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?

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".

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

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

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!

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]

I'm headed back to the OS tomorrow...hopefully we can get this figured out. If it continues, I'll inquire with ENT.

Thanks again!

-Rick

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Bryanna help me if you can
 

Bryanna
I just had 2 upper molars pulled opposite sides on Friday 3/4/16 and on Sat i noticed air and fluid coming out of my nose went to the periodontist first thing Monday 4/7/16 that put me under and took them out i have a perforated sinus he said he can't repair it till 3/24/16. 2.5 weeks away the pain is bad is this common to wait that long I thought it would be done right away he did put me on Amoxicillin for 7 days i've seen you answer questions on here I have no insurance and little money to just pay to be told the same same thing from another doctor i was hoping i could get a verified time frame to get it fixed (surgery) is a periodontist qualified for this type of thing he made it sound like no big deal thank you Robert s

Hi Rick,

So what did the oral surgeon say?

Drop us a note when you can... thanks!
Bryanna



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Robert,

I answered your inquiry on the other thread where you also posted it.

Bryanna

Hi Bryanna...so here's the latest,

I've been to the VA ENT. They did a CT scan and put me on 1 month (2x day) Amoxicillian. Said I have a deviated septem and will likely do surgery. They saw the soft tissue from the extract but said the septem is more of the problem.

Today I felt a pop sound at the extraction site and puss just started flowing out. I'm guessing this is the same puss the doc showed me on the scan (he compared one side which was black and the other which was white with a little black) Said "black sides matter," not really, ha. He did say the black indicates air and is what the issue side should look like (saw only a small air pocket)

I can now bring in air (communication) from the sinus, not the "water coming through" size, but if I apply suction from the mouth or blow it releases or introduces air. I'm guessing this is bad?

Yikes!

Hope all is well on your end - Rick

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Hi Rick,

Yes, black sides do matter ..... I mean the black on the scan indicates air which is what you want to see pertaining to the sinuses.

The air is a problem as it means the sinus is open someplace. You also have a nasty infection that may not be related at all to your deviated septum but it may be just as, if not more, significant than the septum issue. The oral antibiotic may not work and/or it may not be the appropriate species for the bacteria that is causing the infection. A clean catch specimen of the pus sent to the lab for a culture would determine the proper antibiotic. I would ask the ENT if he can do that. Also if the infection is still present when you have the septum surgery, you could have surgical and/or post op complications due to the unresolved infection. So the infection is an issue.

I'm sorry you are going through all of this....
Bryanna





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Ugh, lol.. I feel like there has always been something "stuck" that kinda kept the sinus closed after the extraction. When I sneezed (a couple days ago), a rice-shaped piece came out along with all the puss. I now have all the advertised sinus communication symptoms "air flow to/from sinus, can't drink with a straw, etc." I'm guessing since it has been so long since the procedure and I have easy air flow, the OS will have to do surgery to close the communication or can it heal on its own? Can the OS capture a culture and determine the correct antibiotic?

ENT may be a bit more time waiting as it's through the Veterans Administration (VA) but I do have an appt in a week.

Thanks again for the input...hope you're having a great Sunday!

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Rick,

Was that "rice" like thing that came out a piece of tooth? Was it hard? Did you save it? I ask because it may be the link to your situation with the infection.

I would consult with the OS and the ENT as to who can do the culture asap. If the proper antibiotic is not taken the infection will not clear and the bacteria will become resistant to that medication and treating it can become more complex. So it is very important to know the proper meds and time is crucial.

You may need surgery to close this perforation and clear the infection for 2 reasons. One is it is long standing, meaning it's been present for at least as long as the tooth was root canaled. Two, it's had time to progress.

I'm not a big fan of the VA healthcare system for a variety of reasons based on my professional experience. They are not usually up on the latest approaches to things, especially in dentistry. Can you see someone who practices privately?

Bryanna



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I didn't save it, but felt it was the "plug" that would occasionally "pop," irritating that area resulting in new sinus infections. I don't think it was part of a tooth, as the tooth I saved shows metal breakage. The OS later did an xray and I assume would have been able to see anything hard-like.

ENT is through the VA who did the CT scan. They didn't say anything about the extraction site other than being able to see a missing tooth (soft tissue). Their focus seemed to be unrelated to the extracted tooth and concluded the deviated septum as the root of the sinus infections.

The VA medical side has been positive from my experience; their process to get things done is more of an issue.

My OS is private practice and did the extraction. I'm assuming he can do the bacteria culture test and the surgery flap? I'm scheduled to see him this week.

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Rick,

It was a foreign matter but could have been tooth or bone related. Sometimes (quite frequently) when a tooth is extracted, a piece of the tooth or a piece of the jaw bone gets splintered or fractured off and it gets pushed during the surgery into a place where it may or may not be seen on an xray or a scan. Depending on where it is, sometimes it will work itself out through the mouth or the nose. The infection however may have progressed beyond the actual site of where the "piece" was pushed to. This could account for chronic sinus infections and the current perforated sinus.

It is imperative that your OS and the ENT collaborate on your case. One should not be doing anything without giving consideration to the problems in their entirety. Meaning, neither issue should be dismissed or overlooked when dealing with the other. The septum issue and the tooth related infection should not be dealt with separately.

The ENT must take into consideration all that has transpired with the extracted root canaled tooth. Beginning with the history of that tooth ... the fact that it was root canal and when ... the problems you had that lead up to the tooth being extracted ... the oral surgery to extract it and what was found during the surgery ... the post operative complications that occurred ... the timing of the sinus infections ... the "rice" like finding ... the pus that extruded ... the abnormal air flow ..... ALL of these things are important notes to be taken into consideration when dealing with your septum if you are to heal properly from that surgery.

The ENT and the OS need to collaborate on your case. You may have to insist upon it because doctors often have egos that get in the way of sharing cases with other doctors. Or they hesitate to make the contact because they know or suspect something has gone amiss with the care and they have to be careful how they approach the case. Either way, those issues are not your problem. Your problem is getting the best and most thorough care possible.

Please consider the information that I have given you seriously. If you have some doubt about the importance of the doctors collaboration ... read through all of Angels31 dental saga here on this forum. She's been through hell because her ENT and OS have yet to collaborate on her dental situation Which by the way with a few minor differences, happens to be very similar to yours.

Bryanna





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I saw my OS on Monday. He took a look at the area and said it was likely a "splinter" working its way out and the opening should heal on its own. He's pretty "legit" and knows his stuff and now knows why I've had all the sinus infections. I'm going to hold off on VA ENT until this all heals and I get the implant.

But my OS was quite confident this will be taken care of over time and have a follow-up in 8 days. I'm still passing air through and its like going through post-op stuff; no straws, decongestants, and talking is miserable, ha...and I have a date Sunday...so heal!! (OKC Thunder, baby!!!!) :)

Should I use some sort of antiseptic? I have like 7 more days worth of Amoxicilian the VA ENT gave me, continue to take it?

Happy Wednesday!

[/QUOTE]

I did read that girls story and hope she's doing much better!

To clarify, I'm going to just let the OS do his thing (he's pretty legit) and then maybe re-approach VA ENT to fix the deviated septum later, as I've had that "issue" way before the tooth extraction.

The OS looked at it and was pretty confident it'll close on its own, again, I see him in 6 days for a follow-up. I'm still passing air through today, though not as easily as yesterday. I don't think all of the "motivation/yelling" from me teaching our Wed morning CF class helped with the healing process.

I'm keeping talking to a low volume, doing the usual netti pot, sinus moisturizer, flonase, mucinex-d, and have 5 more days of Amoxicillan from the VA.

Should I use mouthwash or an antiseptic? Also I read something about a "gel" to promote clotting...should I ask my OS for this? And do you think it'll close on its own?

Thanks again!!



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Rick,

Yea, keep the motivational yelling to a minimum if possible. Lots of air exchanges via the mouth and nose when we yell.

There is no need to use a mouthwash of any kind. Mouthwashes that kill bacteria kill all bacteria, both the good and the bad. The problem with that is the mouth needs good bacteria to help prevent cavities and gum disease. Just make sure to brush and floss your teeth thoroughly to keep the plaque down.

The gel is used immediately after the extraction of a tooth. Your situation does not warrant using the gel.

Bryanna




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Hope you had a great Memorial Day! it's been about a week and most of the communication path has closed, feel like I have just a small hole now. I can (by accident) blow air through if I eat/drink a certain way that applies pressure to it. Again, the hole is much smaller now (water doesn't flow through anymore when I netty pot it). Still think it'll close completely?

I see the OS Wed.

Cheers!

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Hi Rick,

Had a great weekend, thanks for asking ~'.'~ Hope yours was great too!

Glad to hear that the perf is getting smaller. As far as it healing completely, if the "reason" for the opening is remedied completely and there is no infection, then it should close completely. But if the "reason" is still present even after it seems to have healed, then eventually problems will develop again. I hope you are fortunate and the problem resolves completely.

Have a good week ...
Bryanna





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Sinus lift scheduled in 2 weeks. Said procedure will ensure pathway is clear of any foreign object(s), close up communication, and I'll leave with some type of mouth guard to use when I'm able to start working out again.

Feel relieved big time; btw my OS does CrossFit as well :)

Thank you again for providing the "calmness" during all of this. Will keep you updated when I'm all said and done!

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Rick,

Sounds like a plan!! You will have several days of healing from the sinus lift but hopefully the surgery will go well and healing will be healthy and complete!

Perhaps when all is said and done ... you can put your OS through a cross fit workout!! :)

Take good care of yourself and please keep us posted!

Bryanna




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Hey there, hope all is well on your end!

Had the lift which was much less painful than the initial procedure. No more antibios and infections, sutures are set to be removed/cut next week.

I'm sure I could have already started working out again, but used this as an excuse...will get back into it soon.

Have a happy 4th!

-Rick

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Hi Rick,

Thanks for the update!

Glad to hear the sinus lift went well! Did the surgeon say what his findings were ... tooth root or other?

I would wait to work out until the sinus is closed. If there is no irritation or infection, the sinus should close pretty quickly.

Hope your healing is uneventful and complete!!

Keep us posted .... take good care of yourself ~'.'~

Bryanna


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Haven't worked out yet, but today I was able to send air flow to/from the extraction site today indicating there is still a communication, ugh. Is this common?

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Hi Rick,

Depends on what you were doing when you felt the air exchange? If you were doing something that put pressure on the sinus floor, like drinking through a straw, blowing your nose or some other physical activity, then it's possible that the sinus reopened. To what degree is hard to say.

If you felt the exchange just while regular eating or with no added pressure from another source, then obviously the sinus is still open. Do what degree, that too is hard to tell.

Did you have the sutures removed yet? If so, then it would be wise to call the surgeon, explain what you were doing when you felt the air exchange and get his opinion.

BTW.... did he inform you of any findings like a root tip or other when he did the sinus lift? If not, then I would suggest that you specifically ask him what his exact findings were and if he removed it/them in their entirety.

Bryanna




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