Hi all , found the forum while searching for info on a situation i have. I have been reading about some of you with roots into the sinus cavity, and that is why i am here. Today i saw a dentist for a tooth ach and it is an upper wisdom tooth that he says the roots protrude into the sinus cavity. He says it will be $275 for the extraction and $600 to repair the membrane . What is involved in this prosess ,it sounds odd to me , or should i find another dentist ? Thx! pkeen

What matters is how good is the dentist. You could google his name.

I had one wisdom tooth pulled when I was 17 by family dentist. No problems there. The other three in one go when I was 24. No problem there either, only this was done surgically by a professor who used the opportunity to teach young dentists. You know, the best thing that ever happened to me was to become a patient that young dentists practiced on in a university setting? I paid like a quarter of the usual amount for a solid gold tooth and crown, had 4 of them around age 24 because my rich parents refused to let me have proper dental care. Anyway, after that, I had no more problems for 25 years, whereas I had been in pain from age 12.

So as far as I can see, a professor showing off and surgery versus pulling by a dentist is the way to go.

Hi Bryanna, I hope you're still around I've been to a dental surgeon (after much debating with medical specialists and a CT scan) for what they've finally agreed is a severely abcessed tooth that has invaded deep into the sinus cavity.

I'm booked in for surgery on the 27th, I'm just wondering if you can tell me anything about what to expect/are there any risks associated with this surgery?

The doctor doing the work comes highly recommended, and seems to really know his stuff, but isn't very good at explaining what to expect

I'd really appreciate any insight you or anyone else can give.

Hi Nibbles,

I assume that you are seeing an oral surgeon or a dentist who performs ALOT of oral surgery?

Sometimes dentists do not fully explain a procedure to a patient because every case is a little bit different and they don't want the patient to get "stuck" on something they said and needlessly worry. Sometimes a dentist will get the feeling that a patient would prefer to not know too much and other times the dentist is just not that good at explaining things!

It sounds like you have had an ongoing problem that took alot of steps to get properly diagnosed. I'm glad that the CT scan was done and showed the area of infection. What were your symptoms and did you have any dental pain?

This type of situation can be a bit complicated depending on how much of the sinus has been affected by the infection. Although the CT scan shows a detailed picture, the surgeon won't know the extent until he removes the tooth. It is sometimes difficult to eradicate a long standing sinus infection from a tooth even once the tooth is removed. Antibiotics will be prescribed until he feels the infection has cleared.

As for the surgery itself, it's similar to any other extraction it just may take a little longer to debride the area and close the sinus membrane. It should not be painful to you during the procedure. Post operative pain is different for everyone and it depends on the surgery and your threshold of pain. The risks of this type of surgery are the inability to close the sinus due to the infection and a constant draining occurs. This eventually needs to be remedied because it will cause a chronic infection and can cause you to feel unwell. Another risk is breaking off a root tip in the sinus. If this occurs, then the root tip should be found and removed or the area will not heal properly. Both of those risks are very small and you should not concern yourself about either of them!!

It is imperative that you follow the surgeons home care instructions to the T. It is also very wise to prepare your diet ahead of time so you will have plenty of nutritious foods to eat and drink. Your immune system will need to be healthy while healing. Many times after we have surgery whether we are in pain or not, we just don't feel like doing anything........... so prepared meals that are easy to cook are ideal! Eat light and often, non spicy, no sugar, soft foods high in protein if possible. Drink lots of water and don't use a straw.

Homeopathic remedies that seem to be very helpful are hypericum, arnica, ruta, aconite, gelsemium, ledum, and phos. Sometimes you can purchase these together in one pill. This remedy helps to relieve anxiety, tissue and nerve trauma, bleeding, soreness and brusining. We use a formula with all of these ingredients called Pre Dental Procedure by Arrowroot. It is meant to be started the day before, then the day of and then continued for a few days after the procedure.

Arnica pellets can be used alone after the surgery as a pain killer and tissue healer. Our patients take it about 4 times a day for at least a week post operatively and some say they experience no pain or swelling!!!

If you are a smoker, now is the time to stop. Smoking can prevent the area from healing which could lead to multiple surgeries to close the sinus.

Please let us know how you are doing ~">"~

Bryanna

Thank you so much for your reply Bryanna

I've been having severe headaches for about three years (which is around about the time that I had an extremely bad cavity filled- the dentist at the time wanted to avoid doing a root canal, even though the cavity was very deep. I was happy to save the money so I didn't object )

I started noticing a rotting smell, and I was getting dizzy spells a few months after. I went to the Dr who suggested a sinus infection and gave me antibiotics. It cleared up for a while, then same thing, same diagnosis.

Long story short, it all started getting worse about 6 months ago- I was so run down and sick, infections were cropping up all over- I had a lump the size of a fist on the back of my head under my hair, and several infected lumps on my legs and face. I was getting reoccuring strep infections. The tooth was so painful and headaches so severe that I was waking up in agony every night.

Since the tooth hurt I thought I'd go back to the dentist and get the root canal in the hope that it would solve some of these issues. The dentist that I saw was the head of the practice, he took an exray and insisted that it was a really bad sinus infection, nothing to do with the tooth.

I went back to the dr. He gave me more antibiotics and ran some blood tests, and I asked him to please refer me to a specialist for the sinus problems. Came back that I had glandular fever, a severe iron deficency.

When I went to the sinus specialist, he sent me for the CT, and referred me to the dental surgon. It looks like (from the scan) well over half the sinus is bad And you can see the tooth in the sinus.

The dental surgon seems really good, and he does quite a few of these. I think I'm just freaking out a bit- I feel like I've been sick forever. This has really knocked me flat and is driving me crazy- I can't keep things straight in my head most days because I have such a headache/spacey/tired feeling.. I cannot wait to get this fixed.

Thank you again. I really appreciate all the advice, I'll pick up some arnica before next week, and I've let hubby know he is my slave for the recovery time *evilgrin*

What is the average recovery time for something like this? I've taken 4 days off work, and then have another 2 days over the weekend- do you think that is too much, or too little, or appropriate?

Hi Nibbles,

You have certainly had a very rough time. I am so glad you posted here because this is what can happen when an infected tooth remains in the mouth. Other infections can crop up anyplace in or on the body as the immune system becomes burdened. Infected teeth in the upper arch of the mouth can cause sinus infections. It is NOT uncommon for people to be misdiagnosed and repeatedly treated with antibiotics for sinus infections when the tooth or teeth are what is causing the sinuses to be infected. As long as the infected tooth is present the other areas of infection will not get better until the infected tooth is removed.

We have alot of little membranes in our sinus cavity. Chances are that this tooth has infected the area of the sinus around the tooth root. Once the tooth is removed, the area of infection will be visible to the surgeon and he can clean it out and repair the membrane. Keep in mind that this is done all of the time, it's nothing new. Hopefully, he will have the access he needs to do that through the oral cavity. Sometimes (rarely) the person requires additional sinus surgery to remove the infection. Did he talk to you about that at all? I'm sure he will do everything he can to try to avoid any additional surgeries. You do have a complicated situation but rest assured that the surgeon deals with this situation all of the time and he is prepared to deal with yours.

You will feel SO much better when that tooth is gone and your body has an opportunity to heal that area. Your immune system will be SO happy!!!

Please follow his instructions and make sure you eat nutritiously and drink lots and lots of water post operatively!!

The time you have reserved from work should be adequate. It really all depends on how extensive the infection is in the sinus. If you stay healthy post operatively, your healing time will be quicker. You will be on antibiotics for awhile. If you are not supplementing with a probiotic, it would be very wise to do so. Antibiotics destroy all of the good bacteria in the intestines which can lead to long term intestinal issues and actually slow down the healing process. In our office we recommend a probiotic called Culturelle. You can buy it online at culturelle.com or in a large drug store. It is best to start taking it now and then continue for at least a few months post operatively. For optimal health, it is best to supplement with a probiotic daily for life so the intestinal bacteria has a large abundance of good bacteria for times of stress and so forth.

Please keep us informed of how you are doing ~'.'~

Bryanna

After 13 months and numerous visits to the dentist for tootaches, I am considering (leaning more toward) having my #3 molar removed as it has an obvious and deep penetratrion to my sinus. My dentist has encouraged me to "save" the tooth as it appears to be healthy and teeth #1 and #2 have previosuly been removed. His suggestion was to have a root canal and subsequent crown. I understand the reasoning for necessity in chewing, however, I suffer from headaches and sinus infections at a rate of nearly 1 per month/6 weeks. The last 4 have been very severe in nature and almost debilatating as it is hard to function with a migraine type of headache and all the pleasures of runny nosy, sore throat, ear-aches, dizziness, and the added bonus of infections in the roof of my mouth and gums behind my upper right teeth. My question is basically will it be a huge detriment to me in the future (I'm 35 years old) if I demand to have the tooth extracted? I like my dentist, I think he knows what he's talking about BUT is it really necessary to go through a root canal/crown (and the expense) when I should just have the tooth removed? I do have an appointment scheduled with a dentist who specializes in endodontics (he was referred by my dentist). Should I keep this appointment or head straight to an oral surgeon? I guess I'm really just looking for justification of what I want to have happen =/

Thanks for taking the time to read.

Hi Magi,

You are faced with a complex situation. However, I can simplify it for you but only you can make the best decision for you.

A root canal is done in an attempt to TEMPORARILY retain a tooth in your mouth. Once the root canal is done, the tooth is nonvital (dead) due to the severing of the nerve which connected the tooth to your blood supply. Keep in mind that every living organ and body part including teeth require nourishment from the blood supply to be healthy. During a root canal, some of the nerve material is removed from the larger canals but the millions of microscopic canals inside the tooth that are not accessible will continue to harbor nerve material that becomes necrotic due to the lack of nourishment because of the lack of blood supply to the inside of the tooth.

I emphasize temporarily because most dentists do not inform their patients of this fact. They also do not inform patients of the necrotic material that remains in the tooth nor what this necrosis eventually does to the jawbone surrounding the tooth. In your case, your sinuses would also be affected by this necrosis going on in the tooth and bone.

It does not matter what specialist you see to perform the root canal procedure.... it does not matter what instrument is used or not used.... even laser root canals can only debride the large canals because a laser beam can only travel in a straight line and the microscopic canals are windy, curvy, loopy and incredibly tiny. Even the best of the best cannot sterilize a tooth so it is ridden of all of the necrotic nerve material, it's just not possible.

So in a sense, you currently have a chronic sinus condition that is undoubtedly going to be very hard to get rid of, but not impossible if all of the irritants are removed. Keeping a dead tooth in or near a chronically infected sinus may keep your sinus condition at status quo or could make it worse.

Chewing will be a challenge, at least temporarily if you decide to remove that molar. But you may be able to replace it with a removable appliance or a dental implant some time in the future.

I leave you with this one last thought.....
Countless literature informs us that there is no place in the body that it is medically or scientifically acceptable to keep a dead body part. If you are curious about that, ask your endodontist why it is then acceptable and healthy to keep a dead tooth in our mouth which is the opening to our entire immune system?

I know this is a difficult decision. But sometimes we just have to step away from the symptom and evaluate what the condition is doing to our overall well being.

Please keep us posted on how you are doing! We wish you all the best!

Bryanna

Well, I met with the Endodontist who barely examined me (he didn't look at the tooth directly) and told me the tooth looked good based off the xray from my regular dentist. I now wish I had kept a copy of that xray to post here. He stated that all teeth penetrate the sinus cavities in that manner. This one was well into the sinus, not near it, but actually in it. However, it has been close to 2 months, I still have the same toothache/headache and general pain in that are of my mouth (behind the tooth in the gums). I just feel at my wits end here. If I have the tooth removed because I "feel" like it needs to be but it doesn't correct the issues, what then? I wonder if when tooth #2 was removed my sinus cavity was perforated causing an opening to remain untreated. Could that be the cause of this? If so would an ENT specialist be capable of repairing it after so much time has passed (12 years)?

Hi Magi,

It is difficult for conventionally trained dentists to think outside of their basic training. Unfortunately, they are not taught about the whole body connection, they are taught to be tooth carpenters. Unless they have sought additional education about how the teeth/oral health affects the rest of the body, they rarely look past the "tooth" of the matter.

Perhaps you misunderstood him or he misspoke because it is absolutely not true that ALL teeth penetrate the sinus cavity. If that were the case, then every person who has ever had a tooth extracted would have a sinus exposure....... completely false. In some people, the upper posterior molars are in or near the sinuses. In others, there is little to no correlation between the teeth and their sinuses.

The teeth and sinuses can be in close proximity for a variety of reasons.

1) Rarely but sometimes large sinuses and/or long rooted posterior teeth in healthy people.

2) Missing teeth in the upper molar region of the mouth will cause the sinuses to eventually hang lower as they fill up the space that was once a tooth.

3) Normal size sinuses that have become inflammed or infected will swell. As they become larger, they press down on the roots of the correlating upper molars. The inflammation/infection can be severe enough where the membrane perforates and infects the tooth/teeth.

4) The infection from a tooth can proliferate into the sinus through a perforation in the membrane which will cause the sinus to swell.

There is a strong correlation between chronic sinus infections and tooth infection. As there is just as strong a correlation between a tooth infection and a sinus infection. ENT's are more likely to discuss this issue than a conventionally taught dentist. The reason being is because the ENT has performed sinus surgery on people who have had sinus infections that were clearly tooth related.

Yes, there is always a possibility that when #1 or 2 was removed that there was a sinus perforation and due to infection or necrotic tissue left behind, the membrane never closed completely. The fact that you had the other two molars removed indicate that there was some type of infection going on up there 12 years ago. The fact that you still have chronic issues in that area of your mouth along with chronic sinus infections in spite of removing those teeth may mean that you have an unresolved long term infection going on in that area of your mouth.

Our bodies are marvelous at fighting infection. But when a bad strain of bacteria overwhelms a particular site of the body, the immune system cannot ward it off any longer so the bacteria travel in the bloodstream to another area of the body to set up shop there until that area becomes saturated and the process continues. The healthy mouth has over 400 different strains of bacteria, both good and bad. So most oral infections are of a variety of different strains of bacteria and as they grow, new bacteria join in. This is the body's way of continually trying to kill off the invaders but it can only do that successfully for a short period of time.

I would seek the opinion of an ENT who would take a CT scan of the sinus. This may be very helpful in determining the cause of the problem. Make sure you explain your tooth concerns to him because the CT scan ordered for dental/sinus problems is different than a normal CT scan.

I think your intuition is telling you something is not right and to ignore this tooth or treat it with a root canal may not be in your best interest.

Please keep us posted on how you are doing! I know this is very difficult, please try to stay positive and forge ahead with your intuition!!

Bryanna