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What is Odontogenic Sinusitis?

Odontogenic sinusitis is inflammation of the maxillary sinuses caused by a dental infection. Infections in the upper teeth, like periapical lesions, can spread to the sinuses. Symptoms include facial pain, dental pain, and foul smell. Diagnosis involves clinical examination, dental x-rays, and imaging. Treatment focuses on resolving the dental infection and managing sinus inflammation.

Causes of Odontogenic Sinusitis

Currently, the predominant cause of maxillary sinusitis is iatrogenic injury, accounting for about 56% of cases, often following dental surgery. Such injuries can arise from improperly performed sinus lift procedures, implant placements, foreign bodies left during surgery, dental extractions that may push root fragments into the sinus cavity, orthognathic surgery, labio-palatine cleft surgery, Le Fort osteotomies, inadequate closures of oro-antral fistulas, periimplantitis, or failures in endodontic treatments.

Dental Infections

Dental infections, such as periapical infections or periodontal disease, can spread from the upper teeth to the maxillary sinuses, causing odontogenic sinusitis. Symptoms include tooth pain, facial pain, and nasal congestion. Endodontic treatment, like root canal therapy, is often needed to treat the infection. Regular dental check-ups and good oral hygiene are key prevention measures.

Tooth Extractions

Tooth extractions, especially of upper teeth, can lead to odontogenic sinusitis if an oroantral fistula forms, allowing bacteria to enter the sinus cavity. Symptoms include facial pain, foul smell, and nasal discharge. Treatment may involve surgical closure of the fistula and antibiotic therapy. Preventive measures and careful techniques during extractions are essential.

Dental Procedures and Complications

Dental procedures, such as extractions and root canals, can sometimes cause odontogenic sinusitis through iatrogenic injury. Symptoms include facial pain, sinus mucosal thickening, and chronic rhinosinusitis. Accurate diagnosis via dental examination and imaging is crucial. Treatment may involve endodontic therapy, surgical interventions, and antibiotics to resolve the infection.

 

Symptoms of Odontogenic Sinusitis

Common Symptoms

Odontogenic sinusitis symptoms include facial pain, dental pain, foul smell, nasal congestion, and reduced sense of smell. These result from infections in the upper teeth spreading to the maxillary sinuses, causing inflammation and mucosal thickening. Chronic sinusitis or rhinosinusitis may develop without prompt treatment.

When to Seek Medical Attention

Seek medical attention for persistent facial pain, dental pain, or foul smell. Other indicators include chronic sinusitis, nasal obstruction, and reduced sense of smell. Early diagnosis and treatment, including endodontic therapy or surgical interventions, are crucial to prevent complications like oroantral fistula and chronic rhinosinusitis.

Dental Examination

A thorough dental examination is crucial for diagnosing odontogenic sinusitis. This involves checking for dental infections like periapical lesions and assessing the upper teeth. Procedures like root canal treatment or dental extractions may be needed if a dental infection is found.

Imaging Studies

  • X-rays: X-rays are essential for diagnosing odontogenic sinusitis, revealing periapical lesions, dental caries, and mucosal thickening. They provide detailed images of the maxillary teeth and sinuses, guiding appropriate treatments.
  • CT Scans: CT scans offer a comprehensive view of the sinus cavity and maxillary sinuses. They detect mucosal thickening, sinus opacification, and obstructions from dental infections, aiding in precise treatment planning, including surgical interventions like endoscopic sinus surgery.

Medical History Review

Reviewing the patient’s medical history is vital for diagnosing odontogenic sinusitis. This includes assessing past dental procedures, infections, and symptoms. Accurate diagnosis through history review ensures effective management and treatment.

 

What medical treatment options are available?

  1. Antibiotic Therapy: To address infections linked to dental issues like apical periodontitis or periodontal disease.
  2. Endoscopic Sinus Surgery: Minimally invasive procedure to remove blockages and enhance drainage.
  3. Dental Treatments: Including tooth extraction and treatment of periapical lesions to address root causes.
  4. Addressing Anatomical Irregularities: To prevent persistent sinus issues.
  5. Management of Mucosal Thickening: To improve sinus cavity health.

Is surgery necessary for odontogenic sinusitis?

Surgical intervention and dental extraction may be needed if medical management fails to relieve maxillary sinusitis. This is especially true with anatomical blockages like mucosal thickening or maxillary sinus opacification. Surgery clears obstructions from dental sources and tissue such as dental caries, frontal sinuses, or poor oral hygiene affecting the maxillary teeth. Restoring the maxillary sinus floor can significantly improve symptoms and overall quality of life.

 

Expert Care Under Dr. Moustafa Mourad

Dr. Moustafa Mourad, MD, FACS, sets the standard in facial plastic and reconstructive surgery in New York City. Board-certified in Facial Plastic & Reconstructive Surgery and Head & Neck Surgery, he is renowned for rhinoplasty and reconstructive nasal surgery. Dr. Mourad trains future surgeons as Fellowship Co-Director at the American Academy of Facial Plastic & Reconstructive Surgery and Chief of Otolaryngology-Head & Neck Surgery at Medisys Health Systems.

Odontogenic sinusitis, often caused by dental infections like periapical lesions or periodontal disease, requires a multidisciplinary approach. Expert treatment can relieve symptoms such as facial pain, dental pain, and foul smell, significantly improving quality of life.

If you experience symptoms of odontogenic sinusitis, seek specialized medical advice. Explore treatments, including endoscopic sinus surgery and other interventions, for comprehensive sinus health management.

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Learn more about Odontogenic Sinusitis

Does insurance cover odontogenic sinusitis surgery?

Insurance coverage for a patient of odontogenic sinusitis surgery varies depending on the provider and the specifics of your plan. Generally, if the surgical dental treatment is deemed medically necessary due to chronic sinusitis or a severe dental infection affecting the maxillary sinuses, it is more likely to be covered. Procedures such as endoscopic sinus surgery and other dental interventions might fall under both medical and dental insurance. It’s essential for patients to consult their insurance company to understand their coverage and potential out-of-pocket costs.

Does treatment involve any risks or side effects?

Treating odontogenic sinusitis can involve risks and side effects, particularly if surgical interventions like endoscopic sinus surgery are required. Risks include infection, sinus mucosal, bleeding, and adverse reactions to anesthesia. Dental treatments, such as tooth extraction or endodontic treatment, might also cause temporary dental pain or facial pain. Additionally, antibiotic therapy for bacterial infections can lead to antimicrobial resistance. Patients should discuss potential risks with their healthcare provider to ensure they are informed before undergoing any medical or dental treatment or antibiotic therapy.

How common is this dental sinusitis?

Odontogenic sinusitis is a relatively common dental pathology, particularly among patients with untreated dental infections or those undergoing dental procedures affecting the maxillary teeth and membrane. Conditions like periapical lesions, dental caries, dental disease, and periodontal disease can lead to this form of sinusitis. The close proximity of the upper teeth to the maxillary sinuses makes the spread of infection more likely, resulting in sinus mucosal thickening and other symptoms to the tissue. Regular dental examinations and good oral hygiene are crucial for preventing this type of sinus infection.

Meet Moustafa Mourad, MD, FACS

Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck... Learn More »

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