Sinus perforation during tooth extraction
 

I had my #3 molar removed and they told me they opened up my sinus. They used a foam to repair the hole and all was good for 4 days. I was rinsing with salt water as instructed and it started gushing out my nose as I spit it out. I called but they couldn't see me for a few days. I was taking Clindamycin to prevent infection as I'm allergic to penicillin. Now it's been 9 days since the extraction and the hole is still open and the infection smell has gotten to the point where my boyfriend even tells me not to look in his direction. I still rinse with salt water and got another script for the antibiotic but it's so incredibly painful and hard to deal with. What are some home remedies to help heal the hole and infection. I'm at my wits end with all this pressure and pain.
The infection has gotten so bad that even though I'm takin Sudafed and mucinex to keep them dry my nose drips orangeish fluid. The dentist told me I needed to be seen ASAP but didn't have any openings til March :(

Oh that is horrible. Sorry you are going thru this. I'm working all I can to keep this broken molar and not go thru major trauma of an extraction, yet the bridge next to it with RC under the bridge. I've talked about it here somewhat. I've had plenty of dental work in my long life and at this point hanging on to what is left.

I work with a made up remedy which includes oil of oregano. One can work with OOO on it's own and there is a lot of info on the net. OOO was used for so many infections forever before all the abx drugs. I've used some abx drugs in my life, but avoid them if I can. For this current issue which is going on 10 yrs I had two courses of amoxicillan which quieted things and now managing with my remedies. If you want to know my total remedy, send me a PM.

On general good gum health I know a couple decades of taking grape seed extract has kept my gums in good condition. Read some of my recent posts, fluorides are not our friends.. Coconut oil is huge in my life and I make up my own toothpaste now in my retirement and all I've learned.

I have a smelly sinus infection after upper molar extraction, too
 

I am in the same boat with HeatherKelly and just created an account today to ask about it!

My extraction took place October 15, 2015, upper right molar and premolar that had a root canal. I am thinking that some food must have gotten into my sinus at some point, to cause the horrible smell.

The smell has dissipated somewhat, but there is still a dull ache and sour post nasal drip that almost feels like it's burning the back of my throat sometimes. I have been doing sinus rinses, which helped, but I only did the right side, and must have flushed some of the infection to the left since smell mucous started coming out that side too.

I am assuming that since the gums have healed over nicely, the opening must have healed, too? And now whatever got in there is trapped and causing the pain, smell and mucous?

My question is the same, does this sort of thing EVER clear on its own, or must the oral surgeon go back in and clean out the site and the sinus? Maybe there is some other way to clear this I have not thought of, but I read that antibiotics don't work for sinus infections because of the low blood flow to the area. Plus, how can it ever clear if there is foreign matter in there, just rotting???

Hi HeatherKelly,

Was tooth #3 previously root canaled? What was the reason for the extraction?

It is not uncommon for there to be a sinus communication with the upper molars because frequently the roots of these teeth are in close proximity to the sinus membrane. When there is an infection in a tooth the bacteria from that infection can easily travel through the membrane and into the sinus.

Sinus infections from infected teeth are considered serious because of the fact that the sinus is in close proximity to the brain. The bacteria has no limit as to how far it can travel so it is unwise to attempt to treat this infection on your own.

You need to get in to see an oral surgeon, not a general dentist, asap to evaluate the extent of this infection. If intervention is warranted and isn't done, then repeated doses of antibiotics alone are not going to cure the infection. It's important to know that this infection can make you very ill if it is not dealt with properly.

You definitely should not wait until March..... find an "oral surgeon" to get you in as an emergency patient asap.

Bryanna

It was extracted because I had an accident on new years eve and it cracked. An oral surgeon took it out packed the hole and sutured it. It was an understudy that I seen a few days ago and said I needed to be reseen asap.
I'm still in agony, it's my entire top jaw that hurts now though. I still rinse with salt water every few hours but the water goes straight in my sinus and out my nose. It's becoming more of a dark greenish color and the smell is horrific. But after I rinse to the point where it's coming out clear I have awful pressure (I know because water is still in my sinus) but I really don't know what to do. I am seeing the oral surgeon again but not until 1/19. I just need to figure out how to survive until then. But am open to any suggestions because I've never felt pain like this.

HeatherKelly,

An understudy? You mean a dental student? Did you have the extraction done in a dental school?

Unfortunately, there is nothing you can really do at home to make this better. You need to be seen by an oral surgeon.... perhaps someone in private practice would really be best.

There are several different classifications of sinus openings which determine the treatment needed to close them. It is beyond anything that you can do personally. Also, you can overdo it with the antihistamines... so do not be of the mindset that more is better. The lowest effective dosage is best.

By any chance do you smoke?

Bryanna

No, I am not a smoker. I haven't used straws or even sneezed with my mouth closed. Yes it was done at the University of Minnesota dental school. I just wanted it pulled because it cracked and was painful. I was only visiting and couldnt find anywhere to accept my out of state insurance. I had no idea it was going to turn into this. Oh to your previous reply it was not a root canal however the tooth next to it is. I've only been taking Sudafed when the pressure is to the point where I can't move.

Webinfusion,

At 3 months post op the tooth extractions you should not be experiencing any of those symptoms if the infection is not present. The infection is not necessarily from trapped food debris. It is more likely that there is still bacteria lurking in the bone and possibly sinus from the infected root canaled teeth.

The bacteria causing a sinus infection can spread to various areas of the sinus and even beyond the sinus cavity. So it is best to see an oral surgeon for a radio graphic and clinical evaluation of the surgical site and both sides of the sinus. That would require a panoramic xray and/or a more detailed 3D scan.

We think of our sinuses as holes that we can flush something out of. In reality they are correlated with various other organs which can become infected also. So repetitive irrigation of the sinus when there is an active infection brewing from say the jaw bone can actually spread the bacteria. I will attach a diagram of the sinus to give you an idea of some of the areas they are correlated to.

The gum tissue at the site of a tooth extraction closes over long before the jaw bone fills in with bone. Under healthy circumstances, the bone takes up to one year to heal completely. So the closed gum tissue does not mean that it's also healed underneath.

Antibiotics can be helpful with sinus infections so long as the "culprit" of the infection is found and removed.

So it's best to see an oral surgeon... possibly an Ear Nose and Throat specialist also after the oral surgeon.

Bryanna

Thank you Bryanna. I really thought it was just an annoyance that would resolve on its own. Apparently not! Considering I also have cancer, I better get this taken care of asap.

HealtherKelly, my heart goes out to you. I've been in situations where not having the right insurance or money to cover an expense made me hesitate to get help. Then I found out that Drs and hospitals will take payments, and they will except LOW payments, too. They make a lot of noise about wanting the payment 'now', just to apply pressure in case there really is $ available to the person now, but they will take payments. Whatever you can afford, just make it known that is ALL you can afford and then make on time payments. Take the best care of your mouth that you possibly can. It's worth every penny!

That said, you might consider going to an emergency room today, based upon what Bryanna has stated about the seriousness of your condition. :hug:

Thank you and I wish you the best with your situation. Please keep updating as I am genuinely interested.

Webinfusion,

Okay, thank you for sharing a bit more about your health. Yes, you have to be especially careful about having chronic infection as your immune system is already dealing with so much.

May I ask.... did your oncologist or your medical physician ever ask you about your dental health or specifically if you have root canaled teeth or periodontal disease?

I agree about offering to make payments due to the high cost of dentistry and the financial stress it can cause. Most dentists will consider taking on patients who commit to a set monthly payment amount. Frequently those cases that are costly require a substantial amount of $$ down first. The reason for this is.... #1 there will be costs incurred to render that treatment to the patient and the dentist does not want to have to put those out of their own pocket as there is no guarantee that the patient will follow through with the treatment and ...#2 it is not uncommon for additional work to be needed if something unexpected happens which would change the original financial arrangement.... #3 good or bad may happen in that patients life good (a vacation or other expensive expenditure) or bad (loss of a job or other) that would prevent them from making payments on their dental work. I am speaking about this from professional experience as a financial manager in the dental office setting.

Many offices also offer something called Care Credit which is an interest free line of credit through a credit agency for treatment over $200. There is no set up fee or monthly interest to the patient as long as they pay their minimum required amount each month to the agency. The dentist bills the agency for the dental work and he is charged to use the service. So that's another option people can look into.

Bryanna

HeatherKelly,

The adjacent tooth which is root canaled has some degree of infection brewing inside of that tooth as all root canaled teeth do. So that tooth could be exacerbating the infection in the sinus. What type of accident did you have? It is possible that the rc tooth fractured but was not diagnosed? Did the dentist mention that to you?

My personal opinion which is based on my professional experience in the dental field, dental schools are not really the ideal place to have tooth extractions or other oral surgery because the procedure tends to be less thorough than it should be and there is often very little expert post operative care given. Seeing a student for post operative complications is not acceptable but it is routinely done that way.

I understand that you tried to save money and wanted to use your insurance but now you'll have to seek additional care from an oral surgeon. Also a word about health insurance coverage... if you have dental coverage and you have an accident out of state, the insurance will most likely reimburse you something towards the cost of the emergency dental treatment. So in all probability you could have sought care from a private oral surgeon, paid his fee and then submitted a claim to your insurance explaining the situation and gotten reimbursed whatever amount you would be eligible to receive if you had seen someone in your state. The same goes for most medical coverage as well.

You need to see an oral surgeon to evaluate the extraction site, the rc tooth and the sinus. I'm sorry, but until you know why this is happening and have it treated accordingly, there is nothing I can recommend for you to do. I'm sorry.

Bryanna

[QUOTE=Bryanna;1193709]Webinfusion,

May I ask.... did your oncologist or your medical physician ever ask you about your dental health or specifically if you have root canaled teeth or periodontal disease?
Bryanna[/QUOTE

Hi Bryanna, No I was never asked about my dental history. That is a major flaw in the medical world, imo. They look at us as a grouping of parts that are not interrelated.

How are you doing, Heather? I hope you are feeling better....

As for me, I saw my oral surgeon this morning and he looked at the site and carefully checked for any sort of opening that might still exist. It has healed perfectly, so talked about all of the possibilities for what could be going on, and what to do next. He was very kind and thorough. He said he could take an xray, but I decided against images there, and will go to an ear, nose, throat Dr if it persists. They will want images too, and I don't want the double exposure.

Now for what I am doing on my own. I have been using diluted clove essential oil very carefully, inside my mouth on the gums and outside on my cheek. I dilute it with fractionated coconut oil, but you can use olive oil, or regular coconut oil, too. You MUST dilute it or it will burn and it hurts! Don't ask me how I know this ;-)

You can also do the same thing with oil of oregano as was mentioned, which I do have, but have not been using for this since I smell like an Italian dinner with that one, lol! I also use frankincense, undiluted. You need to make sure you buy therapeutic grade oils for this sort of use. The oils penetrate into the tissue and work on the inside in ways that oral antibiotics can only dream about.

As of today, I have intermittent pressure and then post-nasal drip. It is still somewhat smelly, but not as bad, and not ongoing, all day long, like before. So I believe I am healing, and will take the next steps if it worsens. :)

Webinfusion,

I truly hope your problem is not related to your sinuses because even though all of the essential oils that you are using are therapeutic, they cannot travel up into the maxillary sinuses via oral rinsing. Also if there is something still in the socket or in the sinus like a piece of tooth or other debris that is causing an infection, the oils will not have any affect on removing that irritant.

It's important to know that the gum tissue can close over an extraction site even if the sinus is infected. So without an xray, the oral surgeon can only see a limited clinical view. The xray also would have be helpful in determining if there were any tooth remnants, bony spicules or other irritants in the closed site. Does the oral surgeon know that you have cancer?

An ENT doctor often works in collaboration with an oral surgeon if a sinus infection is thought to be related to infected teeth or extracted infected teeth. That's because it is common for there to be an irritant, as I have mentioned above, in the site or in the sinus that is tooth related.

I know you are concerned about having any radiation.... I completely understand that. However, the radiation from a single dental xray is less than what you would get if you walked outside for a few minutes. If the problem does not go away completely on it's own, then please reconsider the dental xray as a first line of diagnostic measure before seeing the ENT.

I hope all goes well.... please keep us posted!
Bryanna




QUOTE=webinfusoin;1194701]

I appreciate your comments, Bryanna, and will definitely not ignore any signs that might indicate there could be debris in there! Thank you:)

Hi Bryanna,

OK, I'm back with an update. Things were not getting appreciably better, so I saw an ENT on Monday. He ordered a full set of sinus xrays. This was done at the hospital. They told me they showed inflammation in both maxillary sinuses. He prescribed 3 weeks of augmentin, 2 tabs per day with breakfast and dinner (I got the sub called IC AMOX-CLAV 875-125 MB TABLETS). I started yesterday, so have had 3 so far. I'm wondering, since I have never had this before, how long do reactions take if they are going to happen?

If there is debris in there would this type of xray show it? They imaged my head from all angles (yes I'm glowing now, lol!) so it seems like anything that shouldn't be in there would have been visible.

The pressure in on the right side of my face is actually more uncomfortable today. Could that be the antibiotics starting to work?

Hi webinfusion,

Thanks for checking in with us.

Sinus xrays specifically view the 4 different pairs of sinuses and can indicate the presence of a problem but they cannot determine the specific cause of the problem. These xrays may not show the upper arch of your mouth clearly enough to see if there is a retained tooth root tip, etc.

Why the antibiotic? Inflammation does not automatically mean infection. Sinuses can be inflamed for a number of non bacterial reasons especially when the inflammation is seen on both sides rather than just one. So the antibiotics should only be taken if there is a strong suspicion of an infection or a definitive infection has been diagnosed. If infection is present, then it needs to be determined what is causing the infection or the antibiotic will not cure the infection. If there are tooth remnants or root canal filling material still present in the tissue or bone, the infection will not go away.

Oral antibiotics take 24-48 hours to start to work on an infection. As far as a negative reaction to the antibiotics.... that could occur immediately, after a few days or even after a couple of weeks of taking them.

The worsening of the sinus pressure on the right side where you had the root canaled tooth removed is not a sign that the antibiotics are working. It is more indicative of a chronic problem caused by an irritant ... may or may not be infectious, could be environmental, allergies, etc.

A periapical dental xray of that upper right area might be helpful to see if there is tooth or bony fragments or other debris not removed during the tooth extraction. It has to be taken at an angle to capture the maxillary bone above where that tooth was taken from. So if you decide to have this done, just be sure to tell the technician that you need that specific area captured on the xray. Otherwise, she may take the xray straight on and not get that area in it.

Bryanna

There is definitely infection.

Are you saying a periapical dental xray would show something that the one I had, doesn't or can't? I thought this set of xrays would show it, if there was something in there? I asked that they be shared with my oral surgeon but I don't think he has gotten them yet.

If there IS something in there, would it be the OS who would remove it or the ENT? My guess is OS since it began with the tooth.

Thanks!!!

Webinfusion,

Definitely infection? Is that what the ENT said or did he say inflammation? Or are you going by your symptoms?

A periapical dental xray is a 2 dimensional view which is not ideal for some situations. However, when taken at an angle to specifically show the entire bony socket of where the tooth use to be, it can often detect tooth remnants and root canal filling material if these were left behind after the tooth was removed. This xray can also show if the periodontal ligament was removed or not during the oral surgery and also how the bone graft is integrating with the existing jaw bone. The radiation from a single digital periapical xray is almost non detectable.

It would behoove you to follow up with the oral surgeons office to give them a heads up that the scan is being sent to them. Tell them you want the os to call you with his opinion on it. If you want the periapical xray done, then just make an appt with their office to have that xray done and discuss the findings on the ENT scan and the periapical xray.

The os would be the one to go in and retrieve whatever remnants are present so long as they are attainable within reason via the mouth.

Bryanna

The ENT said, "Sometimes people think they have a sinus infection when they really don't." I replied, "OK. What would cause the smelly mucus if not an infection in my sinus?" To which he replied, "Well, sometimes the DO have an infection. In that case I would prescribe 3 weeks of augmentin. That should knock it out, and if not we go from there."

When I spoke with his office, his nurse said that inflammation was visible in both maxillary sinuses in the xrays and that he called in the prescription. So I am going by my symptoms and his statement and actions. I will also follow up with OS to see if he sees anything the ENT missed. Thank you!

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 Robert,

Were the molars previously root canaled?
Did the periodontist warn you ahead of time that there may be a sinus perforation or did he mention a perforation occurred during the extraction?
Is the air coming out of both nostrils?
I really don't know why he wants to put off closing the perforations unless he thinks they will close on their own.??

The best dental specialist to see for extractions of teeth is an oral surgeon. I know money is an issue but that is the type of dentist I would recommend that you go to for an evaluation. You would need to either bring your xrays or have them sent to the oral surgeon prior to your visit with him.

Please keep us posted.
Bryanna