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Dr. Thomas

What’s Taking So Long for a Sinus Perforation to Heal?

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A woman holding her nose because a sinus perforation is unhealedAfter I had an upper right molar extracted, the dentist told me I had a sinus perforation. A piece of bone came out. I thought it had healed, but I felt something strange after blowing my nose two days ago. The point of extraction pushed away from my gums. Will this heal, or do I need to do something else? The extraction was in early February. Should I be concerned? Thanks. Marlo from San Diego

Marlo,

The perforation should have healed in almost five months. However, if air continually passes through it, healing can be challenging. You should seek care from your dentist or get a second opinion.

The dentist who completed the extraction should have followed up or referred you to an oral surgeon. If the dentist is still practicing, you can return for a resolution. A sinus perforation can happen with any extraction, especially with long tooth roots or tooth roots that touch the sinus, only separated by a thin layer of bone or membrane. The dentist should realize a perforation occurred and provide treatment to close it, following the case until you’ve healed.

You can follow up with your dentist and request a referral to an oral surgeon if your dentist cannot resolve the issue.

Sugar Land, Texas, dentist Dr. Siny Thomas of Cornerstone Dentistry sponsors this post. Read about Dr. Thomas’s commitment to giving his patients the best dental care possible.

Do I Really Need 17 Teeth Extracted?

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Mature woman with a tense face portraying concern about tooth extractionsI lost several teeth due to bone loss from gum disease. After gum disease treatment, my dentist wants to extract my 17 remaining teeth and replace them with upper and lower dentures. Some of my teeth are stable, and I don’t have any problems with them. Is my dentist’s recommendation overtreatment? Is it risky to keep my teeth since I have a history of gum disease? Thanks. Wynn from Georgia

Wynn,

Dentists with a conservative approach strive to preserve teeth whenever possible. However, saving a tooth can be challenging for some dentists. You are not at risk by saving healthy teeth.

Replacing only the unsavable teeth may be better to reduce the stress on your remaining teeth and help them last.

You can get a second opinion from another dentist without revealing your dentist’s recommendation to remove your remaining teeth. It’s better for your oral health if your dentist or another dentist is willing to try to save as many teeth as possible.

Maintaining healthy gum tissue requires a dental hygienist to clean your teeth and roots to remove tartar accumulation thoroughly. Some dentists recommend more frequent dental or deep cleanings for patients with a history of gum disease. Your dentist and hygienist will also closely monitor your teeth and gums. You must also commit to diligent oral hygiene and regular dental cleanings and checkups. Floss between your teeth daily and brush at least twice daily to protect your remaining teeth.

If you need complete dentures, consider stabilizing them with dental implants to preserve your jawbone. Otherwise, individual implants can restore the function of your missing teeth and your smile.

Sugar Land implant and cosmetic dentist Dr. Siny Thomas sponsors this post. Read how he strives to give patients some of the best dental care in Sugar Land.

Sinus Perforation with a Tooth Infection

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I had a molar extracted. Four days later, I called letting them know there is a popping sound in the right side of my nose, which is the side of the extraction site. That is when they told me there was a small sinus perforation, which they described as routine. They suggested I take Sudafed, which I did. By the next day, I had a 102-degree fever. They called me in an antibiotic, but by day 10 of this, I was getting worse instead of better. I called asking for a referral to n ENT, which they provided for me. Should they have to pay for this?

Carol

Dear Carol,

Woman holding her jaw in need of an emergency dentist

Your dentist has not handled this properly. I’m disturbed by the fact that they didn’t tell you about the sinus perforation with your tooth extraction until four days later. Even then it was only because you called and told them there was a problem. There is a standard treatment for this type of thing, which does happen sometimes. In most cases, with the right course of treatment, it is no big deal and heals quickly.

First, they should have informed you right away and asked you not to blow your nose for a few days in order to aid healing. There is also a biocompatible resorbable sponge they can pack the area with called, Gelfoam, which will help the tissue to regrow sooner.

When healing doesn’t take place, it can mean there is a piece of bone that not only broke through your sinus cavity but was left there. This can lead to infection. I suspect this is what happened in your place.

Going to an ENT is the right course of action for you. It also sounds like you may be on the wrong antibiotic. The infection should be healing by now. When you call the ENT, let them know what is going on so they can write you a new prescription for the proper antibiotic. You’ll want to get this under control before it turns serious.

Additionally, I would insist your dentist pay for this treatment that is now required. If he doesn’t do that, let him know you’ll be in touch with the dental board. That should sober him up and help him see how reasonable you are being.

Tooth Replacement Options

At this point, I do not have confidence that your dentist has given you all the correct information here. As such, you should know that it will be important you replace your missing tooth as soon as possible. With an open space in your jaw, your adjacent teeth will eventually start to shift or tip into the open space. When this happens it can lead to painful TMJ Disorder and expensive orthodontics. Replacing the tooth now will save all of that.

Your top two tooth replacement options are a dental implant (that best option) or a dental bridge (the second-best option). Though, there are times that second-best is a good idea if you already have a tooth adjacent to the missing tooth needs a dental crown already.

If you decide on the dental implant, please make sure your dentist has the training to do this properly. Too many dentists do not, which is one of the reasons implant procedures are one of the leading causes of malpractice suits.

This blog is brought to you by Sugar Land Dentist Dr. Siny Thomas.

When are Steriods the WrongTreatment with a Root Canal?

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I had a root canal treatment done along with a dental crown a few months ago. It started hurting again. I went to see my dentist. When he x-rayed the tooth he didn’t see anything. Because of the pain, he referred me to an endodontist who placed me on an antibiotic. That helped for a bit. I revisited and she said it would only get better from there. It seemed to and then it flared up something vicious. Now she’s prescribed me some steroids but they don’t seem to be helping. Where do I go from here?

Corinne

Dear Corinne,

Woman holding her jaw in need of an emergency dentist

I’ve got several problems with how your treatment has been handled. I’ll work back to front regarding what she has done wrong here.

Steriods as a Treatment with Root Canals

Steroids are an anti-inflammatory treatment.  This means it will control swelling and inflammation. Sometimes that is useful. Other times it is counter-productive. How do you know when it is a good idea and when it does more harm than good? The swelling that comes when there is an infection serves an important purpose of bringing in white blood cells in order to help battle that infection. If you use an anti-inflammatory when you are dealing with an infection, you are essentially shooting yourself in the foot.

That leads me to my second issue here. Endodontists are supposed to be experts in root canal treatments. As such, she should know that they often need a secondary treatment. Some of those canals are hidden or hard to reach. It is not uncommon for a tooth to need a second treatment. As an endodontist, this should have been obvious when the tooth flared back up that it was possible you’d need more than just an antibiotic. Then, when it flared back up after the antibiotic, to me, that was a no brainer. Steroids were the wrong treatment and you needed a root canal re-treatment.

A third issue I have is that they put a dental crown on the tooth before being certain it was a successful treatment. This makes it much harder to re-treat because you have to drill a hole through the crown. There is limited visibility this way.

My first piece of advice to you is to get a new endodontist. After that, you have three options:

  • 1. Root canal re-treatment
  • 2. Root canal surgery
  • 3. Extraction of the tooth.

If you do end up having to extract your tooth, it will be important to replace it. The best replacement is a dental implant. However, it does require someone with real expertise. Make sure you go to a dentist who knows what they’re doing. The best implant dentists are fellows with the International Congress of Oral Implantologists.

This blog is brought to you by Sugarland Dentist Dr. Siny Thomas.