Friday, February 23, 2007

I have a sinus communication

(This isn't my mouth, my tooth had to be sawed in half, then broken, then twisted out....the result is a sinus communication in my case, WHICH my doctor didn't advise me about AT ALL)

Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure--depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.


The todd said...

So... there's a hole between your mouth and sinus cavity? That's some crazy posting.

How long does this thing take to heal? Will it ever heal? If the sinus membrane is perforated, and there is no gelfoam, could you feasibly pass material through your mouth into the sinus??? I'm thinking... spagettini.

Sounds like a rough week for you She. Heal soon--I'm smelling coffee.

Sheyde said...

Well, I am told if the blod clot does its thing the hole should heal, although the chance is low. Yes fluid does go through it...I'm gonna find out if I can live with it, because to get it repaired costs more than my rent!!!! Besides me and that dentist will have words if this doesn't heal right!

I think coffee will be in order as well...just gotta get rid of a course and I think I will have time for it!!!

Simply Unpredictable said...

Ok, I'm going to ask something stupid.... how long did it take to heal to the point where fluid doesn't go through it?

The reason I ask something so stupid is I had a sinus exposure (or communication? I don't know which) with the removal of wisdom tooth #5 (labeled "1A") two weeks ago, and it's getting annoying feeling air come in through it, and have Listerine go up and out of my nose when I rinse.

diana said...

i have the same problem.just my dentist decided that the hole is not big enough and he stufed with plnty cotonwoll.the infection progress ,he change antibiotics but after one week all exploded in my mouth.i am still on antibiotics after aprox.a month. i use coton buds for ears dip in listerin 6 in 1 but the coton stick is not long enough to reach the top of the cavity.regular dentists study the site and advise me to go to a oral surgeon because this occrs very rare and they do not have the knoledge to deal GP refered me to a oral surgeon whitch i will see in a month time.the worst part is when i talk becouse i cannot use letters 'P' and 'B'.any advece???

Simply Unpredictable said...

Diana -- give it time. After I made my post begging for info (which, alas, I did not recieve, but I am mostly healed now). I can give you 10 easy steps to help with the healing process:

Important step #1: Keep it clean. Ask for a syringe... One that you can bend a little to get into right angle to squirt Listerine up there. The cotton swabs aren't doing anything since it's not reaching.

Important step #2: Keep it clean. Don't use full strength Listerine. Water it down to about 50% strength, or less. And, the Cool Mint flavor tastes best watered down... and if a few drops comes out your nose, it's fine. You may also be able to get a prescription for ProDenRx, which is also a pretty good antiseptic.

Important step #3: Keep it clean. Rinse every time you eat, and any time you feel it's not clean. It doesn't hurt to rinse more often.

Important step #4: Keep it clean. Sudafed (generic is fine) will help keep your sinuses dry. Dry sinuses heal faster than inflamed sinuses. You'll probably want to be on this until the hole is sealed. I recommend the real stuff and not the "new formula" and generic is fine. There is also a nasal spray from Ocean that's just pure saline.

Important step #5: Keep the pressure down. Don't say the letters "P", "B", "M", or anything else that may change the pressure in your mouth suddenly.

Important step #6: Keep the pressure down. Don't smoke. Don't use a straw. Don't blow your nose. Don't pinch off your nose. Don't "sniff your snot down". Don't snore.

Important step #7: Keep the pressure down. When rinsing your mouth, don't close your mouth to swish. This increases the pressure and could increase healing time. Also, don't spit forcefully. Let the liquid "fall" from your mouth and wipe your mouth afterwards. Spitting is like saying a "P" and that's a bad thing.

Important step #8: Keep the pressure down. Don't sneeze! If you feel the urge to sneeze, push up on the bottom of your nose between your nostrils (kinda like you see on TV when someone stops from sneezing). If you sneeze, you risk rupturing the think barrier that develops.

Important step #9: Give it time. You're not going to instantly heal.

Important step #10: Keep it calm. Don't do strenuous exercise or work. That puts extra stress on your entire body and will take longer to heal.

There's no "instant bandaid" you can use. If the hole is as small as you say, it'll take a couple weeks before a thin barrier will develop. This is when you'll notice nothing is moving between your sinus and mouth. You're almost there. A few more weeks on this regimen will allow the barrier to strengthen up to where you can slightly blow your nose and start drinking thin liquids through straws (no milkshakes or smoothies). Your oral surgeon will probably tell you all this.

dizzycat said...

Thanks for this post and the advice. My daughter has a perforated sinus after a tooth extraction, we have been given little advice apart from not blowing nose or using a straw. The surgeon even suggested my daughter was imagining the sensations she has felt even though we were not told that this can occur and had not even heard of it! only after googling her symptoms was it that I discovered what had happened and contacted the surgeon the morning after surgery unfortunately by this point she had been huffing air in and out of the hole and drinks!! She has been given a five day course of antibiotics and no oral hygiene advice, should she be doing mouth washes? how long should I keep her off school? would a blow to her head damage any healing? sounds harsh but she gets bullied and this does occur. any advice would be appreciated.

Simply Unpredictable said...

to dizzy cat: Just try to keep everything in my previous post in mind during the healing process. Chances are, it'll take a number of months to heal. My oral surgeon kept me on antibiotics for the four months it took for me to heal -- especially after I got an infection during the brief time I was off of them.

Keep it especially clean. Mouth rinses are ok, provided you don't pinch your nose while you're rinsing. You WILL get whatever you're rinsing into your sinus cavity. Don't fret... just be a little careful.

If you're concerned, don't feel bad about going to an oral surgeon for a second opinion. They're more used to dealing with these than a dentist.

Baby~on~board said...

I just had a molar pulled and my dentist is also certified to do oral surgery as well. She informed me after doing an xray that the tip of my root was in my sinuses and there was a posibility that it could puncture my sinuses on the way out and she would have to put in some stitches to sew it up.

I'm glad she told me this before hand because it did happen. She pulled the tooth then held my nose shut and had me try to breath through it to see if air would come out of the whole where my tooth had been. She sewed it up and told me to not blow my nose or sneeze for 5 weeks, also to avoid spicy food. This was a week ago and my stitches have since desolved and I haven't had any problems. She put me on Zpac because I am pregnant and didn't want to risk me getting an infection.

She also told me that if I couldn't avoid sneezing, to leave my mouth open and this would help keep the pressure down. She told me that I wanted to avoid pressure in that area as best as I could. She also told me that I could use all the saline I needed to and that I could suck in through my nose but not to blow out. She also recommended decongestants to help ease the discomfort of swollen, irritated sinuses. But I can't really take decongestants due to health reasons so I just deal with a little stuffiness as needed and take tylenol when I get a headache from it.

I don't know how much help this will be since my doctor knew what she was doing and it sounds like the ones you all have gone to didn't know.

I don't know if it will actually take the whole 5 weeks to completely heal or what exactly will happen if I accidentally sneeze or blow my nose. I assume it will just take longer to heal.

I'm sure that the fact that she put in stitches helped a whole lot. I haven't had anything come out my nose since this happened, not even liquids.

I hope that everyone else heals quickly.

Freyja212 said...

I just had a sinus communication. At first something smelled really bad coming out through my nose. I tried to sneeze, then the air came out through the hole left by the removed wisdom teeth. I was scared, but the dentist who removed my wisdom teeth said it will heal itself, and gave me prescription of amoxicillin. I also followed his advise, but today I can feel the air coming out without sneezing, what should I do?

Atlantis451 said...

A few ideas. I just got a sinus communication and am planning my protocol.

1- Mouth guard for eating. Possibly supplement with a strip of knotted cloth between the teeth.

2- Immediate irrigation with iodine. Rinse after five minutes. Repeat for up to a few days. But no more to avoid iodine poisoning.

3- Neti pot for sinus irrigation. Also... irrigate sinus directly with an irrigation syringe. Just tip the head and it should go right into the sinus. So flow is sinus to mouth and not vice versa.

3- Xylitol and Lactoferrin to combat biofilm. Per "chronic wound" strategies. Which in this case is to avoid having it turn into a chronic wound.

Atlantis451 said...

Oh... also hydrogel. I just bought some DuoDerm Hydroactive Gel. Which is a hydrocolloid. Competitor is Carrington Carrasyn V. My plan is to inject it right into the hole. Possibly impregnate with Xylitol and Lactoferrin. Possibly thin if needed to get it to squirt out the syringe.

Also should be able to get an irrigation syringe from your dentist. An endodontic needle will do. 28 guage is too thin. 23 guage is a good compromise. But more like 20 guage is good for flowing a thick fluid.

Anchorage said...

I also have a sinus communication. I had a CT scan and it said I had an obstruction in the osteal meatal unit, that's the part of the sinus that drains to the nostril. Until that obstruction is corrected, the communication can't heal. The sinus fluid is taking the path of least resistance through the tooth socket. It is NASTY stuff. Oh, and I have a sinus infection, no surprise. Now it's steroids and antibiotics. If that doesn't work to clear the obstruction, it's surgery to clear the obstuction and plug the sinus communication.

Counsellor said...

Thank you Simply Unpredictable - I have searched for days and you're the first post I've found to acknowledge the "p", "b" and "f" pressure problem. Those letters send a sudden shock in the form of pain to my tooth, or rather the hole next to it in the gum leading to my sinus. I had an apicoectomy 2.5 weeks ago. My surgeon said I could go back to work in 1 or 2 days! Well, I'm an adult ed teacher (amongst other things) and with the sinus communication talking to a room full of people is just a nightmare! I'm doing all the rinsing, steaming etc. and the pain (read that as only when pressure happens) seems to get much worse after class and for the next day or so. I know it's early days but the hole is a fair size - I could fit a matchhead into it, it's plainly visible above my premolar. How long did it take before you could function normally?

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Kody Mcclanahan said...

I have perferated sinus after extraction a month ago dr said itd heal on its own but i stil have air going n and out of it and its been a month no sites give me an estimated time on how long its gonna take to heal starting to get worried.. any help is very much appreciated

FreddieF said...

Most of these comments are from years ago. There area really three main ideas. First is keep it clean, which assumes it is already basically clean, with what you could call "passive-aggressive." Here you can use periodontal brushes, toothpicks, brush-picks to jostle everything. Likewise you can use the irrigator. And also use a Neti-pot. Here if you get mild streams of bloody stuff you are freeing up the bad stuff. You can also add a touch of iodine to the water. You can also buy 20 and 23 guage needles on the web and squirt stuff up their, like water, hyaluronic acid and DuoDerm hydrogel.

The negative of all this stuff mentioned is that it will also tend to break up any scab already formed and undo whatever healing has taken place. But normally what will probably happen, from my own personal experience is the edges will tend to come together within a few hours and you won't be any worse off than before.

The second idea is to get even more aggressive than I suggested before. This is if you are risk risky. But also keep in mind there are nerves up there and down there too. So there is a negative downside too. The third would be to put the main focus on the hydrogel and less on the physical debridement. This would be more in line with what a doctor would likely say is okay. With the 20 guage needle being the most practical. But also keep in mind that a sinus full of hydrogel isn't so great either.

I have had a bunch of sinus communications and have gotten everyone to close without extraction using DIYPERIO strategies, which are what I call nasty-nasty business and not for the faint of heart, but they have worked for me.

Laura Podczervinski said...

I just had several of my teeth pulled, one of my upper teeth left the whole to my sinus cavity also. I actually had tuna fish salad come out my nose. I was having major pressure when I ate, and found that was because food was being pushed into that hole when I ate. I've been back to the oral surgeon twice now. The first time he had to so my cheek to the hole in order to have enough skin to cover it. When it didn't heal I had to go back a week ago. At that time he did say that it looks better, there seems to be enough skin to show it. Not an hour after leaving the last appointment, the stitches begin to untie. I had string hanging out of my mouth. Anyway, I decided to reply to your particular post because I began to not be able to say the letter F. Now because more stitches have come undone I am unable to even talk without holding my cheek. I don't know what to do now. The dentist that I go to isn't exactly gentle with his needle. I just feel like all of the pain that I've gone through was for nothing. If anybody has any suggestions feel free to reply.

ScarletMicroscopist said...

Okay I am new to this thread. I recently (a couple weeks ago) had my upper tooth removed and I bet you all can guess what happened if I wound up here.

Now after clotting and other stuff stopped happening my dentist stitched some stuff (collagen) into the hole and told me I can't rinse etc. for a couple days.
I can still feel the hole as I attempt to talk (yes the dreadful letter mentioned above) I have been off antibiotics for the past several days and I am pretty sure I have a sinus infection as well.

I am planning on following some of the steps outlined here. I am very glad to have found this.
A couple questions:
How did everyone turn out?
What was the overall healing time.
When can I eat again? (I have lost 10-15 pound ....some I don't mind but I really was not heavy).

Did anyone get a mouth cover? I really wanted to try one.

Thanks for anything you can share.

Sickly said...

I had my entire top teeth pulled. A day later i cam down with a sunus infection. Over the next 6 months came down with 4 more sinus infections. Now i have just went through sinus surgery. Hoping this is the end of it now.

Sickly said...

I had my entire top teeth pulled. A day later i cam down with a sunus infection. Over the next 6 months came down with 4 more sinus infections. Now i have just went through sinus surgery. Hoping this is the end of it now.

sarah lee said...

I really enjoyed reading your article. I found this as an informative and interesting post, so i think it is very useful and knowledgeable. I would like to thank you for the effort you have made in writing this article.

Cynthia Mercer said...
This comment has been removed by the author.
Cynthia Mercer said...

My story is a bit different and complicated. I had been dealing with chronic sinusitis for 3/months that wasn't responding to traditional medical treatment. I was referred to ENT for right sided chronic maxillary sinusitis. He asked if I had any bad teeth. He said in 10% of cases that come to his office with one sided maxillary sinus infections they are due to having a bad tooth on the same side. I told him I had root canal done a month prior, but it was fine. A month later the root canal failed and the upper right molar was removed. After the extraction two weeks later on 11/17/2016 I saw mucus draining out from the extraction site and it was coming from my sinuses. I immediately went back to the Periodontist in which at this time she confirmed a sinus communication also known as an Oro antra communication. Which is an abnormal communication between my oral cavity and my sinuses. I was completely freaked out. She referred me back to ENT for Sinus Endoscopy surgery and to Oral surgery. I called my dental insurance and found out this type of surgery was not covered,which meant in order to have this done I would have to pay out of pocket over 2,500. I don't have that kind of money and now I was really worried. My periodontist would not touch me or look at the site because it was beyond her expertise. I then went to see my Primary medical doctor and informed her on what was happening. She said that we could possibly get this covered under Medical if we can show systemic effects on my system. A CT scan of my sinuses was ordered. The test came back showing I had chronic and acute sinusitis on the right side only and it showed that the extraction site had issues as well. This was the confirmation needed for medical to cover this procedure. I was referred to a Oral Maxillofacial surgeon. It is now two months that this sinus communication had been opened. After seeing the surgeon he looked at the site and said these type of communications can heal on their own if given the time. He thought the site looked like it was trying to heal and wanted to see me at three month mark. During the third month I started to experience no air rushing through the site so upon my third appointment I asked if he do a complete exam on the area again. He looked at the site no air coming was going through it, he tried to enter my sinus through a little bity hole and it would not allow him to enter my sinus. He felt that it had closed and had a thin film across. He wanted to wait until the forth month and just keep an eye on it. He said we don't want to have to do surgery if it is not needed. I agreed. The problem I am having with this is that I am still having sinus infections but now it is on both sides and having pretty bad headaches. So I went back to my regular dentist who knows all I've been through. He reexamined the site and also could not enter. He feels that the surgeon is correct in watching it. If it is closed it is closed. He felt that because I was I was suffering from sinus infections before the tooth was removed that this is strictly now just a sinus issue that needs further investigation. I don't know, I've literally been traumatized by this whole situation pardon the pun. The longer a sinus communication stays open it can lead to a Oro - Antral- Fistula and if that happens it will require a much more invasive surgery that looks horrible and very painful. My main reason for sharing my story is to inform people who do have this happen to them that it is possible for a sinus communication to close on its own and sometimes it takes many months for this happen and to also inform patients that if you are having chronic sinus problems due to this sinus communication and don't have dental insurance to cover it, you may be able to get Medical insurance to cover it. Hope all goes will for everybody. This has been a complete nightmare. I need a conclusion one way or another. Thanks

Unknown said...

After having an upper molar removed two weeks ago and now having a mild sinus oral communication, I am totally disgusted. I hope this heals up quickly on it's own. Although I was warned of this before having the problem tooth removed I NEVER would have thought this would have happened. I truly regret not trying to save the problematic tooth now. REGRET, that is my favorite with now. Going into my third week of slight oral sinus communication, I hope it heals quickly on it's own as the oral surgeon believes it will.

john smith said...

I have lost almost all the weight I gained after injuring my back. My surgeon has been amazing through all of this though. brisbane

superconscious said...

My problem is identical help

superconscious said...

Please let me know what happened. As I am facing the same problem. I have a sinus connection upper molar. As big as a matchsticks head.

Cynthia Mercer said...

Dear superconscious,
My oral surgeon feels that my sinus communication has healed on its own, it has took 4/months. I no longer lose air when blowing my cheeks up with air, nor due I feel air rushing though the extraction upon taking a deep breath. I'm still dealing with right sided sinus infections. I had a second CT scan done on my sinus recently through my medical insurance which showed I had right sided sinus issues. It also said that they could not rule out an Oral Antral Fistula at the site of extraction, I have mild maxillary sinus thickening.
My doctor and the test are contradicting themselves. I'm tired of dealing with this issue!! I took it upon myself to get a definitive answer. I did some research and found out that a special dental scan is available called a CBCT scan this is a Cone Beam Cat Scan which has absolute clarity to help diagnose a sinus communication or an Oral Antral Fistula. The problem with this is that it costs $250 dollars because my insurance won't pay for this. I will be getting this report read on 5/7/2017. My story may be different than yours, but I would say to you, to give it some more time to close because they can close on their own and it can take many months. I'm just tired of worrying that's why I'm going to the extreme. I need to know what I have to due to protect my sinuses. I hope by this time yours has closed!!

Evangeline Mitul said...

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carsonlewis1 said...

I just had a tooth removed during which a sinus communication occurred. The dentist put in sutures to close the hole and aid in connecting the tissue to close the hole permanently. It's been 4 days and no fluids or air are passing through. If it's been 2 weeks and you still have a communication you need to go back to the dentist and be referred to an oral surgeon to get this fixed. Not having this fixed could lead to chronic sinus infections in the future not to mention the annoyance of things passing from your mouth up into your sinuses.

Jeff said...

I too have an oac after getting a top molar pulled.
I am a chain smoker and am having trouble quitting.
To seal the 1/4 inch hole I used candle wax in the finger of a surgical glove, put in the micro wave to make it pliable, then fitted into the hole. I've been using mouth wash to keep the sinus irrigated.
My dentist sent me to an oral surgeon when it showed signs of infection, and he said to let it drain.the dentist had tried to plug it and sew it shut initially. Two times over a one week period. My medicare begins in four months and I am hoping it will cover it if surgery is indicated. I'm going to switch to sterilized salty water to irrigate with. Probably need to see the oral surgeon again soon.any information would be helpful please. I'm down to one meal a day and protein powder at night.

FreddieF said...

I have had a bunch of oral antral communications from DIY periodontal scaling and was pretty leaky for awhile. The bottom line as everybody knows is hygiene. One possibility, which I did, was using a neti pot, to drain the hole from the top down. Here I added honey, EDTA and hyaluronic acid. Some iodine is helpful too, but not too much too frequently or you will OD. Which I am pretty sure I did, leading to nervous twitches for a few days... Another idea is to make thick batches of water and hyaluronic acid and use either a periodontal brush or irrigation needle to put it in place. I bought a bunch of irrigation needles from a dental supply house. The thickest one I used is a #16 (I think). The #18 is okay too. But the #20 and #22 are too thin to hold much thickness. Can get vet syringes cheap too. Mostly I use the 10cc ones. Six to eight years later all of my holes are pretty well sealed off and hygienic still

Cush said...

Several years ago, I had a very deep cavity filled and my Dentist suggested that he put a crown on it. I remember him vaguely saying something about the root may have punctured my sinus cavity, but he wasn't sure. The comment went unnoticed until...5 years later... I wondered why I can't smell and have congestion on my left side, but nothing comes out when I blow. I finally see an Allergist ( thinking that I may have allergies). No Allergies! However, he proscribes Flonase and Prednisone. A week later, I having bronchial spasms that prevented me from moving to far away from my bathroom, if you know what I mean. Another week goes by and I see and ENT who gives me
a CRT scan of my chest and nasal cavity, and prescribes an antibiotic. I know you can guess what it revealed. That's right, a puncture in sinus cavity - the size of a needle point. I see my Dentist, who refers me to an Endodontist. The endodontist gives me a root canal and I go back to the dentist for my build-up. A month later, I see another ENT, who confirms the hole is still there and gives me Flonase and Prednisone again and tells me it's too small to operate on and it should heal on its own. Well, it feels like its the size of Texas, because I feel like I'm farming mucus, the expectorating is unbelievable, and I've lost an inch off my waistline from all the bouts of coughing, not to mention, I am still congested! I follow-up with the ENT in a month.