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Molly Maloof, MD

Director of Clinical Content

So half of a molar tooth broke off and because of the severity, I have to get it extracted. Today, I went to an oral surgeon who saw that there was also an infection that reached the sinus. He gave me two options: to just get the tooth extracted (covered by insurance) or to clean the infection and get a bone graft where he would add artificial bone. (+$495.) So I called my local dentist and he says that the infection isn't anything to be concerned about and he doesn't recommend paying extra. He says this is usually for if you want implants later on. Does anyone have similar experience or knowledge on this topic? I'm kinda freaking out and have to decide by tomorrow. If I just get the tooth extracted without dealing with the infection, will it get more intense? What will be some consequences of leaving the sinus infection untreated? Will it continue to spread even after the tooth is extracted? I know I'm asking a lot of questions but this sounds serious and I'm jumping to conclusions about my health. (I'm a bit of a hypochondriac.)


-bad breath

-ear pain

*some of these, I can't tell if it's real or psychological
  • 21 years old
  • Ethnicity: Other Asian
  • Height: 5'3
  • Weight: 114lbs

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Featured Answer

16 UpVoted this answer
I think the most important aspect of your situation is the infection, and your efforts should be prioritized to focus on the infection. Based on your description of the options, it sounds like you may need a more involved debridement of your infection. In routine infections (periapical infections) removal of the tooth and clearance of any local infectious tissue is quite simple. With larger, more invasive infections, as one which has significant involvement of the sinus, it would require a more aggressive approach. Keep in mind, an infection that is not dealt with in a responsible manner can lead to very serious complications later.

The second part of your questions refers to bone grafting. Bone grafting in an area that is infected is not always predictable, and also must be performed by an experienced surgeon, or someone very familiar with the anatomy in that region.
James Sunwoo
13 UpVoted this answer
If you don't have the money for the recommended grafting, don't worry about it. Your body is well equipped to regenerate bone without the graft. I started grafting after extractions 17 years ago and found very little difference (if any) in bone quality and density whether or not I grafted. So I don't graft very often now.

On a side note- You are 19 you can still allow the other molar to move and if you have a wisdom tooth there, you can allow it to move in place (assisted by ortho) in most cases. Or you can place an implant. But upper molars slide forward very nicely to fill gaps with the 3rd molar (wisdom tooth) pushing.

Best of luck, Brian
Brian L. Kirkwood, DDS
11 UpVoted this answer
You can have the tooth extracted anh the surgeon put you under antibiotics and this will take care of any infection ,bone graft doesn't heal or remove infection it just help your body to build bone again to the same level it was .
Randa Nasr
5 UpVoted this answer
If there is already an infection that enters or extends to your sinus, the priority is to clear up the infection and remove the source (the tooth). If the tooth is restorable a root canal might be another option.

As far as bone grafting, I would generally advise against this if the infection truly does extend to the sinus. There is the chance that there could be further infection and extension into the sinus. When the tooth is removed there should be care to attempt to remove as much or all of the infected tissue as possible while hopefully not creating an opening through the sinus if it doesn't already exist. This may require careful evaluation and meticulous surgery in experienced hands. If there is a perforation, it is important to know how to handle it and hopefully treat it promptly. Assuming all is cleaned out thoroughly and there is no evidence of residual infection, I would then reserve tooth socket bone grafting here where it is not possible to maintain width due to missing or loss of the bony socket wall, especially the outside (buccal). Even with this width reconstruction bone graft, there may still not be enough bone height for an implant due to the level of the sinus. If this is the case, I would not graft the sinus area (sinus lift) in the face of infection. This can be done later when all is healthy and sometimes in conjunction with implant placement. It is important to do the right thing based on science and your health and not be overly influenced by insurance coverage and profit. This goes for the doctor and the patient. I always recommend for the doctor to be a patient advocate, be ethical, educated, and not motivated by greed. My 2 cents!
5 UpVoted this answer
Sorry you have this problem.

Get the infection resolved, extraction if it can not be saved via endodontist, root canal specialist.

If it's non restorable, get it extracted.

Bone fillers are great if you can get an implant later on.

You need enough bone to support the implant.

If you have teeth on either side, a bridge can be an option

or a unilateral partial until you decide what you want and can afford.

Without a film X-ray it is difficult to give you exact answer.

A second opinion would be a good idea if you are still in doubt.

Certainly antibiotic coverage is indicated clindamycin,

Or one that you can tolerate, should you have allergies.

Good luck,

Daniel Sena DDS
Daniel G. Sena
4 UpVoted this answer
Taking the tooth out may clear up the sinus infection with a course of antibiotics. If it does not, I would recommend seeing a ENT physician. By the way, a bone graft has no bearing on a sinus infection. We do add bone to an extraction site so that the ridge of bone does not shrink in height and width.
3 UpVoted this answer David J. Darab, DDS, MS Oral and Maxillofacial Surgeon, Hickory
Whether or not you do the bone graft, the extraction and an antibiotics course should resolve the infection. However, if a bone graft can be included as an option and done carefully in conjunction with thorough irrigation of the infected sinus area, it would be more ideal since that sets a stage for good bone health, dimensions, soft tissue health and eventually a nice implant site. As a healthy person with a normal immune system, the sinus infection should resolve itself .
3 UpVoted this answer
Taken the tooth out will completely end the infection of course with the combination of an antibiotic. To do the bone graft is also optional if you intend to do an implant at a later date. It should not exceed more than a regular extraction that we do everyday on a regular basis.
Mohamed Arafa
2 UpVoted this answer
You sound confused with conflicting facts so I suggest you go to your trusted general dentist for an examination and follow his advice. If you do not trust him, then seek out help from another dentist. If you cannot make up your mind what to do, simply take some antibiotics to relieve the infection now and stall until you locate a trusted dentist. I agree with previous answers, a thorough physical exam is required. You need good explanations. Right now, you are too confused to make treatment decisions.

Seek to understand the condition you have, the consequences of the condition, the benefits of treatment and then the actual treatment choices. You need to understand all of this to make an informed decision.

Good luck!
Douglas E. Hamilton
1 UpVoted this answer
The extraction and an antibiotics course should treat the infection. I think it would be best if you get the bone graft, for future implant placement, since you are so young to have a missing tooth for the rest of your life.