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tooth extraction when root is in sinus cavity

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Unread 02-03-2009, 11:05 PM   #51
rams
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Default root pushed into sinus cavity

Quote:
Originally Posted by Bryanna View Post
Hi Miranda,
To answer your question....
Does this mean that it is definitely going to involve extraction of teeth with roots in the sinus cavity?
No, not all upper back teeth have roots in the sinus. Depends on the anatomy of your sinuses and the length of the roots of your teeth.

Sinus exposures are not uncommon during extractions of maxillary posterior teeth. They are usually not a cause for concern and can easily be repaired. Sometimes the perforation into the sinus is so small that it just heals on it's own.

There are usually two (rare) situations that would be of concern:
One is if a tooth were severely abcessed and the the infection had invaded deep into the sinus cavity.
The second would be if the root of a tooth were broken off during an extraction and it was pushed up into the sinus.

Both of these situations are rare and not something that you should worry about. If you had an abcess that caused a severe infection into the sinus cavity, your dentist would have already told you about it.

The novocaine shots that you said were painful may have been when you were given an injection in the palate. Extraction of upper teeth requires a palatal injection and they can be a bit ouchy. However, this area numbs up very quickly so the subsequent injections in that area should not be uncomfortable.

The burning pain that you described in the roof of your mouth could have been an irritation in the surgical area from something you ate. Or, you could have developed a canker sore in that area, which is very common after oral surgery for some people.

Have you ever tried homeopathy for pain relief? I have lots of patients who have great success using Arnica, Belladonna, Hypericum, Ruta, or Staphysagria. Each of these does something a bit different and not all are necessary to take. A google search on each of these which regard to dental anxiety and oral surgery pain, could give you some insight into which one may be helpful to you.... if you choose to try it.

Hope this information is helpful to you.
Bryanna
Bryanna,

Reading your post, I have one of those "rare" situations to worry about.

During an extraction of my upper molar (nearest to wisdom tooth) the dentist lost the tip of the root. It appears he pushed it into the sinus cavity while trying to extract it.

The root tip is about 1/4 inch long (sized by looking at what is missing from the tooth).

Questions:

1) Is it possible to leave this alone unless it causes problems.

2) If it must be removed is there a better procedure than a Caldwell-luc.

I have researched this on the internet and the normal procedure seems extremely invasive just to remove a small piece of root.


3) Or what would you recommend?
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Unread 02-04-2009, 07:15 PM   #52
Bryanna
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Hi Rams,

Well I can see that you've been doing some reading! Good for you!

The procedure to remove the root tip depends on where it is located in your sinuses. The Caldwell luc is considered a very invasive procedure and is typically done to remove tumors or large cysts. Sometimes, the combination of the caldwell luc and transnasal endoscopy can be done which is a bit less invasive because the endoscopy is the primary entry from which the matter is removed.

Generally, a root tip that has been pushed into the sinuses is first monitored with panoramic xrays and then a CT scan to see the exact location and to see if a cyst has developed around the root tip. Sometimes no treatment is needed and other times it is best to surgically remove it. If the root tip ends up with a growth of tissue around it like a barrier, it could block off some of the natural openings in the sinuses causing infection and difficulty breathing through that side of your nose.

If it were me, I would have the area monitored periodically to see if any changes are taking place and also be aware of any symptoms of blockage or infection.

If the root tip is not far up into the sinus, then it may be surgically removed with a minor caldwell luc procedure. But it is imperative that a surgeon who is well versed and well skilled in this type of procedure be sought to do it.

Please let us know what you decide to do........ all the best to you!!

Bryanna




Quote:
Originally Posted by rams View Post
Bryanna,

Reading your post, I have one of those "rare" situations to worry about.

During an extraction of my upper molar (nearest to wisdom tooth) the dentist lost the tip of the root. It appears he pushed it into the sinus cavity while trying to extract it.

The root tip is about 1/4 inch long (sized by looking at what is missing from the tooth).

Questions:

1) Is it possible to leave this alone unless it causes problems.

2) If it must be removed is there a better procedure than a Caldwell-luc.

I have researched this on the internet and the normal procedure seems extremely invasive just to remove a small piece of root.


3) Or what would you recommend?
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Unread 02-04-2009, 10:36 PM   #53
rams
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Many Thanks,

Similar to what I had planned, have it xrayed to find out where it is at and go from there.

But you have given me more insight on what to watch out for... thanks again.
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Unread 02-28-2009, 11:33 PM   #54
deborahann24
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I began reading this thread because i am experiencing something quite similar. I just learned The roots of my teeth are in my sinus cavaty, which now makes it clear to me why I am so miserbale when i have sinusitus, which is often. Having said this, my dentist told me I absolutley needed a root canal dfor a fractured tooth because removing the tooth would cause the rest of my teeth to begin to drift. The problem is, the only other time I've had a root canal(two years ago) I was in so much pain afterweards I was in bed for three days , with towels and scarves wrapped around my head tightly in order to alieviate the pain. I dread going through this again, as the entire procedure(done in two parts) was absolutley terrible. The surgeon had to stop every few minutes because my motuh, being so small, kept giving him problems as I could'nt keep it open long or wide enough without choking.

The dentist tells me that the root canal is a must because I have one tooth already missing next to the tooth in question, and having two teeth missing, according to her, is unnacceptable due to drifting of teeth. But if i have it removed couldn't I get a bridge or some sort of other procedure to replace the two missing teeth? She told me no, but perhaps I misunderstood her?
Any help would be appreciated so very much. I guess I'm asking is it wrong for me to ask the tooth be removed? I've been made to feel it is. But, the thought of another root canal, after what I went through is making me absolutley frightened.
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Unread 03-01-2009, 02:48 PM   #55
Bryanna
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Hi deborahann,

Generally, not all of the upper posterior teeth are in the sinuses. Perhaps a tooth or two, but not all of them. Unless you have abnormally large sinuses and/or abnormally long rooted teeth...... were you told they are ALL in the sinuses? Could you be speaking about one tooth in particular?

It is totally unfair, unwarranted and illegal to tell a patient that they must have a root canal. First of all, a root canal does nothing to cure a fractured tooth. The fractured area will remain fractured and microscopically open to bacteria. A fractured tooth is not salvagable, not even temporarily with a root canal.

Secondly, teeth do tend to shift in an unnatural pattern when there is a missing tooth next to it. However, this depends on where the tooth is in your mouth. Which tooth are you referring to?

Thirdly, you may be a candidate for a removable partial denture. Are you missing any teeth on the other side in the top of your mouth? A fixed bridge is not a good idea in most cases when there are two teeth missing side by side. This would be called a 4 unit bridge..... the teeth on both sides of the spaces would be crowned and 2 fake crowns would be sodered to the anchor crowns. The reasons this type of 4 unit bridge is not a great idea is because first..... the span is too long in the middle which puts alot of pressure on the anchor teeth. Secondly, if anything goes wrong with either anchor tooth, then the entire bridge would have to be remade and additional teeth would have to be crowned to hold yet another longer span bridge.

Even if you are not missing teeth on the other upper side of your mouth, there is an appliance called a Nesbitt that may work in your case. This is a small removable partial denture that just snaps into the space where the missing teeth are. It has gum colored clasps that snap along the gumline on the "anchor" teeth and 2 white false teeth adhered in a gum colored acrylic in the space. It is meant to hold the space open and prevent the "anchor" teeth from shifting. If your dentist is not familiar with this type of appliance, then I would seek someone else who is. You could do that by calling different dental offices and specifically asking if they make Nesbitt's that replace 2 missing teeth side by side.

The experience that you had with your previous root canal treatment is horrible! When that happens, it means that there is still alot of bacteria in that tooth and the pain is from the pressure of the inflammation. The only way this pain subsides is either the tooth is removed or the bacteria has managed to find a temporary escape out of the tooth. However, the bacteria is still harboring in the tooth and the escape route is something that does not resolve, the bacteria is always draining there. By any chance is this root canaled tooth in your upper jaw...... near a sinus?

You have every right to not feel pressured into doing any particular thing. There are usually options and you should be told what they are and how they can affect your other teeth and your overall health. It sounds to me like this dentist just wants you to do what she says and ask no questions. I would seek another dentist ..............

I'm sorry you are having this trouble... I wish I could help you make it all better. But you really should seek some options and weigh out the pros and cons of all of them so you can decide what is best for you.

Please keep us posted on what's going on........ we're here if you have any questions!

Bryanna



Quote:
Originally Posted by deborahann24 View Post
I began reading this thread because i am experiencing something quite similar. I just learned The roots of my teeth are in my sinus cavaty, which now makes it clear to me why I am so miserbale when i have sinusitus, which is often. Having said this, my dentist told me I absolutley needed a root canal dfor a fractured tooth because removing the tooth would cause the rest of my teeth to begin to drift. The problem is, the only other time I've had a root canal(two years ago) I was in so much pain afterweards I was in bed for three days , with towels and scarves wrapped around my head tightly in order to alieviate the pain. I dread going through this again, as the entire procedure(done in two parts) was absolutley terrible. The surgeon had to stop every few minutes because my motuh, being so small, kept giving him problems as I could'nt keep it open long or wide enough without choking.

The dentist tells me that the root canal is a must because I have one tooth already missing next to the tooth in question, and having two teeth missing, according to her, is unnacceptable due to drifting of teeth. But if i have it removed couldn't I get a bridge or some sort of other procedure to replace the two missing teeth? She told me no, but perhaps I misunderstood her?
Any help would be appreciated so very much. I guess I'm asking is it wrong for me to ask the tooth be removed? I've been made to feel it is. But, the thought of another root canal, after what I went through is making me absolutley frightened.
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Unread 06-03-2009, 06:00 PM   #56
Hobokinite
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Default Probably need a top premolar extarcted that is near a snus - worried

I guess I am a professional worrier and procrastinator.

I had a root canal and didn't crown the tooth in time. It has now cracked. Seeing regular dentist tomrrow to see if it can be saved, but my gut says no.

It is the 2nd premolar and I remember it goes up into the sinuses.

I know Bryana said not to worry, but my sinus are bad already from allergies and a long bout of Lyme Disease. My sinuses are usually ful of gunk about now -- Pollen season.

If I need an extraction, I wil see an oral surgeon.

I have been doing things to help my sinuses that I fear I can't do if I get an extraction - like using a neti pot to wash out the sinuses, using nose sprays, etc.

Any advice???
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Unread 06-04-2009, 07:39 PM   #57
Bryanna
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Hi Hobokinite,

No, I am a professional worrier and procrastinator....... please get in line!!!

By now you have probably been to your dentist.... what did he say?

You have good reason to be concerned about hanging onto this tooth, perhaps moreso than someone with a different medical history.

Here's why...
Chronic sinus problems mean chronic inflammation..... lyme disease means chronic inflammation and root canaled teeth are chronically inflammed. So to try and treat one while the others are still present is not going to be very successful. So it may come down to which of these issues can be eliminated the easiest so the process of healing can begin.

It is not wise to use a neti pot or any sinus spray if you have an inflammed tooth in or near your sinuses. Doing so can cause even greater inflammation because there is no place for the pressure of the inflammation to release itself. It is like trying to blow air into an already full balloon.

A couple of ideas...........

One...... consider the option of removing the root canaled tooth as a means of eliminating one source of chronic inflammation. That tooth can be replaced with either a permanent bridge or a removable appliance. Your dentist can explain both of those options to you. It would probably not be wise to replace that tooth with a dental implant due to your chronic sinus issues. At least not until you get a handle on reducing the sinus problem.

Two..... do you have other root canals in any other upper teeth? Inflammed teeth will inflame sinuses. Infected teeth will spread infection to the sinuses. It can be a vicious cycle of inflammation between the sinuses and the non vital teeth. SO when allergy season starts......... the already weakened areas of the sinuses are more prone to becoming even more inflammed. The mucus is the bodies way of trying to rid itself of the irritants.

Three.... have you ever tried accupuncture for your sinus problems? I know of several people, including my husband, who have had great success in reducing their allergies with regular accupuncture treatment.

Four.... if you decide to have the tooth removed....... do not use a neti pot or nasal spray until the extraction site has healed closed because either one could prevent the site from closing. This could take a couple of months depending on how quickly you heal.

What are you using in your neti pot and what's in the nose spray? Have you always had seasonal allergies?

Bryanna






Quote:
Originally Posted by Hobokinite View Post
I guess I am a professional worrier and procrastinator.

I had a root canal and didn't crown the tooth in time. It has now cracked. Seeing regular dentist tomrrow to see if it can be saved, but my gut says no.

It is the 2nd premolar and I remember it goes up into the sinuses.

I know Bryana said not to worry, but my sinus are bad already from allergies and a long bout of Lyme Disease. My sinuses are usually ful of gunk about now -- Pollen season.

If I need an extraction, I wil see an oral surgeon.

I have been doing things to help my sinuses that I fear I can't do if I get an extraction - like using a neti pot to wash out the sinuses, using nose sprays, etc.

Any advice???
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Unread 08-12-2009, 06:16 PM   #58
ThomasJ
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Hello Brianna, I just had a upper left side tooth pulled and the Dentist said the root broke off and is in my sinus cavity. She took 2 x-rays and couldnt see it. Then she sent me to a Oral Surgeon. He took one x-ray and couldnt see it! I'm really concerned. Why isnt an x-ray showing the root? I'm freaking out and I need help.
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Unread 11-15-2009, 11:45 AM   #59
laurynnn
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Hello,
I hope Bryanna can help me on this, at least to make me feel less... afraid.
I have had a problem on my upper jaw for a while now, the gum will swollen (only have this in the morning when I wake up) and when I press it a yellow stuff comes out. So I thought this is an infection... due to the fact that I moved to Canada from Spain a couple of years ago, I didn't go to the dentist until my papers were ready.
So I told my dentist about it and he sent me to a Maxillo-facial surgeon. My dentist was saying I'm missing a tooth. My parents never took me to the dentist when I was small so I told him nothing had ever been removed from my mouth.
So I went to the surgeon and he took some x-rays. Apparently, one of my teeth never came out, it seems to be located very close to the sinus and he said that if there is infection it has to be removed....
he also told me that he couldn't guarantee 100% that I wasn't going to have problems with the sinus after, and that he has dealed with problems like this a few times.
he has 30 years experience, I mean, I'm not worried about that, but since he said he has to go through the sinus and that is tricky to remove it when it is in that location... I'm literally freaking out...
I've been reading some people's posts here and in other forums, and they have had some serious problems after surgery.
The operation is next wednesday... how worried should I be?
please reply before wednesday!
thank you.
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Unread 11-15-2009, 02:31 PM   #60
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Hi laurynn,

Your description of your dental problem indicates an infection in what is called a retained tooth up in your maxilla bone and it's possibly partially located in your sinus cavity as well. This is a very different issue from the other posts discussed on this thread here. Your tooth is not present/visible through the bone or gum tissue because it never came down with your other teeth. The other questions here are about teeth that are present (visible) in the mouth and their roots are located in or near the sinus. Different issue altogether.

Your oral surgeon has performed this type of surgery many hundreds of times in 30 years of practicing dentistry. It is a complicated procedure in that he needs to get adequate access to the tooth in order to remove it and that is a bit tricky considering where it is. Depending on how far up it is and how close to the sinus it is will determine if he has to enter the sinus or not. Again, he is well versed on this procedure and will know what to do when he gets in there. Any incisions he makes will be sutured closed and post operatively you will need to take a few days to rest and take extra good care of yourself. It is important to plan a nutritious soft diet ahead of time so it's one less thing to think about at the time. Make sure you have plenty of water to drink and a really great natural homeopathic pain reliever is called Arnica Montana. It can be bought online or at a health food store. It comes in small vials and the pellets are put under the tongue every few hours. You can actually start taking it twice a day a few days before the surgery. Homeopathy is very helpful in reducing swelling and pain for all oral surgery if it is taken properly. The pellets should never be touched, use the cap of the vial to place them under your tongue and you should not eat or drink for one hour after you take them.

As for the post operative problems with your sinuses...... that all depends on how extensive the infection is into the sinus.... how much of it he can remove..... how much of the sinus is affected by the infection.... and your body's own natural healing abilities. It is imperative to be healthy during the healing phase of this surgery. Avoid illness as best as you can, keep yourself well nourished and well hydrated with water...... avoid sugary foods, hard to digest foods, and empty carbs because they all lower the immune system.

I know this is scary but you will be ok. Are you being put to sleep for the procedure?

Bryanna


Quote:
Originally Posted by laurynnn View Post
Hello,
I hope Bryanna can help me on this, at least to make me feel less... afraid.
I have had a problem on my upper jaw for a while now, the gum will swollen (only have this in the morning when I wake up) and when I press it a yellow stuff comes out. So I thought this is an infection... due to the fact that I moved to Canada from Spain a couple of years ago, I didn't go to the dentist until my papers were ready.
So I told my dentist about it and he sent me to a Maxillo-facial surgeon. My dentist was saying I'm missing a tooth. My parents never took me to the dentist when I was small so I told him nothing had ever been removed from my mouth.
So I went to the surgeon and he took some x-rays. Apparently, one of my teeth never came out, it seems to be located very close to the sinus and he said that if there is infection it has to be removed....
he also told me that he couldn't guarantee 100% that I wasn't going to have problems with the sinus after, and that he has dealed with problems like this a few times.
he has 30 years experience, I mean, I'm not worried about that, but since he said he has to go through the sinus and that is tricky to remove it when it is in that location... I'm literally freaking out...
I've been reading some people's posts here and in other forums, and they have had some serious problems after surgery.
The operation is next wednesday... how worried should I be?
please reply before wednesday!
thank you.
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