Yes, so don't poke any needles into your eyeball or brain. This is a grim fact.Study the location of your teeth relative to both eyeball and brain and ear. And make sure you don't poke any holes into any of them. Reality though is both are reasonable far enough away as long as you don't stick the needle in too far. And obviously extra special hygiene should be paramount.   If the tips of the molars are already in the sinuses and the bone between the teeth is completely gone then you are totally screwed. Or are you? In my case everything between the upper two molars looked totally shot. But managed to reduce the infection anyway. Using a combo of everything. Curettes. Needles. Toothpicks. Etc. Now finally down to close to nil. Bone shards hardly even stick out anymore. And the area mostly looks healed over. With what? I don't care. And I largely can keep it clean with a Furcator. Plus the Hu-Friedy - Langer 4-5 - Extended Access w Mini Blade.  Plus it seems real tough too. And now I even have dreams it will regenerate some day. But also realize it will certainly mostly stay dead space.

Which sort of leads to a conclusion that a person should forge ahead with the instruments even under highly dicey circumstances. But could argue that the hole was pre-existing until you stepped into it. So then the real issue becomes when to deal with the problem, now or later.

Alternately some dental professionals will probably tell you that your tooth is shot and needs to get pulled out to save the sinus. Bad expensive traumatic news. Which if you think about it at least temporarily opens up the hole into the sinus even more. Since the tooth is blocking the hole. Once the tooth is gone then the infection can pretty much be eliminated. Since it doesn't have anywhere to hide anymore. This is another example of Killing for Peace. Pulling the tooth to eliminate its ability to provide aid and comfort to the ongoing infection.

So naturally one would think that if you can just reduce the infection without pulling the tooth  - cutting it in half, then in half again etc - eventually the area will run clean. Even the sinus itself is designed to help keep people alive under even the most adverse circumstances and will somehow attempt to close itself off from the infection. Don't really know how this happens. But if the infection can be eliminated the sinus will magically close itself off. Somehow. Most of the time.

Think the sinus might lay down some cruddy quasi-living scab. Which is not so good. Since once you dislodge that the sinus might naturally get a hole. Also removal of infection can cause the material to shrink. Which should also open up the hole. But otherwise think just have to trust in the healing process. Which more or less claims this: As long as highly negative consequences can be avoided during physical intervention with instruments and water jets it is ALWAYS  better to clean things out. Even a hole into the sinus. And that once a person works through the logic is becomes obvious to go up there with a - BRUSH - TOOTHPICK - BRUSH PICK - WATER JET - IRRIGATION NEEDLE - EXPLORER 

Also, if the hole is properly cleaned out people can always pray to God that their hole will close over and stop blowing air. Or see if their dentist or oral surgeon has any bright ideas. Which indeed they may not. They may just say "wait and see" what happens. Which they often say too about impending abscesses. Which does not sound like such a great strategy to me. If DIY can successfully be executed without causing serious injury, death, extreme trauma or disaster.

Apparently thanks to some cruddy material the sinus lays down as a temporary patch (?).  Or possibly due to the sinus pinching together opposite side of the channel. But whatever it does the hole into the sinus is likely to go dormant reasonably soon. Meaning it is closed and largely stays closed as long as there is not any extreme pressure from the mouth to blow open the hole.

This means that hygiene right around the hole, however this is done, and hopefully eliminating the calculus one way or another, can eventually lead to the hole closing itself off and even becoming  fairly healthy and infection free. Without pulling the tooth.

WARNING on PUNCHING HOLES INTO SINUSES - DANGER - HIGHLY DICEY TERRITORY - deep and scary - And realistically dealt with by seeing an oral surgeon. Who can do surgery to close the flap. But if you try to DIY on this one then be aware that it is highly dangerous and prone to screw-ups. And what the hell why are you trying to DIY on a surgeon's turf anyway? Is this really your big chance to play doctor? Bad motivation if there is any truth at all to this insult. If you can afford it see the surgeon. But if you are SOL or if the surgeon either tells you stories about how much it will cost in huge amounts of money or otherwise wants to do serious cutting without some more reasonable minor alternative. Like more based on curettage and less on cutting and even less based on wide open cutting and extractions. Also if the doctor suggests to "wait and see" in dentistry this often really means let's wait for it to get real bad.

Or if the doctor says to pull the teeth to save the sinus and you decide not. Possibly foolishly. Where the sensible thing to do is to pull the teeth. Then do something. So if DIY truly sounds like the best alternative and the person is motivated and knows what they are doing and is not stupid and avoids making dumb tragic mistakes then they can study up and do what they have to do. And not necessarily regret it. Remember most of even the dumbest mistakes do eventually heal. And people do get better through experience. Even if it is a tough teacher. And sometimes kills people or causes them tragedy.  I would say I have had upwards of five communications over the years and have mostly sealed them off through hygiene. With no recurring issues. And occasional scary maintenance. Where I dart around the presumed opening into the sinus with instruments. And have only had two open holes which blew air and were quite scary. Both caused by my own instrumentation. But both closed up within a day. And only one is still apparently active.

TO REPEAT -  WHEN DEALING WITH SINUS ISSUES IT IS VERY IMPORTANT TO TRY TO REDUCE THE AREA OF THE STRICKEN AREA BEFORE RISKING PERFORATING (PUNCHING A HOLE INTO) THE SINUS. WHICH WOULD CAUSE AN ORAL-ANTRAL COMMUNICATION. WHICH IS A HOLE FROM THE GUMS RIGHT INTO THE SINUS. WHICH COULD TURN INTO THE KISS OF DEATH FOR YOUR TOOTH.

NOTE - From the web it looks like this problem is most typically cause by tooth extraction, and not so much directly as a by-product of periodontal disease. In fact there do not seem to be any professional articles at all on the web about this. So perhaps it is a rare condition. And also indirectly suggesting that if your teeth or so far gone that you have holes into your sinuses then that means your teeth are too far gone. At least to the dental profession. So just forget about trying to save the old tooth and get a new tooth instead.

REASON IS THAT IF THE STRICKEN AREA CAN BE REDUCED AND THE HEALING AREA MAXIMIZED THEN IF YOU DO PUNCH A HOLE INTO THE SINUS THE HOLE WILL BE SMALLER. AND NOT QUITE SO DEVASTATING AND DANGEROUS.

TO MAXIMIZE THE HEALED REASONABLY TOUGH AND TEAR RESISTANT AREA AND MINIMIZE THE STRIKEN SICKLY EASILY DAMAGED INFECTED AREA PRIOR TO TAKING THE RISK OF CLEANING RIGHT AROUND THE HOLE WITHOUT BREAKING A HOLE RIGHT THROUGH THE HOLE INTO THE SINUS.

ALSO SINCE OBVIOUSLY A COMBINATION OF A HOLE INTO THE SINUS AND A BADLY INFECTED AREA IS BAD. SO TO MINIMIZE THE DANGER IT IS BETTER FOR ANY INFECTED AREAS NEAR LIKELY HOLES INTO SINUSES TO BE AS HYGIENIC AND DEBRIDED AS POSSIBLE OR REASONABLE. GFL

REALITY-LAND - SEE AN ORAL SURGEON & SEE WHAT HE CAN DO. OR ASK YOUR DENTIST OR PERIODONIST WHAT HE CAN DO. AND IF DECIDE TO DIY THEN WORK FROM THE PERIPHERY TOWARDS THE CENTER. PROGRESSIVELY. OVER A COUPLE OF MONTHS. AND TRY TO GET ON THE GOOD SIDE OF THE HEALING PROCESS.

BUT... MOST OF THE TIME... HOLES INTO THE SINUSES WILL TEND TO HEAL. IF YOU PRAY HARD ENOUGH. AND KEEP THE AREA CLEAN. WHICH YOU CAN DO TRY TO DO THE TRADITIONAL WAY, WITH PROXY-BRUSHES AND IRRIGATION AND TOOTH PICKS AND BRUSH-PICKS.

OR YOU CAN TRY TO TICKLE THE TAIL OF THE DRAGON ITSELF. STARE RIGHT INTO THE HEART OF DARKNESS ITSELF. AND BE MORE AGGRESSIVE ABOUT CLEANING OUT THE AREA RIGHT AROUND THE HOLE.  WHICH SHOULD CERTAINLY NOT BE DONE WHEN THE AREA IS STILL TRAUMATIZED, FEEBLE AND WEAK... BUT IF YOU CAN CLEAN OUT THE AREA BOTH SUCCESSFULLY AND PROGRESSIVELY AND LET IT HEAL ADEQUATELY BETWEEN TREATMENTS, OVER SAY A MONTH OR SO AND THEN IT IS STARTING TO SEEM LIKE IT IS HEALING OVER AND YOU ARE GETTING VERY REALISTICALLY CONFIDENT THEN MIGHT REALISTICALLY BE ABLE TO APPROACH THE HOLE, VERY RESPECTFULLY AND ARTFULLY,  AND CLEAN THE AREA RIGHT AROUND THE HOLE . THEN SLOWLY CLOSE IN AND LET THE HEALING PROCESS TAKE ITS TIME TO SEAL OFF THE HOLE AS YOU GET IT CLEANER AND CLEANER UNTIL IT CAN FINALLY HEAL OVER.

ALSO - One strategy here is simply to get an instrument into the hole and then hang out for a little while and lightly disrupt the area without getting too aggressive and punching a hole into the sinus. What will then happen is that any loose infection will tend to drip out. Hence it is possible to disrupt a deep and dangerous area by simply giving the infection a chance to escape. Then to go back a few weeks later and do it some more.

AND THEN ONCE IT RECOVERS YOU GO BACK AND CLEAN OUT THE AREA OF THE HOLE SOME MORE. AND KEEP DOING IT EVERY FEW MONTHS OR SO FOR THE REST OF YOUR LIFE. OR UNTIL THE HOLE FINALLY REJECTS YOU AND SAYS: "We don't need your stinkin' help." But realistically have to take the long view. Like months and months to heal. Or even years of unhappy coexistence. Leading to the loss of the tooth in order to finally get a handle on the hole so it closes over finally. Or getting it clean and healed enough so it stays closed. Either-Or.

OR - realistically if you can get the hole to close over then there will likely be latent infection there for a long time. So figure out some way to get at the hole. And certainly a good way is to use the proxy-brush or possibly the tooth pick to keep the area around it clean. Then possibly the brush-pick will work to shake up and disrupt the infection from right around the hole so it bleeds. Then just don't forget to go back regularly. Or the infection will recover and possibly open up the hole again. And also... the hole might not really close... just stay tight enough not to leak. Leading to a dilemma. Where you have to risk opening up the hole again, such as with the brush pick. Or even in fact do open up the hole again. But just a little bit that can close over without too much trouble if it is nice and clean.

NOTE  - I have this particular problem right now. How to clean out the hole without opening it up. Think what I will probably do is find the hole with the curette, possibly the sickle, since it has a point. Or possibly with the explorer, which also has a point. Then to just shake it around a little bit and encourage the infection to drip out.

OR if you can get your periodontist to clean out the exact area without it turning into expensive surgery, or if you just accept the expensive surgery, or go back to the oral surgeon and see if there is anything they can do then you should do that instead.

BUT ideally you should not just let the dentist convince you to pull the tooth and replace it with an implant. Granted, without the tooth there are less nooks and crannies to support the infection.  And granted, realistically, how is a fast and furious dentist going to find the area and clean it out without cutting. And so might want to make life easier for himself by pulling the tooth. But maybe, just maybe you could get the hygienist to clean out the area all around the hole. And then keep it clean with a proxy brush. (And possibly keep the infection down with chemicals too.) Then get lucky and have it heal over.

Also just to keep in mind that although holes into the sinus are certainly serious it is quite possible that a typical dentist won't have any magic bullets. And that instead you might have to put your best hopes on a hygiene strategy, hopefully figured out and supervised by your dentist that can lead over a course of months to the infection right around the hole into the sinus to go into remission and to close.

GOOGLE - oral antral communications treatment

GENERAL GUIDELINES HERE - To repeat, basically idea is to clean out the periphery and work towards the center. Clean clean clean. Then once you stop finding bloody blogs readily available to get liberated then stop. Then allow to get over trauma for at least three days. Then if the aggressive attack on the infection was serious enough then allow to heal for at least 7 to 10 to 14 days. Or more before attacking again. Eventually the infection will "give up." But it might take six months or more.

INSTRUMENTS - SLOW DOWN TIME - Also, my experience with the instruments is that I always try to be as careful as I can. And my answer to many of the scary and strange difficulties I have faced is to slow down time. Which largely means to just get in there with the instrument and move it around some. And no real damage will be caused. But... once you start to engage the blade then potential damage can result.

So what is the answer? Slow down time even more. And treat it as equivilent to travelling under your gum line with a space ship. Thereby taking extra trouble to be careful.  But with the Furcator there is no blade. So the chances of doing any real damage, besides accidently punching a hole into your sinus, is reasonably small. But also keep in mind that infected areas are also more easily damaged. But in which case it usually hurts a lot too. So can let the intense pain prevent you from overly damaging the area.

Personally I have had multiple openings into the sinuses and the only answer is to get it clean one way or another and let it heal. At one point I had three communications between my upper right molars, plus two more communications between the first molar and bicuspid. Yet I managed to clean all of them out, with brushpicks, toothpicks, proxy brushes, aspiration needles, irrigation, curettes and probing. Including sticking brushes and needles right past the hole. Which could have easily re-opened the air communication.

MY STORY - 2/3 GAP - PART 1 - In particular had infection and breakdown of the bone between tooth #2-3, upper right molars. March 2011. The entire area was definitely and persistently infected. On a bi-weekly basis I was clearing out the crud. Mostly with Graceys. Plus symptoms persisted well after a professional SRP. So as I was fiddling around with the Gracey Micro-Mini, trying to clear out some calculus from right around the bone the bone suddenly collapsed. Huge amounts of bloody crud poured out for at least a minute. I was pretty upset for awhile too, since there was obviously a big hole going right into my sinus. But then gradually figured it had to go and it did. Then right after, in the buccal area I punched a hole right into my sinus. So what to do? I washed it out as best as I could and it closed up again within two days. Let it heal

MY STORY - 2/3 GAP - PART 2 - So I figured my goose was cooked with these two teeth. Saw an oral surgeon and a different periodontist. Who told me there was no particular reason to pull the second molar. So I let the entire area heal for well over a month. But did pull blood from the gap using the aspiration needle. Wasn't sure if that was the right thing to do. But later learned it was. Then continued with the needle and then later with the curettes and after a few more months the entire area healed. The bone is still gone, but the area is not infected anymore. So the sinuses have laid down some type of protective tissue and I now largely seem to have a functional area with the disease largely in remission. Apparently.

MY STORY - 2/3 GAP - PART 3 - The continued ongoing infection between the two molars was literally threatening to take down the tooth. The sudden collapse of the bone and release of the infection, as scary as it was, was in fact what sent the area back onto the path to recovered health. Which also included further debridements in the areas that were the previously the most sensitive. Including debridement with the aspiration needle to liberate fairly large colonies that missed the previous time around. Ultimately taking an area of highly severe infection to what I term as a "neo closed perimeter" situation. Meaning the infection has theoretically been liberated from everywhere. But it will come back of course. So deal with that too. On time.

 So, as bad as things might seem to be, if the area can be kept clean and healing allowed to take place then can reasonably predict that a month or two later the area will be healthier. After it has had the chance to heal. And the particular teeth involved can become healthier. Even if the entire situation looked really scarey and dicey while it was getting cleaned out.

MAINTENANCE WITH FURCATOR - Current plan is to go back with the Furcator. Which is a curved furcation probe excavator - Idea is not so much to scrape but to give any pockets of infection an opportunity to escape. I do this by fishing around and then looking out for blood. Like a truffle dog. Once I find blood then I explore the area in detail to give the infection a chance to escape unharmed down the drain. In some cases I have found and dislodged the proverbial "mother lode" which represents a large amount of localized infection. Finding and dislodging all of the mother lodes is the path to periodontal health. Especially to find the deep ones, if they exist. Which is typically accomplished by being proactive. Have suspicions about where you think the mother lodes could be hanging out and then plan to visit them with the Furcator or other convenient instrument Including brush picks and also tooth picks too.

THAR SHE BLOWS - HOLE IN SINUS ! EMERGENCY ! - Also, my experience with communication holes is that if they are not too big that they may blow air for a day or two. But if you clean them out well they will tend to close up within a day or so. Then from there to mostly heal after a few weeks. But if they don't get properly cleaned out they might never heal. But they can mostly be cleaned out with the proxy brushes and toothpicks and real careful squirts of water. Just don't blow open the actual hole! And get close but not too close. GFL! And meanwhile try to get the hygienist to clean out the surrounding area as best as she can so eventually the area can get and stay clean. And hope you don't blow any holes into your sinuses to begin with.But if you do, or your sinuses are already compromised by missing upper jawbone or teeth that already go into the sinuses, then you will either have to learn about how to keep the gap into the sinuses in good repair or you can guarantee that the tooth will untimately turn into a goner. And maybe only after an abscess or other dental emergency. Or maybe because the tooth is dead or standing on stilts.

COMMUNICATIONS - GET CLEAN & KEEP CLEAN - Would tend to think that a professional SRP would be a good start. But to go after the crud in a very incomplete way is just inviting the infection to have its way. Plus the strategy of SRP is to get to the bottom So after recovey from that a reasonable attitude would be to go after the remains. The Gleanings so to speak. And if some of the areas end up scary deep in real life can just go back to your periodontist, can't you? You can simply say "Sir, I have a deep bleeding area right here (point to spot" - Can you use your curettes to clean it up for me? Just that one area - please do it separately from the rest." -- What is wrong with that? Meaning all you have to do is find the blood and then tell your periodontist to clean it for you please.