Can a Tooth Extraction Cause Sinus Problems?
Yes, it is possible for the extraction of an upper premolar or molar to cause problems with the nearby maxillary sinus.
In some cases, the complication is a hole or opening between the oral cavity (mouth) and the sinus cavity. In other cases, there is a chronic infection and/or inflammation between the two.
This article will help you understand the potential interaction between teeth extractions and sinus problems.
The Anatomy of the Upper Teeth and Sinus Cavities
In order to understand the potential for complications, you must first have an idea of the anatomy of these structures. The maxillary sinus cavities are air spaces in the skull just behind the cheekbones and just above the upper jaw. The floor of the maxillary sinuses rests on top of the roots of the upper back teeth. Generally, this involves only the molars, but some people have sinus cavities that extend further forward and rest atop the premolars as well.
The roots of teeth are surrounded by the jawbone, and the sinus cavities are lined by a thin soft tissue membrane. There is also a small ligament between the teeth roots and the bone, and all of these layers together can be as thin as just a few millimeters. So from the mouth side, you have root – ligament – jawbone – membrane – empty space (the sinus cavity).
Your dentist can usually show you how thin this separation is on a close-up dental x-ray. Anatomy-wise, the thinner these layers are, the higher the risk for damage during a tooth extraction.
Teeth related sinus problem causes
While the specific anatomy of the thin layer separating tooth and sinus plays an important role in the risk for complications during an extraction, there are other factors that can have an impact as well.
Chronic Dental Infection
When a dental infection is present in a tooth, it often rapidly spreads to the surrounding ligament and bone through a tiny pore in the tip of each root. The infection can then destroy healthy tissue, creating an actual hole. It is possible for this to occur at the end of an upper molar that has roots extending upward into the maxillary sinus cavity. Untreated infections will often destroy the ligament, bone, and membrane that separates the tooth from the sinus. Thus, when the tooth is removed, the hole is automatically present.
When a tooth has roots with drastic curvature or “bends”, it makes damage to the surrounding bone more likely. In many cases, the dentist must remove the surrounding bone to get the tooth out. This predisposes the already thin bone to fracture during the tooth’s removal.
Quality of Bone
The health of the jawbone plays a substantial role in the risk for communication between the mouth and sinus cavity. Someone with weak, brittle bone (i.e. osteoporosis) is more likely to experience complications with tooth extractions.
How to Avoid Sinus Complications
In many cases, it is impossible to avoid sinus complications with an upper tooth extraction. This is simply due to the anatomy of the tooth, bone and sinus. However, it is important to take every precaution against them.
What Your Dentist Will Do to Reduce the Risk of Sinus Complications
Your dentist will perform thorough pre-operative planning before an extraction, which includes imaging with dental x-rays. In some cases, the dentist can tell from the x-ray that a sinus complication will occur. This is typically due to severe or chronic infection surrounding the tooth’s roots.
Your dentist, knowing that the separation between tooth and sinus is very thin, will take additional precautions during the surgery itself to protect that delicate bone. This can involve the use of dental lasers or dental drills to aid in the removal of the tooth, making it less traumatic to the tissues.
A general dentist, anticipating a high risk for sinus complications, may refer the patient to a specialist for the extraction. It is appropriate for both oral and maxillofacial surgeons and periodontists to extract this type of tooth.
What You Can Do to Reduce the Risk of Sinus Complications?
It may seem as if you have little control over whether you experience complications following a tooth extraction, especially those regarding the sinus cavities. That is true when it comes to the actual surgery. However, there are ways you can lower the risk for this complication by being preventive.
The most common reason people experience complications between the mouth and sinus cavity is the presence of chronic or severe dental infections. Unfortunately, these infections can often be asymptomatic (causing no pain). That causes some people to put off the extraction of a tooth. The reason that if it isn’t bothering them, it must not be important.
The danger lies in the infection, which is slowly worsening in the surrounding bone and destroying the tissues between roots and sinus cavities. The way that you can lower the risk of a sinus complication is by proceeding with the tooth extraction when your dentist recommends it instead of waiting until you notice pain and/or swelling.
What is an Oro-Antral Communication?
An oro-antral communication is a physical hole between the mouth (oral) and sinus (antral). This occurs when the thin layer of separating tissue is either broken by the force of extraction or destroyed by an infection.
This creates a dangerous situation, which allows bacteria, mucus, and food debris to move back and forth between the mouth and sinus. Both the mouth and sinus cavities contain bacteria, but they are distinct strains, and they should remain separate.
Some oro-antral communications can heal on their own, and others require closure with oral surgery. Close monitoring is necessary to ensure that the communication re-seals as quickly as possible.
What to do if You Have an Oro-Antral Communication
The first, and most important, thing to do as a patient experiencing a sinus complication is to follow your surgeon’s post-operative instructions as quickly as possible!
In order to reduce the passage of material between the oral cavity and sinus cavity, you should not chew on the side of the defect.
You should also take measures to address any allergies or sinus inflammation that could cause forceful sneezing, nose-blowing or sniffling. In order for the tissue to heal quickly, you must eliminate all disruptions to the area, including those caused by forceful air flow.
Your surgeon will assess the situation at the time of extraction to determine whether additional “help” is needed for healing. If the oro-antral communication is significant in size, he or she may elect to seal the socket with a dressing and secure it with stitches.
Does an Oro-Antral Communication Affect the Ability to Replace the Tooth with a Dental Implant?
Many people choose to replace an extracted with a dental implant, which is a wonderfully predictable and successful treatment. Dental implants require healthy bone to surround them in order to function properly.
If you have suffered an oro-antral communication, it could affect your ability to have a dental implant in the future. You may require additional surgical procedures, such as bone grafting, to encourage healthy bone to fill in the socket.
Many patients require a procedure known as a “sinus lift” to create additional space for a dental implant replacing an upper molar or premolar. Sinus lift procedures typically include some type of bone grafting to promote the highest success rate.
Dr. Lara Coseo
Having practiced general dentistry for 13 years, Dr. Lara currently serves as an Associate Professor at Texas A&M College of Dentistry.