Sinus Perforation After Tooth Extraction: What It Means & How PRF Can Help Support Healing

When upper molars are removed, one potential complication is a sinus perforation, where an opening develops between the mouth and the sinus cavity.

If this opening occurs, food, fluids, or bacteria can enter the sinus, leading to complications such as infection, delayed healing, or a persistent opening that may require additional treatment.

Dr. John Wessel, oral and maxillofacial surgeon at Carolinas Center for Oral & Facial Surgery in Rock Hill, SC, recently treated a patient who was referred following multiple upper tooth extractions earlier that day.

Early evaluation by an oral surgeon is important when a sinus perforation occurs, as timely treatment and biologic support such as PRF can help support more predictable healing.

A Large Sinus Perforation Following Multiple Extractions

A 60-year-old patient was referred to Dr. Wessel’s office after having approximately 12 upper teeth removed earlier that day by his general dentist. During removal of the upper molars, an opening into the sinus cavity occurred.

When Dr. Wessel evaluated the site, he found an opening measuring approximately 15 millimeters between the extraction area and the sinus.

To put this into perspective, a 15 mm opening is roughly the width of a small coin and is considered a large sinus perforation, meaning it is unlikely to close on its own without intervention.

Dr. Wessel explains: “When the dentist had taken out the molar teeth, he ended up having an opening to the sinus cavity. And an opening of the sinus cavity above the molar teeth means food can travel from the mouth into the sinus.”

This increases the risk of infection, prolonged healing, or developing a chronic opening between the mouth and sinus.

Why Sinus Perforations Happen

Upper molar teeth are often located very close to the sinus cavity. In some patients, only a thin layer of bone separates the tooth roots from the sinus floor.

Because of this anatomy, removing upper molars can occasionally create an opening between the mouth and the sinus. While smaller openings may heal on their own, larger perforations often require immediate attention by an oral surgeon to support predictable healing and reduce the risk of sinus complications.

Using PRF to Heal the Sinus Opening

To help manage the perforation, Dr. Wessel used platelet-rich fibrin, commonly known as PRF.

PRF is created from a small sample of the patient’s own blood. The blood is spun in a centrifuge, concentrating the body’s natural healing components into a gel-like material that can be used during surgery.

“It’s like a biologic band-aid. We place it on areas we want them to heal,” Dr. Wessel describes.

In this case, PRF was placed directly against the sinus floor and within the extraction sites before the tissues were carefully closed.

One of the advantages of PRF is that it can be placed immediately when a sinus perforation is identified, helping protect the area before bacteria or food particles enter the sinus.

When to Contact an Oral Surgeon

Patients should contact an oral surgeon if they experience fluid passing between the mouth and nose, unusual sinus symptoms after an upper tooth extraction, persistent drainage, or concerns about healing.

Early evaluation is critical to identifying a sinus perforation before it progresses and to begin treatment to support proper healing.

If you need a tooth extracted, our team at Carolinas Center for Oral & Facial Surgery focuses on protecting surrounding structures and supporting healing. When appropriate, PRF (platelet-rich fibrin) may be used at the time of extraction to support the body’s natural healing process and promote a more comfortable recovery. With locations in Charlotte, Greenville, Columbia, and Raleigh, we make it easy to access care close to home.

FAQs About Sinus Perforation After Tooth Extraction

Can a sinus perforation get worse if it is not treated?

Yes. If left untreated, a sinus perforation can enlarge or become infected. This may allow ongoing passage of air, fluids, or food between the mouth and sinus, which can lead to chronic sinus issues or delayed healing.

How long does it take for a sinus perforation to heal?

Healing time varies based on the size of the opening and treatment approach. Smaller perforations may close within a couple of weeks, while larger perforations that require surgical repair may take several weeks to fully heal.

What causes a sinus perforation during tooth extraction?

The most common cause is the close proximity of upper molar roots to the sinus floor. In some patients, only a thin layer of bone separates the tooth and sinus, which can open during extraction.

Can I fly after a sinus perforation from a tooth extraction?

Air travel is usually not recommended immediately after a sinus perforation, as pressure changes can worsen symptoms or disrupt healing. Patients should always follow their oral surgeon’s specific post-operative instructions.

What should I avoid after a sinus perforation?

Patients are typically advised to avoid blowing their nose, using straws, smoking, or forceful sneezing, as these actions can increase pressure and interfere with healing.

Does PRF improve healing after tooth extraction complications?

PRF (platelet-rich fibrin) may help support healing by providing a concentrated source of the body’s natural growth factors. It is often used in oral surgery to support tissue healing and improve surgical outcomes when appropriate.

When is surgery needed to close a sinus perforation?

Surgical repair is typically recommended when the opening is large, does not close on its own, or when symptoms such as persistent sinus drainage or infection are present.