what you wanted to hear... I am sorry to have to tell you this... but it's what your dentist should have told you at the onset.

Please come back and share your thoughts on this.....

Bryanna