Sinus perforation

[AJK64]

I am hoping someone here can help me and answer my questions.

I am likely going to have to have a failed root canaled tooth extracted. The tooth is an upper left first molar. From the xrays taken during the endodontic treatment, it appears that one of the roots of this tooth runs directly into my left maxillary sinus.

I am going to be seeing a new dentist on Wednesday to talk about my options. What can/should I ask during the consultation in order to reduce the risk of sinus perforation? Is there any way of determining for certain if the root does run into the sinus? Are there any procedures I can request that would minimise the risk?

 

[honestdoc]

How certain do you know that the root canal failed? If you have no pain and no swelling, no treatment is the best. It is hard to determine the exact proximity of the sinus with the 2 dimensional x-ray but the roots are very close.

Have a good discussion with your new dentist. Best case scenario, you don't need to take out the tooth. He or she may feel comfortable taking the tooth out but a sinus perforation or damage can potentially occur. If the perforation is greater than 4 mm, it needs to be repaired by an oral surgeon.

 

[AJK64]

It's 10 weeks since the root canal was completed and I am still in daily pain. It has background pain (around a 3/10 constant ache) and is very painful to touch (peeks to around a 7 or 8/10 when I brush my teeth).

I have had pain for about 9 months now since the problem with this tooth began and it's really starting to ruin my life and I just want an end to the pain, so looking like an extraction is my last hope

 

[honestdoc]

Do you have more pronounced pain when you bend forward or walk up or down stairs? If so, it may not be the tooth but a possible sinus pain.

If it is, then extraction is the most predictable option. Again, have a good discussion with your upcoming dentist.

 

[AJK64]

No extra pain on bending or climbing no. It's mainly only triggered by touching the root canaled tooth. The pain radiates up into my eye socket at times and into the side of my head too

 

[MattKW]

Sad to hear it's still going poorly. The RCT looks good, but that doesn't compensate you much. I don't know why it continues to plague you, and I have to agree I'd prob extract too given your history. It's not like you haven't tried to push through. As for the extraction, the tooth will probably fracture and have to be taken out in sections. A bit fiddly but these are done all the time. Chances of sinus perforation are low if your dentist is experienced. You might ask if he's got some long-lasting LA to help control the post-op pain (Marcain, Naropin,...) so you can get a bit of rest. All the best.

 

[AJK64]

Saw the new dentist. She did a thorough examination and took a few xrays. She is referring me to the maxillo-facial surgeons do they can try and figure out what is wrong. She was particularly concerned about the pain I am getting in my head. She also said that they can advise me on extracting the root canaled tooth safely and if there is a sinus perforation they are in the best position to deal with that too. Hopefully it won't be too long waiting