Accidental Dental Displacement into the Maxillary Sinus During Wisdom Tooth Extraction

Removing a wisdom tooth is a common dental procedure that dentists may have to perform several times a day, and it often goes without raising any problems. However, sometimes, some rare complications may occur, such as a tooth or a fragment accidentally moving into the maxillary sinus, an area above your upper teeth. In this article, we asked Dr Roya, our specialist dentist, to explain accidental dental displacement into the maxillary sinus during wisdom tooth extraction, its risk factors, and possible treatment options a little bit more, so be with us.

Accidental Dental Displacement into the Maxillary Sinus

The maxillary sinus is a hollow space that is filled with air, and it is located right above your upper back teeth, including your wisdom teeth. In some cases, the roots of upper wisdom teeth are really close to the sinus, and only a thin layer of bone separates them. In rare cases, they might even be directly connected. If that barrier is weak or gets disturbed during a wisdom tooth removal, a piece of the tooth may slip into the sinus. This is called accidental dental displacement. It doesn’t happen often, but if it’s not managed properly by an experienced dentist, it can cause sinus problems, infection, or discomfort.

Now we understand better why choosing an experienced Perth dentist who uses careful surgical techniques while extracting wisdom teeth is so important.

Causes of Dental Displacement into the Maxillary Sinus

Sometimes, when your dentist is removing your wisdom tooth, especially an upper one, your tooth or part of it may accidentally move into the sinus. This happens because the roots of your upper wisdom teeth are often very close to, or even connected to, the sinus floor.

Below, we have listed some of the possible causes:

Anatomical Proximity

The roots of the upper premolars and molars are often close to the sinus in your upper jaw, and sometimes, they can even extend into the maxillary sinus. This close relationship increases the risk of creating an opening into the sinus during extraction procedures.

Excessive Force During Extraction

If the dentist applies too much pressure while removing your wisdom tooth, especially when it’s hard to see clearly, pieces of the tooth or even the whole tooth could get pushed into the sinus cavity.

Inadequate Surgical Technique

If the dentist doesn’t use the right technique or does not have enough experience in wisdom tooth extraction, it can cause issues like tooth displacement. These problems can be avoided if there is enough light and the dentist has a clear view during the procedure.

Pre-existing Dental Conditions

Teeth weakened by decay, infection, or previous dental treatments may fracture more easily during extraction, increasing the risk of fragments entering the sinus.

For more information about wisdom teeth, go to our comprehensive guide on wisdom teeth removal in Perth.

Risk Factors

Thin or Absent Sinus Floor

For some people, the bone that separates the upper teeth from the sinus is very thin or does not exist at all. This can make it easier for a tooth or piece of it to get into the sinus during removal.

Impacted or Malpositioned Teeth

If your wisdom teeth are misaligned or impacted, they may need more complicated surgery to be extracted, and this may increase the risk of these teeth moving into the sinus.

Age-related Changes

As we get older, the sinus in our upper jaw can expand, and the bone that separates it from your teeth may get thinner, which may increase the risk during tooth extractions.

Inexperienced Practitioner

Dentists who don’t have enough experience or proper training in wisdom tooth extractions are more likely to cause issues like the tooth moving out of place.

Signs and Symptoms of a Displaced Tooth in the Maxillary Sinus

When a tooth or fragment is accidentally displaced into the maxillary sinus during extraction, you might notice certain signs and symptoms.

Facial pain or pressure: You might feel discomfort or a sense of fullness in your face, especially over the affected sinus.

Headache: You may feel pain in your forehead or around your eyes, and it can get worse when you move your head.

Nasal discharge: You may notice drainage that has pus or a bad smell, which could be a sign of infection.

Nasal congestion: You might feel like your nose is stuffed or blocked.

Toothache or dental discomfort: You might feel pain or sensitivity in the teeth near the affected sinus, which can sometimes feel like a regular tooth problem.

Swelling: You might notice swelling over your cheek or under your eye on the affected side.​

Fever: You may have a higher body temperature, especially if an infection has developed.

Some people may not have any symptoms, and the displaced tooth might only be found by accident during an X-ray or scan for something else.

Diagnostic Methods

Your dentist will need to examine you and use imaging techniques like X-rays or scans to diagnose a tooth that has moved into the sinus during wisdom tooth removal.

Clinical Examination: First, the dentist will carefully check your mouth for signs like a gap between your mouth and sinus or an unexpected tooth absence.

X-rays (Panoramic Radiography): This imaging gives a wide view of your jaws and teeth and helps to spot the position of the teeth and any movement into the sinus. However, because it’s two-dimensional, it may not show the exact location of the displaced tooth.

Cone-Beam Computed Tomography (CBCT) Scans: CBCT provides your dentist with detailed 3D images and helps them to accurately see the tooth’s position in the sinus and how it’s connected to nearby structures. It’s especially helpful when regular X-rays don’t give clear answers.

Complications of a Displaced Tooth in the Sinus

If the accidental displacement of a tooth into the maxillary sinus during wisdom tooth extraction is left untreated, several complications may occur:

Maxillary Sinusitis: If a displaced tooth enters the sinus, it can cause inflammation and infection, leading to symptoms like facial pain, nasal discharge, and a stuffy nose.

Oroantral Fistula (OAF): If a connection between your mouth and sinus isn’t treated, it can turn into a permanent opening, which may cause ongoing sinus infections and discharge.

Chronic Infection: A retained tooth may become a source of ongoing infection, which may lead to chronic sinusitis and, in severe cases, spread to nearby areas.

Osteomyelitis: A long-term infection may spread to the maxillary bone and cause osteomyelitis, which is a serious condition that leads to bone inflammation and damage.

Orbital Complications: An infection from the sinus may spread to the area around the eye, which can cause orbital cellulitis or an abscess. This might affect your vision, and you need quick medical care.

Life-Threatening Infections: In rare cases, untreated infections can lead to serious conditions like sepsis, which can be dangerous for your health.

Treatment Options for Accidental Dental Displacement into the Maxillary Sinus During Wisdom Tooth Extraction

Accidental displacement of a tooth or its fragments into the maxillary sinus during wisdom tooth extraction is a rare but serious complication. Quick and proper treatment is important to avoid infections or long-term sinus problems. Treatment options may include:

Caldwell-Luc Procedure

The Caldwell-Luc procedure is a surgical approach where the dentist makes an opening in the upper jaw to reach the sinus and take out the displaced tooth or its pieces. It’s usually done when simpler methods have not been effective. This approach lets the dentist see the tooth directly, which helps lower the risk of future sinus problems.

Endoscopic Sinus Surgery (ESS)

Endoscopic Sinus Surgery (ESS) is a less invasive option where the dentist uses a thin tube with a camera to reach and remove the displaced tooth through the nose. It avoids the need for cuts on the outside and usually helps you recover faster. It’s often used when the tooth fragment is small and easy to reach.

Combined Approach

In some cases, both the Caldwell-Luc procedure and endoscopic sinus surgery are needed, especially if the tooth fragment is hard to reach or there’s an infection. Using both methods can make it easier to reach and fully remove the tooth.

Proper care after the surgery is important and may include:

Medications:

Your dentist may prescribe antibiotics to help prevent infection after the procedure. You might also be given nasal decongestants to help keep your sinuses clear and promote proper drainage.

Follow-Up Appointments:

Regular follow-up visits are important to check how well you’re healing. They also help your dentist catch and treat any problems early.

What to Do If You Suspect a Displaced Tooth?

If you think a tooth or piece of it has moved into your sinus during a dental procedure, it’s important to see a dentist quickly. Early diagnosis and treatment can help prevent problems like infection or sinusitis. Your dentist may check your mouth and suggest a CBCT scan to find the tooth and decide the best way to treat it. Acting fast can help manage the issue and avoid more complications.

Expert Care for ssWisdom Tooth Complications

If you’re dealing with wisdom tooth issues or suspect a displaced tooth in your sinus, you’re in the right hands. Our experienced team at Perth Wisdom Teeth Clinic uses advanced techniques to diagnose and treat even the most complex cases with precision and care.

If you’re in pain, our caring and professional emergency dentist Perth is just a call away.

Don’t wait — call us today at (08) 9474 5083 to schedule an appointment and get the relief you need.