The following should be considered prior to carrying out any dental treatment:
Size of the antrum and proximity to teeth – this can be assessed radiographically
Shape and size of teeth and roots – this can be assessed radiographically
Presence of periapical pathology – this can be assessed radiographically
The age of the patient
The patient’s past dental historyIf the above factors are assessed as increasing the risk of OAC development, the clinician should take appropriate steps to carefully remove the tooth in question, possibly carrying out a surgical extraction and in an appropriate setting. Hence, in such cases:

Avoid using too much of apical pressure during tooth extraction
Perform surgical extraction with roots sectioning
Consider referral to OMFS at local hospital

Treatment
The primary aim of treatment of a newly formed oroantral communication is to prevent the development of an oroantral fistula as well as chronic sinusitis. The decision on how to treat OAC/OAF depends on various factors. Small size communications between 1 and 2 mm in diameter, if uninfected, are likely to form a clot and heal by itself later. Communications larger than this require treatments to close the defect and these interventions can be categorised into 3 types: surgical, non-surgical and pharmacological. Surgery
Surgical methods are required if a large defect is present or if a defect persists. Surgery involves creating a flap utilising local tissue to close the communication. There are a number of different flaps that can be used such as the buccal advancement flap, the buccal fat pad flap, a combination of the two and a palatal flap.
- Panoramic radiographs can also be used to confirm the presence of an OAC. If simple radiographs are deemed not to give enough information, cone beam computed tomography (CBCT) (special x-ray equipment that can scan in 3 dimensions) may be used. Imaging can help locate the communication, determine the size of it and can give an indication as to whether there is any sinusitis and foreign bodies in the sinus. - Normally clinicians should be cautioned against probing or irrigating the site a newly formed OAC as this may reduce the chance of spontaneous healing. - Valsalva test (nose blowing test) The patient is asked to pinch their nostrils together and open their mouth and then blow gently through the nose. The clinician must observe if there is passage of air or bubbling of blood in the post extraction alveolus as the trapped air from closed nostrils is forced into the mouth through any oroantral communication. Gentle suction applied to the socket often produces a characteristic hollow sound. However, there are differing opinions about the appropriateness of carrying out this test. It can be argued that by performing this test, a small OAC may be made bigger thus preventing spontaneous healing. Causes
Extraction of maxillary teeth
The maxillary sinus is known for its thin floor and close proximity to the posterior maxillary (upper) teeth.