Water coming out of the nose after tooth extraction — sinus opening and treatment

Key facts

• Upper molar roots often sit close to the maxillary sinus
• Fluid from the nose when drinking is the classic sign
• Small openings often heal with precautions such as not blowing the nose
• Larger or persistent openings may need surgical flap closure
• Swelling around the eye or high fever needs emergency care

Why it happens after upper molar extraction

The roots of the upper premolars and molars often sit just below the maxillary sinus, the air space behind the cheekbone, and sometimes project into it with only a thin layer of bone or membrane between. When such a tooth is removed, especially if the roots are long, curved, or the sinus has expanded downwards over time, a small opening can be left between the socket and the sinus. Infection around the roots, cysts, or difficult surgical extraction can make this more likely. A CBCT or X-ray before surgery helps the surgeon judge the risk and plan the extraction carefully.

Signs of a sinus opening

The most common sign is fluid passing from the mouth into the nose when drinking, so water comes out of the nostril on the same side. Air may bubble or whistle through the socket when you blow your nose or try to suck through a straw, and your voice may sound slightly nasal. Some people notice a salty taste or blood-stained discharge from the nose. If an opening is not recognised and stays open, sinus infection may develop over the following weeks, causing facial pain or pressure, a blocked nose on one side, and foul-tasting discharge into the mouth or nose.

Precautions while it heals

Small openings, often a few millimetres, frequently close as the blood clot forms and the gum heals. To protect the clot, avoid blowing your nose for about two weeks; wipe instead. Sneeze with your mouth open to reduce pressure. Do not use straws, smoke, play wind instruments, or rinse vigorously. Avoid flying, diving and heavy lifting until advised. Drink carefully on the other side. The surgeon may prescribe decongestant nasal sprays, antibiotics if there is a risk of infection, and pain relief. Keep follow-up appointments so healing can be checked and any persistent opening identified early.

Surgical closure

If the opening is larger, if it is recognised during the extraction, or if symptoms continue after a few weeks, surgical closure may be recommended. The most common technique uses a flap of gum and lining from the cheek side, advanced over the socket and stitched to seal it; other flaps from the palate or buccal fat pad are used in some cases. Any infection in the sinus, or a root fragment that has moved into it, is dealt with as part of treatment. Closure is usually done under local anaesthesia. Persistent openings that have formed a tract, called an oroantral fistula, need surgical repair.

When to seek help urgently

Contact the clinic promptly if you notice fluid coming out of your nose after an upper extraction, so the surgeon can examine the socket and advise. Seek same-day care for heavy bleeding from the nose or mouth that does not settle with pressure, fever, increasing facial swelling or pain, or foul-smelling discharge from the nose. Swelling around the eye, visual changes, severe headache or feeling very unwell need emergency medical assessment. Early recognition gives small openings good conditions to heal and reduces the chance of sinus infection or a long-standing fistula.

Oral and maxillofacial surgery treats conditions of the mouth and jaws that go beyond routine dentistry: impacted teeth, cysts and benign lesions, jaw injuries, and preparation of bone for implants.

Prepared by the Manhal Medical Center editorial team · Updated: 2026-10-18 · Treating specialist: Dr. Moataz Al-Khan

This page is general information and does not replace a consultation. Suitability, risks and results vary between patients.