What is an oroantral communication after a tooth extraction?
An oroantral communication is an opening between the mouth and the maxillary sinus, most often left when an upper molar or premolar is removed. Typical signs are liquid coming out of the nose when you drink, air passing through the socket, or a nasal voice. Small openings without infection usually close as the socket heals; larger or persistent ones need surgical closure. At Creative Arts in Dubai, the socket is examined and imaged before deciding which applies.
Who treats you here Dr. Firas Osman Oral & Maxillofacial Surgeon & Implantologist · Dr. Khalid Saeed Co-founder & Dentist · Dr. Somar Dahdal General Dentist
Every dentist’s licence can be checked on the DHA Sheryan medical directory.
Why can removing an upper back tooth open into the sinus?
The maxillary sinuses are air spaces inside the cheekbones, one on each side, lined with a thin membrane. Their floor sits directly above the roots of the upper premolars and molars. In many adults only a thin plate of bone separates the root tips from the sinus, and in some the roots actually project into the sinus floor, covered only by the membrane.
When such a tooth is removed, that thin layer can come away with the roots or tear, leaving a passage from the socket into the sinus. This is an oroantral communication ("antrum" is the old name for the maxillary sinus). If the passage stays open long enough for its walls to become lined with skin-like tissue, it becomes a permanent channel called an oroantral fistula.
It is more likely when:
- the tooth is an upper first or second molar, or an upper wisdom tooth, whose roots lie closest to the sinus;
- the roots are long, curved or spread apart, so bone comes away with them;
- the sinus has expanded downwards over the years, which often happens after neighbouring teeth were lost;
- infection or a cyst around the roots has already thinned the bone;
- the tooth is broken down and has to be removed surgically, in sections.
It can happen even when the extraction is done carefully, because the anatomy is decided before the first instrument touches the tooth. What good planning changes is that the risk is known in advance: an X-ray, and for higher-risk teeth a CBCT 3D scan, shows how close the roots are to the sinus, so the dentist can choose the technique and warn you what to watch for.
What are the signs of an oroantral communication?
Some appear in the chair, others in the first days after the extraction. Any of them is a reason to have the socket checked rather than waiting.
| Sign | What you notice | Why it happens |
|---|---|---|
| Liquid from the nose | Water, tea or soup comes out of the nostril on the extraction side when you drink | Liquid passes from the socket up into the sinus and drains through the nose |
| Air through the socket | Bubbling or whistling at the socket, or air rushing into the mouth when you breathe out through the nose | Air moves freely between the sinus and the mouth |
| Change in your voice | Speech sounds nasal or you cannot build pressure to suck through a straw | The mouth and nasal airway are no longer sealed from each other |
| Nosebleed on one side | A little blood from the nostril on the same side soon after the extraction | Bleeding from the socket drains through the sinus |
| Discharge or bad taste | Foul taste, salty fluid in the mouth or discharge from one nostril days later | The sinus has become inflamed or infected through the opening |
| Cheek pressure | Aching, fullness or tenderness over the cheek, sometimes with a headache | Sinus inflammation; this is also the main sign of a developing sinus infection |
A small nosebleed on the day of an upper extraction can happen without any opening. Liquid coming through the nose when you drink is the most specific sign.
Will an oroantral communication close on its own?
Often, yes, if it is small. A 2024 review in Dentistry Journal describes openings of up to about 3 mm without infection as usually healing spontaneously, because the blood clot that forms in the socket seals the gap and is gradually replaced by gum and bone. To help that clot stay in place, the dentist may bring the gum edges closer with a few stitches and will give you sinus precautions to follow while it heals.
Larger openings are a different matter. The same review notes that bigger defects generally need surgical closure, and that a communication still open after about 48 to 72 hours can start to line itself with tissue and turn into a fistula, which does not close by itself. That is why timing matters: a suspected opening is best assessed within the first days rather than left to see what happens.
Infection also changes the picture. If the sinus was already inflamed, or becomes infected through the opening, the infection is treated first, because a flap closed over an infected sinus is less likely to hold.
How is an oroantral communication treated?
Treatment follows the size of the opening, how long it has been there and whether the sinus is infected. Your dentist explains which row fits after examining the socket and the imaging.
| Situation | Usual approach | What it involves for you |
|---|---|---|
| Small opening, no infection | Protect the clot, sinus precautions, review | Following the aftercare below for about two weeks and a check that it has closed |
| Small to moderate opening found during the extraction | Stitches to bring the gum together over the clot, plus precautions | Done straight away under the same local anaesthetic; medicines only if your dentist prescribes them |
| Larger opening, or one that has not closed | Surgical closure with a flap of gum moved from the cheek side, or the buccal fat pad | A planned procedure, usually under local anaesthetic, with stitches and a soft diet for some days |
| Established fistula | Removal of the lining of the channel and closure with a flap | Planned after imaging; any sinus infection is treated first |
| Sinus infection through the opening | Infection treated before closure; an ENT doctor may be involved | Medicines as prescribed and a review before surgery |
| Root tip or fragment pushed into the sinus | Imaging to locate it, then planned retrieval | A separate procedure decided case by case |
Antibiotics and nasal decongestants are sometimes prescribed after an opening; take them only as your dentist or doctor directs.
What should you avoid after a sinus opening?
The aim for the first two weeks is to avoid any pressure difference that could push air through the socket and lift the clot or open the stitches. Aftercare leaflets from the NHS (Kingston and Richmond NHS Foundation Trust) give advice along these lines:
- Do not blow your nose for two weeks. Wipe or dab instead, and let the nose drain.
- Sneeze with your mouth open, so the pressure escapes through the mouth rather than through the socket.
- No straws and no smoking or vaping for several days at least; both create suction. Our guide to smoking after a tooth extraction explains why the clot is so vulnerable.
- Avoid straining: heavy lifting, intense exercise, playing a wind instrument or inflating balloons. The guide to exercise after dental surgery covers when to restart training.
- Keep food away from the socket: soft food chewed on the other side, and no probing the area with your tongue or a finger.
- Rinse gently only when your dentist says you can, letting the water fall out of your mouth rather than spitting forcefully.
- Ask before flying or diving. Pressure changes in the cabin or under water act directly on the sinus; our guide to flying after dental surgery explains the general timing.
If the dentist placed stitches, our guide to stitches after an extraction explains how long they stay and whether they dissolve.
Do not test the opening yourself
Pinching your nose and blowing to see whether air comes through the socket is the one thing most likely to dislodge the clot or enlarge a small opening. Dentists use this test with care in the chair, at the right moment. At home, simply note the signs and have the socket checked.
An upper molar with roots close to the sinus, or an opening that has not closed? See how oral surgery is assessed and planned at Creative Arts in Dubai, with 3D imaging before treatment.
Oral surgery at Creative ArtsWhen should you get help quickly?
Contact the clinic during opening hours, 10:00 to 20:00 daily, if:
- liquid is still coming through your nose when you drink a few days after the extraction;
- you can feel or hear air passing through the socket;
- a foul taste, discharge from one nostril or cheek pain develops or gets worse;
- the stitches have come out early or the socket looks empty.
Go to a hospital emergency department straight away if you have facial swelling with fever, difficulty breathing or swallowing, swelling spreading towards the eye or the neck, or bleeding from the socket or the nose that does not stop with firm pressure. The clinic is not open overnight.
Not every pain in the upper teeth after an extraction means an opening. Sinus inflammation can also make healthy upper teeth ache; our page on sinus toothache explains how the two are told apart.
Can you still have an implant after an oroantral communication?
Usually, once the area has fully healed. Closing the opening restores the seal between the mouth and the sinus, and the bone then fills in over the following months. Before an implant is planned, a CBCT 3D scan shows how much bone height is left under the sinus. Where the sinus sits low, a sinus lift can rebuild bone beneath its floor so that an implant has enough support.
If you already know you want an implant, tell the dentist before the extraction. Sometimes the extraction, the closure and the later implant can be planned together, which avoids surprises about bone height later on. Our guide to implants after an extraction explains the usual timing options.
Who manages a sinus opening at Creative Arts?
Extractions at the clinic are carried out by Dr. Khalid Saeed and Dr. Somar Dahdal, and by Dr. Firas Osman, Oral & Maxillofacial Surgeon & Implantologist, who assesses and closes larger openings and fistulas. Upper teeth with roots near the sinus are imaged beforehand, and you leave with written aftercare that includes the sinus precautions when they apply.
If your extraction was done elsewhere and you now have symptoms, bring any X-rays or notes you were given. For other things that can feel wrong after an extraction, such as a sharp piece of bone working its way out of the gum, see our guide to bone fragments after an extraction.