Sinus Precautions After Surgery

     Because of the close relationship between upper back teeth and the sinus it is not uncommon when having an upper molar or premolar tooth removed that a small opening (communication) will develop between the mouth and the sinus.  Most of the time there is a very thin layer of bone between the roots of the upper back teeth and the sinuses however larger tooth roots or teeth that have infections around them often extend into the actual sinus.  It is a fairly common occurrence; there is no reason for alarm when this happens.  You will have been informed at the time of your surgery and will have been told to read these instructions in order to give the site the best chance to heal on its own.  However, sometimes the communication may develop after the surgery and not be known until a later date.  Also, some do not resolve on their own and may require a second procedure, particularly if these instructions are not followed or due to factors beyond the control of anyone involved. 

First you should follow all of the postoperative instructions for a regular extraction as well as the ones that are listed below. 

1. Take all prescriptions as instructed.  Is very important that you complete the full course of postoperative antibiotics. Pain medication should only be taken if needed. 

2. Do not spit forcefully for several days and no spitting at all the first 24 hours after surgery.

3.  Do not smoke for 10 to 14 days. 

4.  Do not use a straw or drink through a water bottle with a suction tip for 1 week. 

5.  Do not blow your nose for at least one week and only gently if you must during the second week after surgery.  It is preferable if you do not blow your nose for the first two weeks.  If your sinuses feel "stuffy" or "clogged" or you develop a post nasal drip or a runny nose you can start taking an over the counter (OTC) decongestant orally.  Examples: Sudafed or Actifed tablets.

Only take these decongestants if you do not have any medical condition that prohibits the use of them, if you're unsure check with your medical doctor before starting them.  See ***note below for contraindications of using pseudoephedrine. 

ONLY TAKE THE ORAL MEDICATION; DO NOT USE NASAL SPRAY DECONGESTANTS.  If your nose is extremely dry you can use a saline nasal spray but spray use sparingly and very gently and do not blow your nose after use.

6.  Try not to sneeze if possible, it will cause undesired sinus pressure. If you must sneeze, keep your mouth open. This is very important! Open mouth sneezing...DO NOT CLOSE YOUR MOUTH AND HOLD IT IN.

7.  Eat only soft foods for several days, trying to chew on the opposite side of your mouth.

8.  You are to start rinsing your mouth 24 hours after surgery but only very gently for the first few days.  Rinse only with salt water; do this 3 to 4 times a day for the first two weeks, most importantly after meals and before bedtime.  Do not use mouthwash, only salt water.

9. Slight bleeding from the nose is common for several days after surgery.  Typically the day of surgery and the first day after surgery this is very common so do not panic this is normal.  It is likely you will wake up with some blood on your pillow the morning after surgery so you may want to cover your pillow with a towel before going to bed.  Try to sleep with your head elevated the first night (propped up on 2 to 3 pillows or sleep in a reclining chair. 

10. It is also very important that you refrain from any strenuous exercise (weight lifting, boxing, swimming etc) for the first two weeks after surgery.   

***Contraindications for using pseudoephedrine: DO NOT USE pseudoephedrine unless cleared by your physician if you have: 

1.     Diabetes: Sugar problems        

2.     Cardiovascular disease: Heart problems

     3.  Severe or uncontrolled High blood pressure 

     4.  Coronary artery disease, clogged arteries

     5.  Prostatic hypertrophy: an enlarged prostate. 

     6.  Hyperthyroidism 

     7.  Closed angle Glaucoma 

     8.  If you are pregnant or think you possibly could be pregnant 

     9.  Patients who are prone to anxiety or panic attacks should use pseudoephedrine with caution,   as anxiety and restlessness are common side effects, mostly due to the drug's stimulant properties.

Drug interactions:

DO NOT USE Pseudoephedrine products (Sudafed/Actifed) if you have recently been on (previous fourteen days) monoamine oxidase inhibitor (MAO inhibitors) this can lead to very, very high blood pressure leading to a hypertensive crisis.  

Use with caution if taking methyldopa, mecamylamine, reserpine and veratrum alkaloids it may increase blood pressure.  

If you are at all unsure if you should take these medications DO NOT take them until checking with your medical doctor first. 

Please keep our office advised of any changes in your condition, especially if you a bad odor from your mouth or a discolored drainage from the site or if your pain increases. It is important that you keep all future appointments until we are sure that the sinus has completely closed. The majority of the time the sinus communication will close on its own however occasionally a second procedure may be required to close the tissue up around the small opening.  Typically I will allow 4-6 weeks of healing before determining whether any further treatment is required.