The image to the right is detail from a panoramic film.The roots of the upper back teeth are always in close approximity to the maxillary sinus. Since everyone is built differently, the roots of the teeth may actually appear to be inside the sinus. There is always a thin wall of bone between the root and the sinus, but can be very thin indeed. Most of the time, the bone remains intact, but upon occasion, a piece of the bone separating the root from the sinus may break off and be removed with the tooth. This creates a direct connection between the sinus and the mouth! That means that you would be unable to suck on a straw, because air would rush into your mouth from your nose through the socket.
When a sinus perforation occurs, the dentist will prescribe an antibiotic to prevent infection and a decongestant to keep the sinuses clear during healing. The patient bites on his gauze as is usual after any extraction, and a clot will form in the socket as usual. If nothing disturbs the clot, it will organize during healing and close the perforation. Dry sockets rarely happen after extraction of upper teeth unless the patient smokes.
- It is IMPERATIVE, however that the patient do NOTHING that could disturb the clot.
- Do not suck on anything for at least a week. This puts pressure on the clot and could dislodge it into the mouth.
- Do not smoke…the longer you wait the better. This will dissolve the clot, or could even suck it out of the socket.
- Do not blow up balloons or anything else. This puts pressure on the clot and could dislodge it into the sinus.
- Avoid sneezing. This explosive event will definitely dislodge the clot. If you must sneeze, do so with your mouth open. This will allow pressure to go out through your mouth instead of your sinus.
In the case of very large perforations, or in case the clot dislodges and a perforation between the sinus and the mouth remains after healing, It may be necessary to perform a further surgical procedure in order to draw a flap of gum tissue over the perforation to close it permanently.