Reviewed by Dr. Matthew Young, DDS
Reading time: four minutes.
If you had an upper tooth extraction, you might notice something that feels unusual, such as air movement near the extraction site or pressure around your cheek or nose. These sensations can point to a sinus perforation, a complication that can occur because the upper back teeth sit very close to the sinus cavity.
Table of Contents
- What Sinus Perforation Means
- Why Sinus Perforation Can Happen
- Symptoms Of Sinus Perforation After Tooth Extraction
- Treatment For Sinus Perforation After Tooth Extraction
- What Patients Should Avoid During Healing
- When To Contact Your Dentist or Oral Surgeon
- Schedule a Consultation
- FAQs
What Sinus Perforation Means
The maxillary sinuses sit directly above the upper molars and premolars. In some people, the roots of these teeth sit very close to the sinus floor or even extend into it. A sinus perforation happens when an opening forms between the tooth socket and the sinus after extraction. Dentists often call this an oroantral communication.
How Common Sinus Perforation After Tooth Extraction Is
Sinus perforation is uncommon, but it is not rare. Studies and clinical data show:
- Overall risk: Around 1 to 4 percent of upper molar extractions.
- Higher risk teeth: Upper first and second molars.
- Higher risk patients: People with thin sinus floors, long tooth roots, or existing sinus anatomy variations.
Most routine extractions never cause this issue. The risk increases with complex extractions, curved roots, infections, or wisdom teeth removal in the upper jaw.
Why Sinus Perforation Can Happen
Several factors increase the likelihood of sinus perforation after tooth extraction.
Tooth And Sinus Anatomy
Some people naturally have sinuses that sit lower in the jaw. This reduces the bone separating the tooth socket from the sinus.
Infection Or Bone Loss
Chronic infection around a tooth can thin the surrounding bone, making perforation more likely.
Surgical Complexity
Difficult extractions, fractured roots, or impacted teeth require more manipulation and increase risk.
Previous Dental Or Sinus Conditions
Past sinus surgery, cysts, or chronic sinus inflammation can weaken the area.
Symptoms Of Sinus Perforation After Tooth Extraction
Small perforations may cause few symptoms at first. Larger openings usually become noticeable quickly. Common symptoms include:
- Air movement through the extraction site occurs when air passes between the mouth and nose during breathing.
- Fluid leaking from the nose can happen when liquid enters the mouth and exits through the nose while drinking.
- Sinus pressure or pain may develop around the cheeks or under the eyes.
- A persistent bad taste or smell can appear due to sinus involvement.
- Delayed healing happens when the extraction site does not close as expected.
- Sinus congestion or infection symptoms may include pressure, nasal drainage, or headaches.
Your dentist or oral surgeon can diagnose a sinus perforation by performing an X-ray or CBCT scan.
Treatment For Sinus Perforation After Tooth Extraction
Treatment depends on the size of the perforation and how soon it is detected.
Small Perforations
Small openings often heal on their own with proper care.
- Sutures may be placed to close the gum tissue.
- A collagen membrane may support healing.
- Antibiotics and sinus precautions reduce infection risk.
Moderate Perforations
These usually require surgical closure.
- The dentist or oral surgeon advances nearby gum tissue to seal the opening.
- Protective membranes support bone and soft tissue healing.
Large Or Delayed Perforations
Larger openings or untreated cases may need advanced care.
- Surgical flap closure
- Possible sinus management in coordination with an ENT specialist
- Bone grafting if future dental implants are planned
What Patients Should Avoid During Healing
Proper aftercare plays a major role in recovery. Patients should:
- Avoid blowing the nose
- Sneeze with the mouth open
- Skip straws, smoking, and forceful rinsing
- Follow medication instructions exactly
- Attend all follow-up visits
When To Contact Your Dentist or Oral Surgeon
Call the provider that performed the surgery if you notice:
- Air or fluid passing between your mouth and nose
- Increasing sinus pain or pressure
- Signs of infection such as fever or worsening swelling
- An extraction site that does not seem to heal
Schedule a Consultation
A dental consultation is an opportunity to review your oral health, discuss goals, and receive professional recommendations in a comfortable setting. It allows you to establish care and understand available options moving forward.
To book an appointment at our dental office in San Francisco, CA, call (415)-392-8611. Visit us at 490 Post Street Suite 830, San Francisco, CA.
FAQs
Treatment depends on the size of the perforation and how early it is addressed. Small perforations may close on their own with sutures, protective membranes, medications, and strict sinus precautions. Larger openings often require a minor surgical procedure to seal the communication between the tooth socket and the sinus and prevent infection.
A sinus perforation is not always a medical emergency, but it does require prompt dental evaluation. Delaying care can increase the risk of sinus infection, chronic sinus problems, or delayed healing, so patients should contact their dentist as soon as symptoms appear.
Patients should avoid blowing their nose, using straws, smoking, forceful rinsing, or activities that increase pressure in the sinus. Sneezing should be done with the mouth open, and all post-extraction and medication instructions should be followed carefully to support proper healing.