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Oral Surgery/extractions with sinus perforation


I had all my back teeth pulled two years ago. I came back to same place to get the last top eight teeth and two bottom teeth pulled, dentures and a partial to be put in immediately following extractions. While getting the last of my top teeth pulled the dentist started to cuss loudly and telling hygienist assisting that he has bubbles. He continued to cuss and both started to work a little frantically when I tried to ask he told me to wait he would explain in a minute. After he finished he put in my denture then called my husband into the room. He told both of us that one of the teeth he pulled was in my sinus cavity and when he pulled it some of the bone came out with the tooth. Not sure what that means. He told me he put in a bone graft which he made sure I knew was 500 dollars that he wasn't going to charge me for. And he represcribed Amoxicillian which I was already on before the procedure and some pain medicine.I went back in Friday morning because he wanted to do a quick check and see how things are healing I was not very swollen and pain was minimal with pain medicine and a 3 on 1-10 scale. I had this done on Thursday morning. Friday night my entire face hurt taking my pain meds pain was a 8 and was very swollen which is understandable with all the work but I also spiked a fever of 102.1 I called the after hrs line when he called me back he told me to double up on amoxicillian and pain pills and go to an clinic we have in town open on the weekends. I went and the doctor gave me clindamycin and told me to keep taking amoxicillian as well and to see dentist on monday since he wasn't dental expert. It didn't change I went into the dentist on monday and he took me off amoxicillian and added flagyl and refilled pain medicine. My swelling has gone down but if I am not taking Ibprophen my fever goes up and on fever reducers it never gets below 99.0 I have gone back to him once and he acting frustrated put me on cephalexin. It has now been 2 weeks total since surgery and the side of the perforation is still very tender and fevers wont go away. He is acting very put out with my questions and refuses to give pain medication even though I still hurt. I get the feeling that since he is not an oral surgeon he is in over his head but I may be wrong. I am exhausted the antibiotics are messing me up digestively and I cant sleep because the pressure and pain on that side is pretty bad. Should I be seeking a second opinion? I am getting treated like an annoyance and they act like I am making up my pain. I would like to know what to do I am a self pay so going to someone else after I have paid this one up front to do this work is going to be hard to swing. I just need a little guidance cause I am scared. Also I do have a lots of yellow green drainage in the back of my throat I keep coughing up.

Hello Jessica,

It sounds like you have 2 superimposed problems. The perforation of the sinus also called oro-antral fistula and a sinus infection probably due to placement of the bone graft which got infected.
You definitely need to see an oral surgeon who is aware of these techniques and not a general dentist. He might need to remove the graft and clean your sinus and try to close the opening if he can at that session although sometimes it will be deferred. there is no use to excessive antibiotics since the infection cause has not been adressed.
I urge you to see an oral & maxillofacial surgeon who will contact your dentist and I am sure that his insurance will take care of the extra unwarranted expenses.

All the best,

Dr. Chawket MANNAI,DDS,Ph.D

Oral Surgery

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Chawket MANNAI, DDS,Ph.D Diplomate ABOMS


I am a US board certified Oral & Maxillofacial Surgeon trained at UCLA and Parkland Memorial Hospital (Dallas) with more than 25 years of experience and will provide answers to all questions pertaining to the Oral& Maxillofacial Surgery region including Orthognathic Surgery, Trauma,TMJ, Implantology, tumour surgery (excluding cancer and Oral Dermatology),reconstructive surgery...


Extensive in all fields for the past 25 years hospital and office based.

American Association of Oral & Maxillofacial Surgeons American College of Oral & Maxillofacial Surgeons British Association of Oral & Maxillofacial Surgeons

2006: Mannai Chawket Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2006;64(9):1420-6. Bayonne, France. 1998: Bell W H; Mannai C [An interview with Dr. W.H. Bell and Dr. C. Mannai. Interview by Colette Orival-Demange.] L' Orthodontie franšaise 1998;69(1):225-9. 1988: Abemayor E; Zemplenyi J; Mannai C; Webb D J; Canalis R F The fixation of malar fractures with the transnasal Kirschner wire. The Journal of otolaryngology 1988;17(4):179-82. Division of Head and Neck Surgery, Harbor-UCLA Medical Center, Torrance 90509. 1988: Wald R M; Abemayor E; Zemplenyi J; Mannai C; Lesavoy M A The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study. Annals of plastic surgery 1988;20(5):409-13. Division of Plastic Surgery, Harbor/UCLA Medical Center. 1988: Di S; Bell W H; Mannai C; Seale N S; Hurt W C; Taylor J; Waite D E Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study. Oral surgery, oral medicine, and oral pathology 1988;65(4):379-86. Division of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Dallas. 1988: Bell W H; Mannai C; Luhr H G Art and science of the Le Fort I down fracture. The International journal of adult orthodontics and orthognathic surgery 1988;3(1):23-52. 1986: Mannai C; Schwartz H C Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report. Journal of maxillofacial surgery 1986;14(6):329-31. 1986: Mannai C; Leake D; Pizzoferrato A; Ciapetti G; Sangiorgi C Histologic evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral surgery, oral medicine, and oral pathology 1986;61(4):315-23.

DDS,Ph.D Fellow and Diplomate American Board of Oral & Maxillofacial Surgery Residency training:Harbor-UCLA MedicalCenter 1982-1985 Fellow OMFS Parkland Memorial Hospital Dallas Texas with William H.BELL

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