Teeth Affecting or Infecting the Sinus’s
Posted on 6/5/2023 by Greg Kammeyer
|Teeth Affecting or Infecting the Sinus’s
A recent conversation with a collage reminded me of something I notice regularly since I have used CAT scans for implant treatments for 24 years. In brief the maxillary (upper) back teeth roots are often in the sinus cavity. When the teeth or gums get infected, they can contribute to or cause maxillary sinusitis. This shows up as a thickening of the tissue at the base of the sinus cavity or a cloudiness in the sinus or both. When I used standard small x-rays I had little to no awareness of this problem.
In a review of the current literature by Little et al, found a consensus that dental pathology, from prior dental procedures, infections of maxillary teeth, or maxillary trauma can cause maxillary sinusitis. Medical care and treatment of the underlying dental/periodontal disease is the key initial step in the treatment of odontogenic sinusitis. Most recently the literature notes that a significant portion of patients will require endoscopic sinus surgery (ESS) for successful disease treatment.
Nimish and Berrylin published in the Current Opinions in Otolaryngology Head Neck Surgery, 2012 that for well over 100 years, it has been known that maxillary dental infections can cause sinusitis. This has been largely overlooked in dentistry until recently. Up to 40% of chronic maxillary sinus infections on both sinus’ are attributed to a dental source. This percentage can be much higher if only one sinus is involved. Routine small dental films and dental evaluations frequently fail to show maxillary dental infection that are causing odontogenic sinusitis. However medical CT scans or dental Cone Beam CT (CBCT) scans are far more effective in identifying dental disease causing sinusitis. Again these authors concluded that treatment of odontogenic sinusitis requires elimination of the odontogenic (tooth/periodontal) source and may require sinus surgery after that. Odontogenic sinusitis is frequently resistant to medical therapy and usually requires treatment of the dental disease first. Sometimes dental treatment alone is adequate to resolve the sinusitis and subsequent ESS is not required. Unilateral recurring disease associated with foul smelling drainage is especially characteristic of odontogenic sinusitis.
Finally Larynx published in 2015 about the association between odontogenic infections and unilateral sinus opacification (thickened tissue or cloudy sinus) in a retrospective study of his cases. In his review of 190 patients treated for unilateral paranasal sinusitis, all patients were diagnosed based on clinical signs, symptoms, and imaging findings, including CT scan, orthopantomography, and other modalities. His findings were the most common cause of unilateral paranasal sinusitis was odontogenic infection, as seen in 72.6%.
Certainly the ENT profession has been aware of this association for some time, as they use CT scans regularly. In dentistry we are becoming much more aware of the connection between infected teeth/bone and sinus disease as using CAT scans (CBCT) has become much more common. Happily dental CBCT scans give 1/30th the radiation that a medical scan does (= 4 small dental x-rays).