I had to have all of my upper teeth extracted. One of the teeth, a molar, perforated my sinus cavity during the procedure. First, my dentist did not even tell me that this was a possibility. Does this mean he messed up? Also, there were problems from that. I want to give you a sort of order of events and get your advice.
- I wasn’t told until the next day that there was a perforation.
- By the fourth day, there was cracking and popping. They suggested that I take Sudafed. That did not help.
- That night I developed a fever of 102-degrees. The next day I called them and they phoned me in an antibiotic.
- Over the next few days there was no change in my fever.
- I went back and they removed some bone pieces and put me on a stronger antibiotic.
- I’m two weeks out and I still have a fever and pain.
I’ve sort of lost faith in this dentist and don’t know what to do.
Micah
Dear Micah,
Your dentist made several mistakes here and, in your place, I would insist that he pay for any subsequent treatment to get this fixed. If he gives you trouble, write me back because he could be in some legal trouble. The first thing I want you to do is see an ENT. You want to get this dealt with because at this point you’re in a situation that could easily turn into a dental emergency.
Before your dentist did any work on you, they should have provided you with a list of possible complications. While a sinus perforation with a tooth extraction is not a regular occurance, it is also not that uncommon, there are protocols, one of which is that he should have alerted you to it immediately. They also should have started treatment for the perforation the same day. There is a good post on another blog that outlines post-doctoral care of a sinus perforation. You can read that in its entirety here, however, I will quote the relevant parts below.
If the dentist suspects that the sinus has been perforated, he or she can ask the patient to blow their nose, and the dentist will see a bubbling of air in the socket. The typical treatment is to pack the tooth socket with a biocompatible resorbable sponge material called gelfoam, which accelerates the growth of tissue to cover the perforation. Or bone grafting material can be carefully placed in the socket. If it’s not too difficult, the dentist can also suture soft tissue over the tooth socket, which also helps accelerate that process. But if it would be too traumatic to move soft tissue to that position, that isn’t necessary. Then the dentist will instruct the patient not to blow their nose for a few days, to give that tissue time to heal without disruption. The opening then heals over with soft tissue, and then gradually over a few months’ time, new bone grows in the socket and the sinus membrane completely heals.
If the dentist has any question about whether any tooth fragments were pushed up into the sinus, he or she may refer the patient to an ear, nose, and throat specialist (otorhinolaryngologist) for an x-ray to check whether or not the sinus is clear.
Leaving a root tip of the tooth in the bone should not cause any problem. There is a tiny risk that it could cause an infection and later need to be removed, but there is a much greater risk, in this situation, associated with trying to remove it now, while there is an opening directly into your sinus.
The first thing I want you to do is get an urgent care appointment with an ENT. Don’t ask your dentist to recommend one. Pick one yourself. The ENT should be able to help you.
This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.