Sinus Communication Issues After Dental Procedures

Q: Sinus Communication Issues After Dental Procedures

Hello： <br>1. <br>It is possible for an intentional replantation surgery on the maxillary posterior teeth to result in an oroantral communication during the procedure; however, after the tooth is replanted, the passage between the oral cavity and the maxillary sinus should close,

The issue of oral cavity communication?

Hello Dr.
Liu,
I would like to ask you a few questions.
I underwent intentional replantation surgery on my upper left second molar in late November, and it has been over a month since then.
The tooth still feels slightly painful, and I have been experiencing a lingering cold with intermittent nasal discharge.
Additionally, when I press on the bone near the affected tooth on my left cheek, it is somewhat painful (I also feel a pulsating sensation near my left eye socket during the pressure), but there is no pain when I am not pressing.
Since it is an upper molar, I am very concerned about the possibility of an oroantral communication.
There is not much information available online regarding this issue, so I would like to ask you:
1.
Is there a possibility of oroantral communication occurring after intentional replantation or standard root canal treatment?
2.
What symptoms can patients use to self-assess the presence of oroantral communication?
3.
I read online that when oroantral communication occurs, drinking water can lead to fluid flowing from the nose.
Would this symptom also occur after intentional replantation or root canal treatment, given that the tooth is still present?
4.
What are the common causes of oroantral communication? If the dentist did not cause it during the procedure, could it occur due to patient negligence (for example, from forcefully blowing the nose)?
5.
Which dental specialty should I consult for this situation?
Thank you, Dr.
Liu.

Leonard, 30~39 year old female. Ask Date: 2004/12/29

Dr. Liu Tiancai reply Dentistry

Hello:
1.
It is possible for an intentional replantation surgery on the maxillary posterior teeth to result in an oroantral communication during the procedure; however, after the tooth is replanted, the passage between the oral cavity and the maxillary sinus should close, and root canal treatment itself does not cause oroantral communication.

2.
Patients typically notice oroantral communication when water flows out of their nose, they experience difficulty smoking, or they have yellow, foul-smelling nasal discharge.

3.
After intentional replantation surgery, as mentioned, the socket from which the tooth was extracted should close due to the replantation, so there should not be any situation where water flows from the nose (in other words, if the tooth is still in place, theoretically there should be no oroantral communication).

4.
There are many causes of oroantral communication, with the most common occurring during tooth extraction (especially of the maxillary molars).
Sometimes, after extraction, the roots of the maxillary molars may be located directly beneath the maxillary sinus, with only a thin membrane separating them.
Experienced practitioners usually advise patients to be cautious and avoid actions that increase sinus pressure, such as using straws or playing wind instruments.
If a patient inadvertently sneezes without opening their mouth, it is possible for this membrane to rupture, leading to oroantral communication.

5.
This issue is typically addressed by oral and maxillofacial surgery.

6.
Your problem does not necessarily appear to be related to oroantral communication for the following reasons: (1) The distance between the premolars and the maxillary sinus is generally greater, and premolars are usually not directly beneath the sinus (they are typically located to the side), making oroantral communication less likely; (2) Since the tooth has been replanted, there should not be a communication issue.
If there is a connection between your nasal discharge and the replantation, it is possible that there was indeed oroantral communication during the surgery, which could have led to sinusitis.
However, based on your description, these seem to be unrelated issues (since root canal treatment has already been performed, the chance of contaminants entering the maxillary sinus through the root canal system is low).
I recommend visiting a hospital with an oral and maxillofacial surgery department for a diagnosis, as there are exceptions to all the situations mentioned above.

Dr.
Chen Yi-Chou, Dentistry

Reply Date: 2004/12/29

More Info

Understanding sinus communication issues after dental procedures is crucial for both patients and dental professionals. Sinus communication, or oroantral fistula, can occur when there is an abnormal connection between the oral cavity and the maxillary sinus, often as a result of dental extractions, particularly of the upper molars and premolars, or surgical procedures like intentional replantation.

1. Possibility of Sinus Communication: During intentional replantation or root canal treatment, the risk of sinus communication is generally low, especially if the procedure is performed correctly. However, if the roots of the upper teeth are located close to the sinus floor, there is a potential risk of creating a communication. This is more common with upper molars due to their root anatomy. If the procedure involves significant manipulation or if the tooth is deeply embedded, the risk may increase.

2. Symptoms of Sinus Communication: Patients can self-assess for potential sinus communication by observing certain symptoms. Common signs include:
- Persistent nasal discharge, particularly if it is foul-smelling or discolored.

- Fluid leaking from the nose when drinking or blowing the nose.

- Pain or discomfort in the upper jaw or sinus area, especially when pressure is applied.

- Swelling or tenderness in the facial area near the affected tooth.

- Difficulty breathing through the nose or a feeling of nasal congestion.

3. Fluid Leakage from the Nose: If a patient experiences fluid leaking from the nose when drinking, this is a classic sign of sinus communication. In the case of intentional replantation, if the tooth is still in place and functioning, the likelihood of this symptom occurring should be minimal. However, if there is any doubt, it is essential to consult with a dental professional for evaluation.

4. Causes of Sinus Communication: Sinus communication can be caused by various factors, including:
- Surgical trauma during tooth extraction or dental procedures.

- Pre-existing anatomical variations, such as a thin bone separating the sinus from the oral cavity.

- Post-operative complications, such as infection or excessive force applied by the patient (e.g., forceful nose blowing).

- In some cases, patients may inadvertently contribute to the problem by engaging in activities that increase sinus pressure, such as sneezing without keeping the mouth open.

5. Consulting the Right Specialist: If you suspect sinus communication, it is advisable to consult an oral and maxillofacial surgeon or an oral surgeon. These specialists have the expertise to diagnose and manage complications related to sinus communication effectively. They may recommend imaging studies, such as X-rays or CT scans, to assess the situation accurately.

In summary, while sinus communication is a potential complication of dental procedures involving the upper jaw, understanding the symptoms and causes can help in early identification and management. If you experience any concerning symptoms, it is crucial to seek professional advice promptly to prevent further complications and ensure proper healing. Regular follow-ups with your dental care provider are also essential, especially if you have ongoing discomfort or other symptoms.

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