Sinus perforation after teeth extraction
Hi!
I normally don't seek medical advice online. But I see some professionals also reply here in occasion, so I thought I'd give this question a go.
I'm wondering, how far past teeth extraction can a sinus perforation occur?
I had two maxillar premolars on the same side extracted 5 days ago, and there was no perforation immediately after the extraction. I had a checkup on day 2 past extraction, and everything was healing perfectly, faster than expected according to my dentist (I normally heal fast). The extraction holes were well covered with coagulant, and new gum tissue was already forming.
Prior to the extraction, I had a severe infection (hence the checkup on day 2). The premolar furthest back had been broken for some time (3 years I think), and during this time it became infected and rotted severely. The infection spread to my jawbone, and ate away quite a huge chunk of the bone (above and around the root, mainly above, covering an area approx the size of two premolar crowns). 9 days before the the extraction I had sudden onset extreme pain, followed by slight swelling of my cheek the next day. I saw the dentist and was prescribed antibiotics and heavy painkillers. However, the infection kept getting worse, and I ended up hospitalised and having heavy doses of IV antibiotics plus IV paracetamol and morphine for the pain. At this point (7 days prior to extraction) the entire side of my face was swollen, from the eye down the neck. I had trouble swallowing and couldn't open my mouth properly, and had an onset of fever. After 24 hrs of IV treatment, the swelling was slightly reduced, and I was sent home with a heavy course of oral antibiotics and heavy painkillers. The hospital also did a full scan of my teeth and jaws, discovering that the first premolar was also badly affected by caries and confirming the infection inside my jawbone. After discharge from the hospital, I took the prescribed antibiotics rigourously, and at the extraction day my face had nearly returned to normal (I was however still in need of heavy pain management). Both the affected premolars were extracted, and despite one being in terrible condition, they came out without needing surgical removal. There was still some puss inside my jawbone, so this was rinsed properly after extraction. Seeing that the infection had eaten away a rather sizeable chunk of bone, and two teeth (one having two roots going in separate directions) were extracted on the same day, I was told healing would take longer than usual. (This is not my first extraction)
All in all, healing seems to be going well. I was off heavy pain medications the first day after extraction, and since ca 48 hours past extraction, I haven't needed painkillers at all. I've been following the cleaning routine given by my dentist, and the wounds seems to be healing well.
I do however also have a sinus problem, and I have chronic rhinitis - which is treated with saline solution nasal spray, and cortisone nasal spray. On the first two days, I was extremely careful with blowing my nose and avoided nasal spray (to avoid pressure on the oral/sinus wall). On the day 2 checkup, my dentist said I could use nasal spray as normal, and also blow my nose (preferably without too much pressure though). I have been following this advice too.
What puzzles me now, is that it sometimes feels like the nasal spray travels down to my jaw (hard to describe, but it's like I can feel the fluids very close to the jaw, in the area I had the extraction and also damage to the jawbone), and sometimes when I blow my nose or use nasal spray, it feels like something 'loosens' from the top of my jaw and chunks of something follows up the nasal canal (this usually goes down the oral tract, so I don't see it). I have no visible bleeding and no pain. Just this strange, unusual feeling connected to blowing my nose and using nasal spray. Leading me to wonder if there could be an oroantral perforation that occurred after the day 2 checkup, or if the strange feeling and discomfort simply stem from a thin jaw/sinus wall now that a chunk of bone is indeed missing?..
I apologise for the long post, and thank you in advance for any advice! (the main reason I haven't gone back to the dentist again, is simply financial, this has been a very costly procedure)