The upper posterior teeth are located just below the maxillary sinus. The sinus is a large hollow space in your cheek bone on either side of your nose which helps to humidify and warm the air that you breathe in. As we age, the sinuses enlarge, especially when upper posterior teeth are missing or have been extracted.
The sinus bone above the teeth is thin and if your roots are long or close to this bone, an opening in the sinus may occur during a dental extraction.
If dental implants are desired in the posterior upper jaw but the jaw bone itself is “too thin” vertically, your surgeon may have recommended a “sinus bone graft” (a sinus augmentation). The bone is added between your jaw bone and the maxillary sinus membrane (which lines the inside of the bony sinus). To make room for the bone, the sinus membrane has to be moved upward, or "lifted" and then bone is grafted.
It is sometimes possible to perforate into the actual sinus with either an extraction or a sinus-lift bone graft. This small opening theoretically can allow bacteria from your mouth to enter your sinus and create a sinus infection. We will close any sinus openings with stitches or other materials at the time of your surgery.
The following instructions are intended to aid in sinus healing by preventing infection and to allow the sinus membrane communication or opening to seal up. Please follow them for 2 weeks in addition to your other post-operative instructions:
I had an upper right molar extracted about six months ago. I have throbbing in my upper teeth, burning, and even drainage. Sometimes it feels like liquid is getting in my nose when I drink. Is this a sinus infection or a perforated sinus?
Kelly
Dear Kelly,
After six months, a sinus perforation should have healed. If it hasn’t, that is serious. One way to know is if you close your mouth and try to blow through your mouth, puffing out your cheeks. If you can do that and hold the air in your mouth, there is no perforation. If there’s a perforation, air will bubble up through your nose.
It is more likely a sinus infection. Our sinus cavities are very close to our tooth roots and can sometimes radiate pain into your teeth. It can also cause burning and drainage.
Either one of these needs to be treated. A perforation would be considered a dental emergency, especially this far out. My recommendation is you see an ENT. If it turns out your sinus was perforated and your dentist didn’t notify you, he (or she) should pay for the repair.
In June, my dentist extracted two teeth, and I’m waiting to get dental implants. For one upper right tooth, my dentist said he could see into my sinuses. He prescribed antibiotics for me to take for a week. I didn’t have any special instructions other than taking antibiotics. My other tooth healed fine, but the sinus perforations still isn’t closed. My primary care doctor prescribed more antibiotics. I have a continual headache and a low-grade fever. How long does it take for a sinus perforation to heal? It’s going to be months before I can get dental implants. I think I need a second opinion. Am I going to need an oral surgeon or an ENT doctor to close the perforation? Thanks. Clay
Clay,
It seems that your dentist doesn’t how to handle a perforation that doesn’t heal. It’s wise to get a second opinion.
How Long Will Does It Take for a Sinus Perforation to Heal?
If your sinus is perforated from tooth extraction, the tissue normally heals within four to six weeks. Bone grafting is often needed, though, and it will heal in about six months. If a perforation from an extraction doesn’t heal, there are several possible causes. Two possibilities include:
- A root tip from the tooth is pushed into the sinus
- A bone fragment remains
Has your dentist or primary doctor sent you or an x-ray of your sinus? It’s best to visit an otolaryngologist (ear, nose, throat (ENT) specialist) who will request an x-ray, see I something if blocking the sinus, remove it, and ensure the infection goes way by prescribing more antibiotics.
If there is a bone fragment in your sinus, it’s good that your dentist didn’t close the perforation. The irritation from the fragment would cause ongoing infection and fluid drainage into your mouth and nose.
Closing a Sinus Perforation
After sinus perforation and bone grafting heal, you can receive dental implants
How is a sinus perforation closed? Although your doctor might have a specific technique, the procedure includes steps like these.
- Place collagen plugs or another resorbable membrane in the tooth socket
- Gently place bone graft around the sides
- Secure the bone graft and protect the site with another collagen plug or resorbable membrane
- Stitch the membrane over the graft to keep it in place
After closing the perforation, a specialist will prescribe antibiotics, and based on the severity of your infection, tell you how long to take them. You’ll have follow-up appointments to ensure the area heals well.
Tell your ENT doctor about your plans for dental implants to replace your two missing teeth. The doctor and your implant dentist can discuss the optimal time for implant placement. Both the perforation and bone graft must heal before you receive dental implants. Otherwise, the implant and your jawbone won’t fuse, and the implants will fail. Be patient.
Steven Brooksher, DDS, a Baton Rouge dentist and Fellow of the International Congress of Oral Implantologists, sponsors this post.