What is an oroantral communication?

What is it all about.
Oroantral communication explaination, OAC explaination Treatment for OAC, Prevention of OAC, Treatment Oroantral communication, Prevention of oroantral communication
Imagine your tooth roots are just like roots on a tree.
In some cases, in the top jaw, these tree roots can run really close. to the pipes underground. Occasionally, in these circumstances pulling out the tree can damage and expose the pipe underneath resulting in a leak. When these happens with tooth roots in the maxilla (top jaw) with the maxillary sinus (Air sacs). This is called an oroantral communication as a passage has been formed between the mouth and the maxillary sinus. The reason this can occur is dependant on the patient’s anatomy. If the patient has long and tapered roots that run really close to the maxillary sinus. They have a higher probability of forming this connection between the two spaces. If this does occur, please follow your dentist’s instructions. Some common but not extensive list has been provided below.
Important Points In This Section
  • What is an OAC?
  • Signs/Clinical Presentation
  • Treatment
What is an OAC?

    In certain individuals, an extraction of a tooth will fracture the thin floor of the sinus, causing an abnormal connection between the oral and antral cavities. The OAC may clos spontaneously or it may epithelialize, forming an oroantral fistula which will not heal without surgical intervention. The reasons it occurs in some individuals and not others. Is because the anatomy of the maxillary sinus is highly variable amongst individuals and changes depending on their age. The apices (tips) of the posterior maxillary teeth are often separated from the floor of the sinus by a thin layer of bone and mucous membrane. In extreme cases, the separation of the apices and the sinus is only the mucous membrane.


    Risks factors that increase the chances of an OAC include: periapical inflammation (which can resorb bone), lone-standing molars (pneumatisation), curved bulbous roots, hypercementosis, ankylosis, traumatic extraction, enlarged tuberosities, and neoplasia.

Signs/Clinical Presentation

    A common symptom and complaint is air and fluids passing between the nose and mouth. The dentist may be able to see bubbling through the communication particularly when the patient is asked to exhale. Other clinical features include unilateral nasal obstruction, alteration in vocal resonance and excruciating pain.

    Patients with an established oroantral fistula will find that the pain becomes negligible but there will be an unpleasant tasting discharge and odour that is evident on the affected side. When this is large enough, patients may be able to pass drink from their mouth into their nose or cigarettes may be difficult to inhale.

    There is the possibility of both acute or choric sinusitis developing which will require treatment as well.

Treatment

    If there is a suspected or confirmed communication, it can either heal spontaneously or it can form a fistula (abnormal connection). The treatment choice usually depends on the size of the communication.

    (click here to see the picture above)


    Advice for prevention or treatment for a small OAC

  • Do not fly or scuba dive for 2 weeks to avoid creating pressure
  • Do not blow your nose to avoid creating pressure
  • If you need to cough or sneeze, do this with an open mouth to avoid creating pressure
  • Use a decongestant that is prescribed by your dentist or doctor
  • After 24 hours use an antibacterial mouthwash like chlorhexidine (savacol), this allows time for a clot to begin formation and heals the area to heal
  • Follow all the aftercare extraction advice that was given
    • (After Extraction Advice)


    Advice for larger OACs

  • Follow the above advice
  • May require surgery to cover the hole with a flap of gum and stitches. Treatment is performed by a dentist with extra training or a specialist.
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Still have concerns?

This page provides general information about dental topics. It does not contain all the known facts of this subject and is not intended to replace personal advice from your dentist. If your not sure about anything on this site, contact us or speak to your local oral health practitioner. Make sure you give your local oral health practitioner your complete medical history and dental history.

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A selection of the references used:
Parvini, Puria; Obreja, Karina; Begic, Amira; Schwarz, Frank; Becker, Jürgen; Sader, Robert; Salti, Loutfi (2019). Decision-making in closure of oroantral communication and fistula. International Journal of Implant Dentistry, 5(1), 13–. doi:10.1186/s40729-019-0165-7
Khandelwal, P., & Hajira, N. (2017). Management of Oro-antral Communication and Fistula: Various Surgical Options. World journal of plastic surgery, 6(1), 3–8.

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