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Infected tooth extraction petrified about sinus perforation



Junior member
Jan 9, 2022
So following a bad experience with a dentist when I was a child, I avoided going for many years as the dentist told me that he was going to make a procedure hurt in order to punish me and teach me a lesson.

About 4 years ago I plucked up the courage to go to a dentist where I was living at that time and had a few fillings done and a couple of extractions. I had an excellent relationship with a dentist and actually found going into him a pleasure. However alas I had to move country because of personal reasons and had to find a new dentist.

I found a new dentist, had an initial appointment and then a filling done and got on well with her. But now she has long COVID and is not practicing so once again I am finding a new dentist. So I've been assigned to another dentist at the same practice, a very young dentist who has only been on the UK General Dentist Council register for about 12 months having qualified in India in 2014.

Just after Christmas I had issue with swelling on the back of my right second molar. I went to dentist who said there was infection and abscess and gave me antibiotics with appointment on Tuesday to get the tooth taken out. The dentist said to me that because of the location of tooth roots directly against the sinus, maybe very slightly inside and the periapical abscess if not reduced, there is a chance of sinus perforation which really terrifies me to be honest.

So now whilst antibiotics have helped, I don't think it has totally gone and since the abscess is at root of my tooth and the closeness of the sinus, I'm petrified of this happening. Part of me thinks that I should get a more experienced dentist to have a look at it or wait till I can get an appointment with an oral surgeon, but the other part of me thinks that I have an infected and badly decayed tooth in my mouth and I shouldn't wait.

Right now I feel like cancelling the appointment as I'm petrified. I haven't slept right all week and just want a hole in the ground to swallow me up. I'm grateful for any advice or reassurance that can be given, as I need to get this done properly, but I'm shaking though fear of being stuck with sinus perforation for months and I have to travel abroad a lot for work and not being able to fly because of that is another problem.

Really thanks for any support you can give.
I had a sinus perforation and it was not that big of a deal. I had worried and worried over it, but when it happened I was like “this is it?”.

Basically, if it happens, you may feel liquid run down your throat as your sinus drains. Mine did. Then the endodontist said not to blow my nose for several weeks until it has healed. She told me to buy some Sudafed (the real stuff you have to get from a pharmacist) and take it to help alleviate any stuffiness in my nose if I felt like I needed to blow my nose. If I had to sneeze to do it with my mouth open to relieve pressure.

Honestly, I couldn’t even tell there was an issue, as far as pain. It added no extra pain, just a little annoyance at not being able to blow my nose. I did end up with a little sinus infection but nothing the Sudafed didn’t help with.
No doubt my anxiety is making it worse. I've read some horror stories about needing to see an oral surgeon to have it packed with a tri-layer and needing a bone graft and the problem going on for months and months. Probably I'm over-reacting as I'm generally very anxious about such things but appreciate any advice and support here as I want to get the extraction done as I am sure if all goes to plan I will finally have the end of the on and off problems with this tooth, but anxiety over the weekend has made me want to run away from it!
Hi, I don't think you're overreacting at all, it seems from your description that you didn't really click with the new dentist you've been assigned to and that you don't have much faith in them. It's really important that you feel comfortable with your dentist, and personally I'd be inclined to look for someone I trusted, even if it meant having to wait a little longer. Of course, with COVID and all that, most practices have backlogs, so it may take longer to get an appointment. We've collected some tips for finding a dentist on these pages:

@letsconnect Thanks, that's really helpful! :)

I've actually only seen him once for an emergency appointment and the guy feels really nice and understanding and actually puts me at ease, no complaints at all. It's just the fact that he is quite young and inexperienced in contrast to the kind of dentists that I would normally have gone to, but as you say there is a big backlog for a good dentist right now because of COVID so I can't afford to be too picky. I just feel that if the perforation was to happen, a more experienced dentist may be better.

Yes - I could cancel and leave it, but I've already paid the cost of the treatment (quite common now that due to COVID people are asking for payment upfront) and obviously a risk of an infection to a back teeth spreading is very real and could be quite serious from what I have read so have that playing in my mind. And honestly cancelling last minute with a practice may well end up burning my bridges with the whole practice, including my dentist whom is off with long COVID.
I've actually only seen him once for an emergency appointment and the guy feels really nice and understanding and actually puts me at ease, no complaints at all. It's just the fact that he is quite young and inexperienced in contrast to the kind of dentists that I would normally have gone to

Ah sorry about that, I was jumping to conclusions (you mentioned getting on well and having an excellent relationship with your previous dentists, so I took the omission to mean that the same wasn't true for the new guy!).

Dr. Google's assessment of the risk of infections spreading is probably a bit exaggerated:

But of course, if you travel a lot for work, the last thing you want is for an infection to flare up while you're away from home! So I suppose getting it sorted asap would be a good idea in that situation ?.

Keeping my fingers crossed that your regular dentist will be back soon ?
Thanks for your appreciated words. Yes, reading that from actual dentists rather than the web puts me at ease in terms of dental infections spreading.

I guess my issue is that it may be a tricky extraction to do to avoid perforation and my stupid worry is a less experienced may be less likely to pull it off without perforation or be able to adequately treat it if it does happen. Saying that the principal dentist who is also the owner at the practice is very experienced, so I comfort myself with the fact that if he doesn't avoid the perforation, she will know what to do to resolve the matter.
That all sounds good :). You could check if it would be possible for the principal dentist to do the extraction, if that's what you'd prefer. No harm in asking...
I initially asked for her but she's taking over the orthodontic work and inman aligners off the other senior dentist who is off with COVID and the even more complex stuff so it's a lot longer to get an appointment with her, whereas it seems the associate dentists are doing all of the non orthodontic work of my usual dentist.
Hello Dublin Dave, I agree with all LetsConnect said and glad the dentist is nice and puts you to ease, he very well could be a great dentist who would do a good job. But your feeling and guts matter too.. and you have to consider that highly.. I had a lovely dentist who was helping me alot but there was something big going on I was nervous about.. I just wanted a second opinion. So I did go in for a second opinion just to give me peace of mind and they did end up really doing that and said he made sense and seemed to be doing the right thing the right ways. even though I was nervous I went ahead. and it turned out.. if I had not gotten that 2nd opinion my anxiety would have gotten the better of me.. So never hurts to at least get a 2nd opinion. Not sure what the rules are where you are as far as privacy but they shouldn't have to know you went for one.. Here in US they respect and won't say a peep to the dentist you went to . I hope you find a solid happy ending in this situation and sorry you keep losing good dentists its hard to have to find another one and start all over.
I have no doubt that he is right about the reasons for the extraction and it needing to come out - my original dentist that I went to a couple of months ago suggested that it is something that I would need to get done soon, I just haven't found time to schedule it due to the field I work in, so no doubt that his opinion is right as it was pretty much the same as my experienced dentist said.

Just a question of skill I guess with someone whose only been practicising here for a year even if he did qualify in his house country 6-7 years ago.
Apparently, sinus perforation is not that big a deal (according to @Gordon anyways, who knows a thing or two about removing teeth):

It's more a case of do you feel comfortable with this dentist or not, especially as a nervous patient ?
Does he have any reviews stating his skill? I agree It is more a case if you feel comfortable , if he listens to your concerns and communicates good with you. If he answers questions and are comfortable he would respect your boundaries and thoughts before, during and after treatment.

Also I'm not sure how it works with getting his license newly in your country but I was on the dental board in my state as a public member wanting to make a difference, and was on the license and credentialling and they go through stringent qualification and interviews and paper tracts to make sure only the best dentist from other countries were given licenses. If there was any question they would suggest more training etc .

Either way if you go with him or not, I hope it goes well and whoever does the work makes it the most comfortable and best experience possible.
I would recommend that you ask him straight out what he will do if there is a sinus perforation and what he will do to try to avoid it. That will tell you if he knows how to handle it and hopefully give you some peace of mind. One of my dentists was just out of dental school and she was fantastic! My oral surgeon actually told me I was in better hands with her than many experienced dentists. I didn’t get to have her for long as she moved soon after, unfortunately.

My endodontist told me that I might have a sinus perforation before she did the procedure and she made it sound like it was absolutely no big deal. She told me it was very likely with what I was having done (apicoectomy), but that it was common and rarely had complications.
@krlovesherkids777 Not much about him in terms of extractions and that kind of work, a fair few comments on Google reviews for some of his (non ortho) cosmetic work such as bonding, whitening and a fair few similar things. There's also a couple of positive reviews about him without stating exactly what was done.

Think way it works here is that if they have a BDS from outside the EU, then they have to pass an ORE or similar exam to get registered with the General Dental Council and be able to practice in the UK.
@MountainMama Sounds a good idea, I'll generally ask him how he thinks it will go and also how simple or complicated the extraction is, probably best to have that chat when I first go into the surgery room so we'll see how that goes! Can't lie though, my anxiety is increasing the closer I get, but at least I slept better last night thanks to support of you guys here!
Think way it works here is that if they have a BDS from outside the EU, then they have to pass an ORE or similar exam to get registered with the General Dental Council and be able to practice in the UK.
The ORE is a ferociously difficult exam, if he's passed it then he's pretty competent.

It's also a very basic bit of dentistry to close an OAF (proper name for a perforation) if it's noted at the time of the extraction. I'd expect any dentist to be able to a) check for one and b) recognise one when they're checking

99% or so of OAFs heal spontaneously within a few weeks at worst. The ones that don't generally need a couple of stitches.
So because of a change in availability of dental nurses due to COVID, I was offered chance to reschedule for this afternoon so took up the offer.

I spoke to the dentist and he felt that there was still a bit of infection there so opted to drain a now much smaller abscess before removing the tooth.

Sadly it was not the most straightforward! He said that there was little of the tooth left above the roots and mostly it was all roots. Pretty early on it became apparent that getting it out by a standard technique was not going to work so something else was going to be needed as it was crumbling when trying to remove it.

So in the end with the main part of the tooth crumbling, each or the three roots had to be removed one by one. Before that happened, I was explained that this may result in some root fragments being left in and because of how close they would be to the sinus if they are very small he would be referring me to a specialist to resolve since he did not want to poke around in there trying to get them out when there was someone better for the job and more specialised in it who could give me a better outcome.

So the first two roots came out really easily. However the third one was a bit more tricky and harder to pull. In the end it fractured (nice loud snap!) during attempts to get it out, but in the end dentist was able to get the other part off as it wasn't such a small fragment. He says that he couldn't see any sinus perforation and also no bubbling when the usual test was done.

I got out with gauze in mouth and biting down hard and all seemed well for an hour or so, barely any bleeding, but then I started to bleed a fair bit (I think gauze may have slipped). So I changed the gauze 90 minutes post procedure and hopefully this is the last piece I need to use - the problem I have is that I also have the opposing tooth missing soo can't get as heavy pressure as I'd like! If I do run out of gauze, what should I use, I know I read tea bags, but is anything else useful? Or can I get more gauze from pharmacy?

Thanks so much to everyone for their help here, without you I may have chickened out!
Moistened tea bags should do nicely (ordinary black tea), or if you happen to be going past a pharmacy, you could buy more gauze if needed...

Congratulations ?!! Hope things have been going well since you posted ?!
Sounds like you made it through quite an adventure today.. Glad you made it though, you are brave and resiliant! Hope you will be able to relax and do something special for yourself tonight taking it easy. Hope the bleeding has stopped and pain has left you! Do you get to take some time between next step to give space from the dental office or do you have to go back quick?