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sinus communication after wisdom teeth extraction

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Old 09-30-2015, 09:14 AM   #1
markt1235
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Default sinus communication after wisdom teeth extraction

Hi on 9/19 I had 4 of my wisdom teeth removed. 2 upper and 2 lower ones. Since the extraction I have had water coming out my nose whenever I rinse. Also on my right sinus i had a ton of pressure and pain which I thought was normal after an extraction. I went back to the dentist on 9/27 after not having the pressure/pain get any better and now have developed yellow dark mucus/disgusting smell in my nose. Whenever I rinse I still have water coming out my nose and I can feel it going into my sinus. Doctor took an x-ray and didn't even look at my mouth. Prescribed me Augmentin and peridex mouth rinse for a sinus infection. I was never given any instructions on what to do with my sinus perf/communication. When I asked he said it will heal and walked out.

1. I am currently on 3rd day of 10 day dosage of augmentin. When I rinse the water still pours out of my nose. How am I supposed to rinse? Do I just hold the salt water in my mouth? Or should I swish it hard back and forth? Should I stop rinsing since it is coming out of my nose? I'm worried I'm not letting the sinus hole heal by rinsing and having water go through it.


What steps should I take and what should I do?
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Old 09-30-2015, 11:34 AM   #2
Bryanna
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Hi mark1235,

You need to see an oral surgeon for the proper evaluation. If this dentist is an oral surgeon, you need to see a different one. You have a moderate sinus perforation and it needs to be properly evaluated and treated. You can get very sick from this condition, so please do not wait to get the proper help. If you see someone new, you need to have your pre and post op xrays with you as this will help give a history.

Please check back with us.
Bryanna


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Originally Posted by markt1235 View Post
Hi on 9/19 I had 4 of my wisdom teeth removed. 2 upper and 2 lower ones. Since the extraction I have had water coming out my nose whenever I rinse. Also on my right sinus i had a ton of pressure and pain which I thought was normal after an extraction. I went back to the dentist on 9/27 after not having the pressure/pain get any better and now have developed yellow dark mucus/disgusting smell in my nose. Whenever I rinse I still have water coming out my nose and I can feel it going into my sinus. Doctor took an x-ray and didn't even look at my mouth. Prescribed me Augmentin and peridex mouth rinse for a sinus infection. I was never given any instructions on what to do with my sinus perf/communication. When I asked he said it will heal and walked out.

1. I am currently on 3rd day of 10 day dosage of augmentin. When I rinse the water still pours out of my nose. How am I supposed to rinse? Do I just hold the salt water in my mouth? Or should I swish it hard back and forth? Should I stop rinsing since it is coming out of my nose? I'm worried I'm not letting the sinus hole heal by rinsing and having water go through it.


What steps should I take and what should I do?
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Old 09-30-2015, 11:57 AM   #3
markt1235
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Originally Posted by Bryanna View Post
Hi mark1235,

You need to see an oral surgeon for the proper evaluation. If this dentist is an oral surgeon, you need to see a different one. You have a moderate sinus perforation and it needs to be properly evaluated and treated. You can get very sick from this condition, so please do not wait to get the proper help. If you see someone new, you need to have your pre and post op xrays with you as this will help give a history.

Please check back with us.
Bryanna

Thank you for the quick reply. When i went back on 9/27 he looked in mouth for 5 seconds, and told me "it will heal by itself" after the original extraction nothing was mentioned about the communication. Should I call a doctor now? Or should I wait for it to "heal".
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Old 09-30-2015, 01:36 PM   #4
Bryanna
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mark,

The sinus perforation needs to be evaluated to determine the size and location of it. If this dentist was not interested in doing that, then seek a consult with another dentist. It is important for that dentist to be an Oral Surgeon, not a general dentist.

Based on your description, the symptoms are not improving they are getting worse. So it is best to get this evaluated asap.

Bryanna


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Originally Posted by markt1235 View Post
Thank you for the quick reply. When i went back on 9/27 he looked in mouth for 5 seconds, and told me "it will heal by itself" after the original extraction nothing was mentioned about the communication. Should I call a doctor now? Or should I wait for it to "heal".
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Old 12-23-2015, 07:02 PM   #5
XFitRick
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Originally Posted by Bryanna View Post
mark,

The sinus perforation needs to be evaluated to determine the size and location of it. If this dentist was not interested in doing that, then seek a consult with another dentist. It is important for that dentist to be an Oral Surgeon, not a general dentist.

Based on your description, the symptoms are not improving they are getting worse. So it is best to get this evaluated asap.

Bryanna
I have a question, I had an extraction of a cracked root canal'd/crown tooth (top right before wisdom tooth) on 16 DEC and experienced the common sinus perforation.

I went in this Monday (21 DEC) and the oral surgeon put me on amoxicillin for the sinus infection I got at the extraction site. Today is 7 days since the extraction and I can still feel air pass through the sinus. I do my best not to irritate the area and let me tell you that is challenging (keep mouth open all the time, speak in a lower voice, cooling down my Starbucks so I can pour it opposed to sipping). On occasion I do something wrong and cause air to pass through the sinus (how I know this is still an issue today).

Is it normal to continue to have the sinus perforation now? I'm thinking maybe the sinus infection needed clearing up first?

Thank you for replying to everyone's inquiries!

-Rick
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Old 12-27-2015, 03:00 PM   #6
Bryanna
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Hi Rick,

There is no real "common" sinus perforation. There are certain pre existing circumstances that can cause or result in a sinus perforation and having a root canal done in an upper tooth is one of them. The reason being is that the root may be perforated during the rc procedure which could also perforate a sinus membrane that is in close proximity of the root and/or the perforation of the root can allow bacteria to flow from the tooth into the sinus area. If the upper rc tooth also had an apicoectomy performed that could deteriorate the integrity of the bone protecting the sinus membrane leading to a sinus perf and/or infection. If the upper rc tooth was severely infected the bacteria can spread easily into the sinus area... etc.

Depending on the size and location of the sinus perforation as well as the resiliency or tenacity of the infection, the opening may take several weeks or longer to close. Yes, the infection needs to clear or mostly clear in order for the perf to close properly.

If the wound and the bone are not infected and healing well, then the best way to gauge if a sinus perf is closing is to be aware of the changes in the symptoms. Meaning are they increasing, decreasing, diminishing slowly....

Keeping your mouth open all the time is not ideal as this causes the oral tissue to dry out. You want the mouth to remain moist with saliva just as it should be. Drink enough filtered water throughout the day to the equivalent of half you body weight in ounces. Not only does this encourage salivary flow but it removes toxins and bacteria from the body, aids in keeping hydrated and encourages healing.

Your name... XFitRick... does this indicate that you exercise frequently? If so, is it extreme or considered strenuous like lifting or are you a runner, etc? I ask, because believe it or not certain forms of exercise should be curtailed during the post op phase of tooth extractions and also during any type of sinus infection. It has to do with elevating the heart rate and the correlation that has to the mouth and the sinus.

Bryanna






Quote:
Originally Posted by XFitRick View Post
I have a question, I had an extraction of a cracked root canal'd/crown tooth (top right before wisdom tooth) on 16 DEC and experienced the common sinus perforation.

I went in this Monday (21 DEC) and the oral surgeon put me on amoxicillin for the sinus infection I got at the extraction site. Today is 7 days since the extraction and I can still feel air pass through the sinus. I do my best not to irritate the area and let me tell you that is challenging (keep mouth open all the time, speak in a lower voice, cooling down my Starbucks so I can pour it opposed to sipping). On occasion I do something wrong and cause air to pass through the sinus (how I know this is still an issue today).

Is it normal to continue to have the sinus perforation now? I'm thinking maybe the sinus infection needed clearing up first?

Thank you for replying to everyone's inquiries!

-Rick
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Old 12-27-2015, 05:59 PM   #7
XFitRick
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Originally Posted by Bryanna View Post
Hi Rick,

There is no real "common" sinus perforation. There are certain pre existing circumstances that can cause or result in a sinus perforation and having a root canal done in an upper tooth is one of them. The reason being is that the root may be perforated during the rc procedure which could also perforate a sinus membrane that is in close proximity of the root and/or the perforation of the root can allow bacteria to flow from the tooth into the sinus area. If the upper rc tooth also had an apicoectomy performed that could deteriorate the integrity of the bone protecting the sinus membrane leading to a sinus perf and/or infection. If the upper rc tooth was severely infected the bacteria can spread easily into the sinus area... etc.

Depending on the size and location of the sinus perforation as well as the resiliency or tenacity of the infection, the opening may take several weeks or longer to close. Yes, the infection needs to clear or mostly clear in order for the perf to close properly.

If the wound and the bone are not infected and healing well, then the best way to gauge if a sinus perf is closing is to be aware of the changes in the symptoms. Meaning are they increasing, decreasing, diminishing slowly....

Keeping your mouth open all the time is not ideal as this causes the oral tissue to dry out. You want the mouth to remain moist with saliva just as it should be. Drink enough filtered water throughout the day to the equivalent of half you body weight in ounces. Not only does this encourage salivary flow but it removes toxins and bacteria from the body, aids in keeping hydrated and encourages healing.

Your name... XFitRick... does this indicate that you exercise frequently? If so, is it extreme or considered strenuous like lifting or are you a runner, etc? I ask, because believe it or not certain forms of exercise should be curtailed during the post op phase of tooth extractions and also during any type of sinus infection. It has to do with elevating the heart rate and the correlation that has to the mouth and the sinus.

Bryanna
Yes Ma'am, I own/run a CrossFit gym here but have not worked out since the procedure. The OS who did my extraction is one of my gym members and set the workout restriction.

I feel the air flow is now harder and maybe even non-existent (I'm not going to test this, ha). Will step up the water consumption.

Like many others, we often jump on social media to find medical answers and panic when we can't find our specific issue, so again, thank you for the reply!

Happy holidays!

-Rick
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Old 12-27-2015, 06:37 PM   #8
Bryanna
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Hi Rick,

I should have been a detective...

Good to hear that the OS talked to you about exercise restrictions and you have complied with his suggestion!

Today's description of your symptoms are positive and indicate the sinus is mending. Yea, the less you bother with it the better. Just let it be and hopefully within a weeks time it will be perfect.

Be well,
Bryanna





Quote:
Originally Posted by XFitRick View Post
Yes Ma'am, I own/run a CrossFit gym here but have not worked out since the procedure. The OS who did my extraction is one of my gym members and set the workout restriction.

I feel the air flow is now harder and maybe even non-existent (I'm not going to test this, ha). Will step up the water consumption.

Like many others, we often jump on social media to find medical answers and panic when we can't find our specific issue, so again, thank you for the reply!

Happy holidays!

-Rick
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Old 02-12-2016, 12:41 PM   #9
XFitRick
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Originally Posted by Bryanna View Post
Hi Rick,

I should have been a detective...

Good to hear that the OS talked to you about exercise restrictions and you have complied with his suggestion!

Today's description of your symptoms are positive and indicate the sinus is mending. Yea, the less you bother with it the better. Just let it be and hopefully within a weeks time it will be perfect.

Be well,
Bryanna
Hey Bryanna,

Hope all is well on your end.

I haven't had seasonal allergies for a few years (when i eliminated dairy from diet). However, since the procedure, I've been congested, bad oder from nasal drip and am now on my third round of antibiotics (Augmentin) for what appears to be a continued sinus infection. The communication (opening) seems to have closed, though I can feel pressure at the site (no airflow) when I blow my nose w/mouth closed. I feel like I need to add a decongestant to minimize the strain from blowing nose, etc.

Should I shoot for the implant now and get all that healing time out of the way?

Thanks!
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Old 02-15-2016, 11:36 AM   #10
Bryanna
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Hi Rick,

I'm doing well thanks ... hope all is good by you too!
Sorry for the delay in replying, I was away for a few days.

Before you do the implant, it is wise to have the sinus checked out more thoroughly. It is not uncommon (although often misdiagnosed) to have residual infection lurking in the area of a previously root canaled tooth. This would account, at least in part, for the chronic inflammation and "sinus" infection that antibiotics are not clearing up. There could be other irritants adding to the problem but the probability of it being related to the original tooth infection is something that needs to be evaluated, treated, or ruled out prior to placing the implant.

I think it's important to keep in mind that your maxillary arch and sinuses are in close proximity to your brain. So chronic infection in that area can migrate beyond it's original source over time. It is imperative that the jaw bone and the sinus are healthy and free of infection before you place a dental implant. Anything less than healthy predisposes you to infection, bone loss and failure of the implant.

If you have not seen an Ear Nose and Throat physician, then it may be a good idea to do so. Sinus scans are used to detect generalized sinus problems which may be useful in your case. While 3D dental scans are good at detecting abnormal pathology in the maxillary arch and certain areas of the maxillary sinus which may also be useful in your case.

Bryanna





=XFitRick;1198820]Hey Bryanna,

Hope all is well on your end.

I haven't had seasonal allergies for a few years (when i eliminated dairy from diet). However, since the procedure, I've been congested, bad oder from nasal drip and am now on my third round of antibiotics (Augmentin) for what appears to be a continued sinus infection. The communication (opening) seems to have closed, though I can feel pressure at the site (no airflow) when I blow my nose w/mouth closed. I feel like I need to add a decongestant to minimize the strain from blowing nose, etc.

Should I shoot for the implant now and get all that healing time out of the way?

Thanks![/QUOTE]
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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