root broken off
 

I went to the dentist 10 days ago and had an upper left molar pulled. The dentist said that the root was very close to the left sinus next to the nose. Sure enough the tip of the root broke off and went thru the skin into the sinus. I had to take a 500mg antibiotic for 10 days x3 and gargle with salty water after every meal and between meals for 10 days. I couldn't blow my nose for 3 weeks. He advised that the piece of tooth root would eventually work it's way out a nostril or my mouth or I would swallow it and pass it. The main thing was to keep the hole to the sinus very clean, which I did.
Has anyone heard of this and should I have been referred to an oral surgeon? Thanks, Tommyd:cool:

root tip
 

Hi Tommy,
I'm a dental assistant with extensive chairside experience, especially in oral surgery.

A dentist who has limited experience with the removal of teeth that have roots in or near the sinus, should always refer their patient with this situation to an oral surgeon or to another dentist who has vast experience with removing these teeth. I am stating this for informational purposes for yourself (in the future) and for others who are reading this. Always ask if the dentist is 100% comfortable in performing this type of surgery because it poses a major challenge for someone who has limited experience with it. For someone who routinely does this, the challenge is minimal and the outcome more positive.

Just to be clear....... the root could not break off and go through the skin into the sinus. It may have been pushed into the sinus during the extraction, but there is no tissue there other than the very thin wall of the sinus floor. Anatomically, all upper molars can have roots that either enter or are close to the sinus. This can be seen on a radiograph and an experience surgeon can tell pretty accurately if the root is in or near the sinus. Either one of a few things happened:

The root was already located in the sinus and it fractured off from the tooth during the extraction and it was simply left in place. Or, the root could have been fractured to begin with and as the tooth was being removed, the fractured piece of root was left in place.

Or..... the root was fractured in the first place or fracutred during the extraction and during the extraction or while trying to retrieve the fractured piece, the dentist pushed the piece of root into the sinus.

I have to be honest with you, in 30 years I have never seen the root of a tooth works it's way out of someone's nostril. I suppose anything is possible but the root is encassed in sinus tissue which quickly forms a barrier around the root as the immune system detects that it's a foreign matter. I have on occasion seen where a fractured piece of root has worked it's way down to near the gumline and was then removed with minimal surgery. But it can take years for that to happen. The likelihood of that happening in someone who had the extraction say in their teens to twenties, possibly in their early thirties, is much greater than in someone older.

When there is a sinus exposure during an extraction, the surgical site is usually sutured closed and antibiotics are prescribed. Warm salt water rinses are beneficial beginning 24 hours after any extraction and in a sinus exposure, an antibiotic is always recommended. However, you should never be able to have access to that open sinus in any way as it is imperative that it closes over as quickly as possible.

There are a few concerns with leaving a tooth root tip in the sinus cavity. One is your medical history indicates that you have some chronic inflammatory issues, cardiac and other. The immune system reacts to any foreign material (like this root tip) by sending inflammatory cells to help ward it off from infection. Initially this is an acute situation, but it becomes chronic especially if this root tip was infected, and it certainly would be if it had been previously root canaled or if the bone around this area is dealing with the bacteria from periodontal disease. In this case you may end up with chronic sinus issues or other unpleasant health issues as the immune system continually tries to deal with the inflammation and infection.

Depending on several factors, there are times when it is best to leave a broken root tip where it is. Perhaps it would be wise to see an oral surgeon to evaluate your particular situation rather than just leave it and hope it remedies itself.

Please keep us informed of how things go!

Bryanna