Yes, a complete perforation can occur or seem to occur a few weeks after the extraction of the tooth. These things are not always picked up right away which could lead to a late diagnosis. Also, the wall of the sinus membrane can be very fragile and close to being perfored after the extraction. Bacteria, inflammation, sneezing, nose blowing... could then cause the fragile membrane to perforate through. Again, this could occur sometime after the extraction during the initial healing phase.

Most of the time sinus perforations heal on their own. Some people have bothersome symptoms for weeks... while others say they have no symptoms. Some people think their symptoms are normal and ignore them...... every one is different. I've already had patients fail to come in for their post op checks.... only to see them a few months later and inform them that their extraction site is still open and they have a sinus perforation. I mean they had no idea it had not healed closed. I know that seems odd.... but I cannot count how many times that has happened and usually these patients are smokers.

I got my x rays but i don't know how to post them here.

I hope I posted the x raysX0443011.JPG

X0443044.JPG

One more x ray, I don't know when these before ones where taken, they are not new, but the OS didn't take any before the extraction

Attached Images

X0443038.JPG (92.0 KB, 59 views)

nyuszisue,

Thanks for posting the x-rays.

First of all the roots of this tooth were in very close proximity if not directly in communication with the sinuses. Because these xrays are only 2 dimensional, the angle of the xray offers a diagnosis based on what is visible from that particular angle. So if the xray had been turned slightly, then a different view would be seen. So the ideal way to know for certain just how close the roots were to the sinus would have been at the time the tooth was removed. Did the dentist ask you do a sinus perf check? This is when the dentist removes the tooth, holds your nose closed and asks you to gently blow through your nose. If bubbles are seen inside of the socket when you do that, then that indicates a sinus perforation. If no bubbles are seen then it is assumed that there is no perf. DO not try to do this yourself now as the site has closed over and you could not see up that far into the socket anyway.

Okay so if you look at any one of those x-rays you will see a small white artifact up in the bone just past the end of the roots. It looks white and almost shiny. From the angle of these x-rays I would say that white spot is either a piece of filling material from an old mercury filling that got lodged in the tissue and worked it's way up that high or it is root canal filling material that was "overshot" through one of the large canals and into the sinus during the root canal procedure or it is a small piece of bone splintered off from the palatal root. Based on these x-rays I'm betting it is the rc filling material... but it's hard to tell. Can you get an x-ray of this tooth prior to the root canal procedure? Because that would tell more of the story about this white spot.

This foreign blob of whatever is a constant irritant to the sinus. It may be causing inflammation and bacteria may be growing around it and it may work its way out either through your sinus or gradually move down towards the gum tissue. Or it may just stay where it is indefinitely. There is no way to tell what it will or won't do. This material should have been removed during the removal of the tooth. However, the OS either didn't go after it or he felt it was up too high to retrieve without messing too much with the sinus in the hope that it will not cause a problem or work it's way down and out.

Irrelevant .... the dentists should have informed you of this piece of material sitting in that space. The sinus scan may have picked this up. So it may be helpful to bring these xrays and to your ENT and let him take another look at the scan purposely looking for this.

It would be helpful if you got the pre op root canal x-ray from your dentist and posted it here.

Yes, I saw that white spot myself, of course had no idea what is it. It's more likely it's rc material, I didn't have filling in that tooth before root canal and no filling in other close by teeth. And I had on and off pain in this tooth since the root canal was done. But I had a sinus ct scan already many years ago because of this tooth ( after the root canal ) and back then they said the ct scan looked ok, just like this time. I can try to get the x ray before the root canal, it's a different general dentist we had back then, but what if that x ray is not digital ? The OS didn't ask me for sinus perf check, he didn't tell me anything before or after the extraction, except that the tooth may break during the extraction bc it was root canaled, and after he said you don't need another appintment, you're fine. Not that the OS didn't inform me about this white spot, the general dentist never said anything about that either, not even when I was at her office specially to look at this tooth couple of years ago when my ear was hurting me ( on that side ) and the ENT dr ( not this one I saw now ) didn't know the reason for my earache.

You said that, that white spot may work it's way out trough the sinus, what that means ? Or if it stays there and don't go anywhere, I should have a sinus surgery to get it out ? I can try to go to the ENT dr. with these x-rays and ask him to look at the ct scan again. And there comes my question again , would the dental ct scan show better about this white spot ? or a different dental x ray ?

Why was this tooth root canaled in the first place? Did it have a large cavity or did it break? How many times was it root canaled and was there any other treatment done on this tooth like an apicoectomy?

So all of these years and noone ever mentioned that white material seen on the x-rays? If the previous dentist did not have digital at the time the pre op xray was taken, then tell him you want him to make a copy of the xray that he has to keep in his records and you want the original. They legally have to oblige your request. The reason you want the original is because a copy may not be very diagnostic. Also, if an endodontist did the root canal... he may have taken a pre op also and you can call him for that original or digital whichever he has.

Anytime you have an infected or root canaled tooth removed, you should always be given a post op appointment within 2 weeks of the extraction. That is just lame to tell you everything is fine and not to come back. :/

Unfortunately more times than not patients with root canaled teeth will have radiographic artifacts or pathology that goes undiagnosed.... never mind mentioned to the patient.... for years upon years. This is truly misleading the patient to believing that because the tooth is root canaled there cannot be a problem with it. I am sorry to tell you that you are a perfect example of that nonsense

This white area could be on the sinus scan as it is very close to the sinus if not in it. But it may not be standing out as anything significant. I think if the ENT was to see the dental xrays he may look twice at the scan and be able to pick it out. A dental CT scan may show this area more clearly but it might be on the sinus one and I would hate for you to have additional radiation for nothing.

I can confidently tell you this..... all root canaled teeth are inflamed and infected as those tiny accessory canals are jammed with necrotic nerve tissue rendering the tooth very unhealthy. So it is no surprise that you have had various physical symptoms over the years most likely associated with that sick tooth. Now the tooth is gone but the bone is still inflamed and it will be for awhile and the white material may be causing further irritation in an already irritated area.

Sometimes the body heals the inflamed area and the symptoms go away. Other times there is a constant irritant. There really is no way to know for certain how this will go.

Whether or not it is wise to go in and remove that material is a judgement call from the oral surgeon and the ENT. It would first be best to determine exactly where it is located so the path of entry is as non invasive as possible. It is up to the OS and the ENT as to what other scans or xrays may be helpful in doing that.