How to tell if root of molar extends into sinus cavity?

Question

I am having an upper 2nd molar extracted tomorrow (#2). I was told if the oral surgeon determines the root of the molar to extend into the sinus cavity it would require oral surgery for removal, which will cost more. I have an xray of my tooth from my dentist. How can I tell if it is in the sinus cavity or not? I have tried to google for pictures, but have had no luck. Just getting a little anxious about the bill... not so worried about the removal, I trust my doctor very much.

Thank you.

This tooth never had a root canal. It had a cavity that spread and part of my tooth broke off. I had an abscess earlier last month, and after finishing a round of clindamycin my dentist referred me to an oral surgeon to have it removed.

Answer 1

With Dr. Albert being the exception, I am a bit puzzled with the responses I am seeing.

Here are the facts, because I am a licensed dentist and I look at X-rays every day:

1 - You CAN see the entire tooth, including the roots, if the periapical X-ray (the "little ones") is taken properly. The borders of the sinus can be visible on PAs of maxillary molars.

2 - Maxillary molars can be very close to the sinuses, yes. Sometimes right under the periosteum (the layer of soft tissue that lines the sinus cavities) if the person has pneumatized sinuses. Again, this can be seen on properly-taken PA x-rays.

3 - There are two dangers in extracting a maxillary molar that is right under the sinuses' periosteum. The first is that when the tooth is pulled, it might pull a piece of that periosteum out with the tooth root, creating an opening between the sinus and the oral cavity (what we call an oral-antral fistula), which can lead to a sinus infection. The second is that a root might break, and in the action of trying to retrieve the broken root, the practitioner might accidentally shove the root tip into the sinus, also causing a sinus infection.

How can a dentist manage the dangers? Experience and judgment. Most upper-jaw molars are not difficult to extract because the maxillary bone is spongy and it is easy to elevate a tooth out of there with minimal trauma. It is the ones that had previous root-canal treatments that worry us, because those do get broken roots quite frequently (with the potential for shoving a broken tooth root into the sinus). For those teeth, dentists often refer those to oral surgeons for extraction.

Basically, your oral surgeon is just warning you of the possibility that a tooth root might be shoved into your sinus in the process of extraction. It does not happen often, but they want you to hope for the best but be prepared for the worst. That's all.

Answer 2

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Answer 3

Unfortunately, based on what your dentist and oral surgeon have told you, there is no way to tell how deep the tooth resides until it is manipulated for removal.

I certainly empathize with your concern about the far greater costs of oral surgery, but if the root of the tooth truly extends into your sinus cavities and the surgeons don't remove it, that root could serve as a nidus for a slew of serious and potentially life threatening bacterial infections.

Don't be worried about the cost. I'm sure your doctors are more worried about your health than about your ability to pay.

Answer 4

Dr Albert says "IT'S BIOLOGIC FACT THAT THE ROOTS OF ANY UPPER TOOTH NEVER EXTEND INTO THE SINUS CAVITY." That may be generally true. It may be "normal". It may be text-book orthodoxy. But I am here to tell you that there are exceptions to this "rule". I know this for a fact based on personal experience. I recently had my second molar #15 extracted. *Before* the procedure my dentist numbed the area with a local anesthetic (lidocaine?). She made two injections on the lingual side. Both caused a definite stinging sensation in my maxillary sinus. My understanding of the anatomy suggests that this could not happen unless there was a pre-existing fistula.

Answer 5

I had an upper tooth extracted years ago that extended into the sinus cavity,I had a hole in my sinus for 6 months after removal..my dentist warned me this would happen,I went back 3 times for check ups and everything was fine

Answer 6

A dentist tried four times to put a crown on my upper back molar and now is referring me to a root canal specialist since I'm in persistent and chronic pain tooth and sinus wise. Due to my recent bout with another failed root canal, same molar, opposite side, I wondering if I should have the molar extracted. What is the long term consequence

Answer 7

Since you already have x-rays, and I assume the dentist has seen them, then I doubt you'd be able to tell on your own if the dentist can't. It's probably either not clear on the x-ray, which means the oral surgeon will find out for sure when he extracts the tooth, or it's one of those things that needs an expert's eye to determine. If that's the case your oral surgeon, being an expert on seeing such things, will probably be able to tell when he sees them.

Good luck!

Answer 8

sometimes the oral surgeon cannot tell until he actually gets in there. if it does extend into the sinus cavity then there is alot more risk of infection etc. so the surgeon will have to use packing etc. to insure you do not get any blood, tissue etc. into the cavity. trust your doc and his judgment. sometimes the angle of the xray and certain things they call 'artifacts' can make it difficult to see exactly where the end of the root lies. if your surgeon warned you that it might be in the sinus then it must be very close and there is a chance it might pose a problem. also follow your oral surgeons instructions carefully, don't swish and spit, it can dislodge the blood clots and you can get 'dry sockets', if he tells you to rinse, then put the liquid in your mouth, move your head slowly and gently from side to side to let the liquid run around gently inside your mouth then turn your head sideways and let it run out. no spitting or swishing. good luck.

Answer 9

You can only tell with a panoramic x-ray, not the little ones. It's just a matter of the dentist seeing where the root ends. I've seen one where the root was in the sinus cavity, but I don't know how to describe it to you.
I'm sorry I can't help you more. I hope you don't have to worry about it! Good luck!

Answer 10

HELLO,
IT'S BIOLOGIC FACT THAT THE ROOTS OF ANY UPPER TOOTH NEVER EXTEND INTO THE SINUS CAVITY.
THE TOOTH WOULD NEED TO BE SURGICALLY DIVIDED INTO 3 SEPARATE PIECES AND EACH ONE REMOVED INDIVIDUALLY. TO AN ORAL SURGEON THIS IS AN EVERYDAY AFFAIR. THE FACT THAT IT'S SURGICAL WILL MAKE IT MORE EXPENSIVE, BUT ONLY BECAUSE IT'S NOT A SIMPLE FORCEPS EXTRACTION.
YOUR DENTIST DIDN'T FEEL CONFIDENT THAT HE WOULD NOT BREAK A ROOT IN REMOVING THIS TOOTH. THAT'S WHY HE REFEREED YOU OUT.