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A sinus infection may not have been something that you expected after getting a wisdom tooth removal done but that is exactly what can happen in some cases. We outline why this happens and what you can do to prevent and treat it.

Getting your wisdom tooth removed can be a bit disconcerting for most patients. One of the things that your dentist might tell you, though, is that your upper wisdom teeth can be removed much more easily than the lower wisdom teeth. Chances of complications like pain, infection after wisdom tooth removal, and nerve damage are much lesser after the extraction of an upper wisdom tooth [1].

Sometimes, though, the root of the upper wisdom tooth can be in close anatomic approximation to the sinus and can cause a sinus infection.

Sinus infection after wisdom tooth extraction

There are different sinuses in our facial structure depending upon their location. With regards to wisdom tooth removal infection, the sinuses being referred to are the maxillary sinuses [2]. A sinus is typically nothing but an air-filled space in the facial skeleton. They serve to humidify the air we breathe in, catch some foreign bodies and potential irritants in the sinus lining, and lighten the weight of the facial skeleton [3].

The size of the maxillary sinuses can vary as can their exact location. In most cases, though, the upper back tooth (2nd premolar, 1st-3rd molars) have roots that are close to the maxillary sinuses or even extending inside the sinus.

The close relationship between the tooth root and the maxillary sinus allows a spread of infection from the tooth into the sinus [4].

Symptoms of sinus infection after wisdom tooth extraction

During the normal extraction procedure of a wisdom tooth, some amount of bone can be lost around the sinus and form a communication between the sinus cavity and the mouth [5]. In such a case the patient may experience a significant amount of swelling post the extraction procedure.

The injury to the bone surrounding the sinus, as well as the flow of bacteria from the mouth into the sinus cavity, is believed to be the cause of this swelling.

Pain, something that is usually quite mild after the upper wisdom tooth extraction, will also be quite severe in the initial healing period.

Both the above symptoms combined will make everyday activities like chewing, talking, swallowing, or even opening the mouth quite uncomfortable [6].    

Symptoms like the ones described above can be seen even when a tooth has a deep infection like decay or gum disease around it. This can spread to the sinus and cause a sinus infection even though the extraction has not yet been performed.

Patients should also be aware that a sinus infection can arise from sources apart from just the teeth. In such cases, symptoms that are primarily because of a sinus infection will cause referred pain with the nearby teeth.

Some dentists may not be able to identify the primary cause as originating from the sinus and may carry out some dental procedures which could have been otherwise avoided.

Treatment of sinus infection after wisdom tooth extraction

In most cases, the dentist will be aware that a communication has been formed in between the sinus and mouth after the extraction. Placing stitches to close up that communication is the first step that has to be taken [7]. The pain and swelling can still be expected but the healing is noticeably quicker if stitches are placed at the right time.

In case the dentist has not noticed the sinus communication the healing will still take place. It will take a lot longer for the communication to be closed up on its own.

In a few cases, the dentist may actually choose to stitch up the communication at a later appointment and rectify the mistake if it was not done so earlier.

During the healing period, it is likely that the dentist will put you on a course of antibiotics, pain medication, and possibly some anti-inflammatory medication as well. The exact combination in which they will be prescribed or the duration for which they are required varies as per the clinical symptoms [8].

Prevention of sinus infection after wisdom tooth extraction

As a patient, the only thing that you can really do to prevent a sinus infection from occurring is to make sure you complete the entire course of antibiotics as directed by the dentist. The dentists, on their part, can take proper pre-operative x-rays to see the position of the sinus and plan their extraction procedure accordingly [9].

Patients are also encouraged to avoid lifting heavy things, going to the gym, doing yoga or other breathing exercises, in case the sinus cavity has been exposed or the sinus manipulated in other ways [10].

All of these activities could result in a re-opening of the communication between the sinus and the mouth.

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