Sinus Surgery

This section is dedicated to the latest information on oral health topics, culled from authoritative sources such as the American Dental Association.

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Heart Disease

Poor dental hygiene can cause a host of problems outside your mouth-including your heart. Medical research has uncovered a definitive link between heart disease and certain kinds of oral infections such as periodontal disease. Some have even suggested that gum disease may be as dangerous as or more dangerous than other factors such as tobacco use. A condition called chronic periodontitis, or persistent gum disease, has been linked to cardiovascular problems by medical researchers.

In short, infections and harmful bacteria in your mouth can spread through the bloodstream to your liver, which produces harmful proteins that can lead to systemic cardiac problems. That's why it is critical to practice good oral hygiene to keep infections at bay-this includes a daily regimen of brushing, flossing and rinsing.


Antibiotic Prophylaxis

In some cases, patients with compromised immune systems or who fear an infection from a dental procedure may take antibiotics before visiting the dentist.

It is possible for bacteria from your mouth to enter your bloodstream during a dental procedure in which tissues are cut or bleeding occurs. A healthy immune system will normally fight such bacteria before they result in an infection. However, certain cardiovascular conditions in patients with weakened hearts could be at risk for an infection or heart muscle inflammation (bacterial endocarditis) resulting from a dental procedure.

Patients with heart conditions (including weakened heart valves) are strongly advised to inform our office before undergoing any dental procedure. The proper antibiotic will prevent any unnecessary complications.


Dentistry Health Care That Works: Tobacco

The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.

Smoking and Implants

Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking. Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.

Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.


External Links

Location of the sinuses.

If you want to replace a missing or failing tooth with a state-of-the-art dental implant (watch dental implant video), your dentist will first need to make sure that you have sufficient bone in your jaw to anchor the implant. This is true no matter what type of tooth is being replaced. However, if it is an upper back tooth and there is not enough bone under the gum where the implant needs to go, the base of the implant could end up poking through an air space (located to the side of the nose) called a sinus cavity. Since you can't anchor a dental implant to air, this presents a problem — but it is one that can often be solved with a minor in-office surgical procedure called a “sinus membrane lift.”

Sinus surgery step by step.A sinus membrane lift, or sinus augmentation, involves adding bone to fill in the bottom of that air space, essentially raising the floor of the sinus cavity. Why wouldn't there be enough bone there already? For some people, it's simply a matter of how large their sinus cavities are, and their shape. In other cases, bone has actually been lost from the area. For example, if your tooth has been missing a long time, the bone that used to surround it may have begun to deteriorate. Bone in general needs stimulation to stay strong; in the case of the jawbone, that stimulation comes from the teeth. When teeth are lost, the bone loses stimulation and the body ceases to make new bone cells in that area. This leads to a reduction in bone volume and density. Also, if your tooth loss was due to periodontal (gum) disease, your tooth-supporting bone may have been reduced as a result of the disease. No matter what the reason is for insufficient bone, a sinus membrane lift can create more bone where it is needed.

Where does this additional bone come from? It can be bone from elsewhere in your body, such as another part of your jaw or your hip. But most often, it will be bone-grafting materials that are processed in a laboratory for these kinds of purposes. The original source may have been a human or animal donor (usually a cow). Synthetic products can also be used. All grafting materials must be approved by the Food and Drug Administration (FDA) and prepared according to their guidelines. The materials are specially treated to render them completely sterile, non-contagious, and free of rejection factors. For the most part, bone grafts act as scaffolds that the body will eventually replace with its own bone.

The Procedure

Prior to scheduling surgery, your dentist will assess the shape, location, and health of the sinus using x-ray imaging. Your options for anesthesia will also be discussed. The surgery itself is usually carried out under local anesthesia by numbing the area, just as is done for a routine filling. Some people require additional sedation or anti-anxiety medication, which can either be administered orally (by mouth) or by intravenously (through a vein) via injection.

When the area has been completely numbed, an incision will be made in your gum to expose the bone that used to contain your missing tooth or teeth. A small opening will be made in the bone to reveal the membrane that lines the sinus. This membrane will be raised and the space beneath it will be filled with bone grafting material. The gum is then stitched back up. In some cases, the implant(s) can be placed directly into the grafting material before the gum is closed, eliminating the need for a second surgical procedure later on to place the implant. Often, however, the surgical site is allowed to heal for approximately 6-7 months before an implant is placed.

What to Expect After Sinus Surgery

You may experience moderate swelling and some minor discomfort that generally lasts a few days — about the same as having an upper impacted wisdom tooth removed. Sometimes a non-steroidal anti-inflammatory medication (prescription or over-the-counter) is recommended to help minimize this. A course of antibiotics may be prescribed to prevent infection. If the sinus membrane becomes a bit inflamed, leading to a feeling of minor congestion, a decongestant can be helpful. If you suffer from seasonal allergies, make sure to schedule your surgery for a time when this will not be an issue.

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