Maxillary sinuses — how to treat odontogenic sinusitis

What is odontogenic sinusitis?

Odontogenic maxillary sinusitis, also known as odontogenic maxillary sinusitis, is an inflammation of the maxillary sinus caused by dental problems. The maxillary sinus is one of four pairs of paranasal sinuses that are located in the jaw bones on either side of the nose.

With odontogenic inflammation, infection or inflammation of the tooth or periodontal tissues is transferred to the maxillary sinus. These sinuses are the largest of the paranasal sinuses and have their mouth in the nasal cavity. Their inner surfaces are lined by respiratory epithelium lined with cilia that help remove impurities trapped in mucus. If the mucous membrane swells, the sinuses can close, leading to the accumulation of secretion inside the sinuses.

The maxillary sinuses are located above the roots of the premolars and molars of the jaw. The tops of these roots are separated from the sinus lumen by a layer of bone and mucous membrane. The proximity of the teeth means that dental problems can lead to inflammation of the maxillary sinuses. Untreated chronic caries, periodontal abscesses, dead teeth, or complications after abnormal tooth extraction or root canal treatment can be the cause of this condition. For example, if proper hygiene was lacking during the tooth removal procedure, bacteria can accumulate and lead to sinusitis. Similarly, during root canal treatment, the dentist may accidentally pierce into the sinus, which can also lead to infection.

This close proximity between the teeth and sinuses makes taking care of oral hygiene and regular visits to the dentist crucial for preventing these problems. In the event of symptoms such as sinus pain, swelling of the face or discharge from the nose, both the dentist and the ENT should be consulted to successfully diagnose and treat the cause of the inflammation.

Causes of odontogenic sinusitis

The causes of odontogenic maxillary sinusitis can be diverse and are usually associated with dental problems. Here are the most important of them:

• Chronic caries Untreated tooth decay, especially molars and premolars, can lead to an infection that can spread to the maxillary sinuses.
• Periodontal abscesses Infections in the area of the roots of the teeth can form abscesses that can enter the maxillary sinuses, causing inflammation.
• Dead teeth — teeth that are dead due to trauma or advanced caries can become a source of infection that can spread to the sinuses.
• Complications after root canal treatment — during root canal treatment, if the dentist breaks into the maxillary sinus, it can lead to infection. Inaccurate cleaning of the dental canals can also leave bacteria that can enter the sinus.
• Complications after tooth extraction — after tooth extraction, especially molars and premolars that are close to the maxillary sinuses, infection can occur if proper hygiene standards are not maintained during the procedure.
• Sinus perforation during dental surgery During oral surgery, such as removing teeth or placing implants, accidental damage to the sinus wall can occur, which can lead to infection.
• Periodontal diseases advanced periodontal disease can lead to bone atrophy, which can allow bacteria to access the maxillary sinuses and trigger inflammation.
• Improper fillings or crowns Improper execution of dental fillings or crowns, which lead to microtraumas or leaks, can become a source of infection.

The diagnosis of odontogenic maxillary sinusitis requires cooperation between the dentist and ENT to effectively identify and treat the cause of the infection.

Symptoms of odontogenic maxillary sinusitis

The symptoms of odontogenic maxillary sinusitis can be varied and often include both sinus-related and tooth-related symptoms and are therefore difficult to recognize. What to look out for:

• Pain in the area of the maxillary sinus — the pain may be dull, throbbing or sharp. Most often it is felt in the area of the cheek, nose or above the upper teeth. It can intensify when tilting the head forward, when coughing or sneezing. The pain is usually unilateral (affects one sinus), but can occur bilaterally, especially if the infection has spread to both maxillary sinuses.
• Tooth pain — especially the molars and premolars, can be permanent or appear with recording and chewing. Often patients feel that the teeth are “blown out” from the gums. Tooth pain is associated with sinusitis, because the roots of these teeth are close to the maxillary sinus, and infection can penetrate between them.
• Swelling of the face — most often affects the cheek on the side affected by sinusitis. It can be seen and felt as tension of the skin and subcutaneous tissue. Swelling is the result of fluid buildup and an inflammatory reaction within the sinus and adjacent tissues.
• Nasal discharge — the discharge may be thick, yellow or green, often with an unpleasant odor. May contain traces of blood. The discharge usually comes from one nostril, on the side affected by sinusitis. With bilateral inflammation, it can come from both holes.
• Nasal congestion — patients experience nasal congestion, which makes it difficult to breathe through the nose and forces them to breathe through the mouth. Swelling of the mucous membrane of the sinuses and nose leads to the closure of the sinuses, which causes the accumulation of secretions and nasal congestion.
• Fever and general malaise Fever, chills, weakness and fatigue are typical of more serious infections. They may indicate the spread of infection to other areas of the body. High fever suggests an active inflammatory process and requires urgent medical intervention.
• Headache Headache can be felt in the area of the forehead, temples, and sometimes spreads to the entire head. The severity of pain often increases when bending over. Headache is the result of an increase in pressure inside the maxillary sinuses and an inflammatory reaction within them.
• Unpleasant taste in the mouth — patients may experience a metallic, rotten or bitter taste in the mouth, which is the result of the presence of pus and bacteria in the mouth and nose. Pus from an infected sinus can enter the mouth through fistulas or directly through the nasopharynx.
• Difficulty opening the mouth — patients may experience pain and tension in the jaw muscles, which makes it difficult to open their mouths. This is known as a jaw squeeze. Jawbone can be caused by the spread of infection to the jaw muscles or tissues surrounding the teeth.
• Increased sensitivity to cold and heat Teeth may become more sensitive to changes in temperature, which is manifested by pain when consuming hot or cold drinks and foods. Increased sensitivity can be the result of inflammation and damage to the tissues surrounding the teeth and the roots of the teeth

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Treatment of maxillary sinuses

Treatment of odontogenic maxillary sinusitis requires a multidisciplinary approach, including both dental and otolaryngological treatment.

Step 1: Dental Treatment

It is aimed at removing the source of infection. It may include root canal (endodontic) treatment in case of infection of the pulp of the tooth. It may be necessary to remove the infected tissue and secure the tooth. If the tooth is severely damaged or dead, it may be necessary to remove it to eliminate the source of infection. In the presence of a periodontal abscess, drainage of pus may be necessary to reduce pressure and pain and speed up the healing process.

Step 2: Otolaryngological Treatment

With bacterial sinusitis, antibiotics are used to fight the infection. Anti-inflammatory drugs can be used to reduce inflammation and swelling of the sinus mucosa. Non-steroidal anti-inflammatory drugs (NSAIDs) or other pain relievers can be used to relieve pain.

Step 3. Surgical procedures

In cases of chronic or severe sinusitis, endoscopic surgery may be necessary to remove infected tissue, improve drainage of the sinuses and restore their normal function. In some cases, it may be necessary to carry out sinus drainage to remove accumulated secretion and pus.

Step 4. Supportive treatment

Rinsing your nose regularly with saline solution can help clear secretions, reduce swelling, and improve sinus drainage.

Humidifying indoor air can help keep the mucous membrane moist and prevent it from drying out.

Step 5. Prevention

Regular dental checkups can help detect and treat dental problems before they become serious. Regular treatment and control of gum disease can prevent infections.

Possible complications

Odontogenic maxillary sinusitis, if not treated properly, can lead to various complications that can affect both the general health and the patient's quality of life.

• Chronic sinusitis

If left untreated, acute maxillary sinusitis can become chronic, characterized by recurrent symptoms such as pain, nasal congestion, nasal discharge, and chronic headache.

• Spread of infection

The infection can spread from the maxillary sinuses to other paranasal sinuses, causing inflammation of the frontal, synovial or sphenoid sinuses. It can also pass to the surrounding tissues of the face and neck.

• Orbital abscess

The infection can spread to the eye socket, causing an abscess. This is manifested by pain in the eye, swelling of the eyelid, limitation of mobility of the eyeball and double vision.

• Meningitis

In rare cases, an infection can enter the meninges, leading to their inflammation. This is manifested by severe headache, stiff neck, fever and impaired consciousness.

• Sepsis

Generalized inflammatory reaction of the body to infection, which can lead to multiple organ failure. It is manifested by high fever, a decrease in blood pressure, an accelerated heart rate and shortness of breath.

• Osteonecrosis

Infection can lead to necrosis of the jaw bone, known as osteomyelitis. This is manifested by chronic pain, swelling and purulent fistulas.

• Loss of teeth

Chronic sinusitis can lead to bone atrophy and damage to the structure of the teeth, which, as a result, can result in their loss.

• Chronic facial pain

Chronic inflammation can lead to long-term facial pain that can be difficult to treat.

Odontogenic maxillary sinusitis is a serious condition that can significantly affect the patient's quality of life. Its causes are often associated with dental problems, which emphasizes the need for regular oral hygiene and preventive visits to the dentist. Symptoms such as pain in the sinus area, swelling of the face, toothache and discharge from the nose should prompt a quick medical consultation. Effective treatment requires cooperation between the dentist and the otolaryngologist to remove the source of infection and restore health to the sinuses. With proper diagnostics and a comprehensive therapeutic approach, it is possible to avoid complications and ensure a full recovery.