Odontogenic sinusitis is an inflammation of the maxillary sinuses that develops from infected teeth of the upper jaw. The penetration of infection is also facilitated by dental manipulations in the area of the maxillary sinuses - treatment and extraction of teeth, implantation and sinus lifting. Without identifying and eliminating the cause, standard treatment by an ENT doctor in a clinic does not bring results. Treatment of odontogenic infections must be comprehensive!
Doctor Levin Center has been specializing in the treatment of patients with combined ENT and dental pathologies for more than 20 years. Comprehensive rehabilitation programs are carried out by maxillofacial surgeons with otolaryngological training.
Causes of odontogenic sinusitis
The maxillary sinuses (maxillary sinuses) are separated from the oral cavity by a thin layer of bone in which the roots of the upper chewing teeth are located. Such close proximity poses a threat of sinus infection. In 15% of cases, the apices of the roots are anatomically located under the mucous membrane of the sinus, without a bone layer, which further increases the risk of developing odontogenic sinusitis.
Conventionally, the reasons can be divided into 2 categories:
Delayed dental treatment
With pulpitis and periodontitis, infection from the dental canals slowly but surely spreads to the surrounding bone tissue. Without treatment, foci of infection grow, melt the bone septum, opening the “gate” for the penetration of pathogenic microflora. In advanced situations, cysts form on the roots of teeth, and when the bone barrier is destroyed, they grow into the sinus.
Medical errors
As a result of dentist errors, mechanical damage to the sinus floor is possible (perforated form of the disease). The result is the formation of a communication with the sinus, the penetration of foreign bodies with the body’s response in the form of odontogenic sinusitis.
The most common treatment errors after which patients turn to our Center:
- Unsuccessful endodontic treatment The therapist did not calculate the effort during mechanical cleaning and filling of dental canals. There was a fracture and pushing of the instrument and/or removal of the filling material beyond the root apex into the lumen of the sinus.
- Traumatic tooth extraction The surgeon, without preliminary diagnosis, having no idea about the location of the roots, damaged the bone septum. Perforation of the sinus floor occurred, often with the tooth or its fragments falling into the sinus cavity.
- Implantation without sinus lift Experimental implantation protocols without prior bone grafting result in damage to the sinus floor by the implant. If the perforation goes unnoticed during surgery, the implant flies into the sinus.
- Sinus lift without diagnostics The surgeon did not calculate the bone tissue parameters and did not assess the condition of the mucous membrane. During the preparation of the bone septum, its perforation and rupture of the membrane occurred. Bone material ended up in the sinus cavity.
How to avoid
There are only two ways to prevent the development of odontogenic sinusitis:
- Treat your teeth in a timely manner, prevent infection of the dental canals and spread of inflammation beyond the apex of the tooth root.
- Contact proven clinics with experienced doctors, the opportunity to conduct a thorough diagnosis and provide for an emergency situation.
In our Center, not a single dental procedure, especially at the border with the maxillary sinuses, is performed without a thorough X-ray examination using a computed tomograph.
The study is carried out using
a high-precision Sirona device with the Galileos diagnostic software package.
Based on the results of computed tomography, we determine the location of the roots and the size of the bone septum. This makes it possible to plan treatment in such a way as to avoid risks.
Tooth extraction operations and other interventions in the area of the maxillary sinuses in our Center are performed only by maxillofacial surgeons with ENT training . Deep knowledge of the anatomy of the maxillary region allows you to avoid mistakes that a regular dentist might make. But each case is individual, and even if something goes wrong, our doctors are always ready for any turn of events and correct the situation.
Therapy for perforation of the maxillary sinus during treatment or tooth extraction
If a hole has formed in the sinus after tooth extraction, the doctor will stop the bleeding if possible by forming a blood clot in the hole. To do this, a tampon soaked in medications is inserted into the wound. The patient is advised to rest completely until the perforation heals.
If, during tooth extraction, the maxillary sinus opened, but the doctor did nothing, then inflammation may develop. In this case, if detected, an operation to restore integrity using special plates or artificial bone material is indicated.
Symptoms of odontogenic sinusitis
Inflammation from infected teeth develops gradually and in the initial stages is most often asymptomatic. If dental treatment has been carried out, symptoms may also not appear immediately - it all depends on the body’s immune system and reaction to foreign bodies. There are cases that sinusitis does not make itself felt for several years.
But sooner or later the infection will make itself known. The symptoms of odontogenic sinusitis are practically no different from rhinogenic sinusitis (when the infection enters through the nose as a result of a cold, flu or acute respiratory viral infection):
- pain and swelling in the sinus area
- nasal congestion and difficulty breathing
- purulent or mucopurulent discharge
- headaches, especially when bending forward
- decreased sense of smell
- temperature up to 39o
An unsuspecting patient first turns to an ENT specialist, but he needs to see a dentist. However, there are points that indicate the odontogenic origin of sinus inflammation:
- pain in the chewing teeth of the upper jaw, especially when chewing
- there was treatment or removal of teeth at the border with the sinuses
- implants or sinus lift were installed
The most important distinguishing feature is that only one sinus is bothering you , which is associated with bad teeth or dental treatment. In this case, first of all, you need to solve dental problems. As a rule, the symptoms of sinusitis disappear within two weeks after eliminating the source of inflammation.
What is the danger of the disease
Without proper treatment, a chronic inflammatory process with pathogenic microflora develops in the sinus, destroying the sinus mucosa and surrounding bone tissue. Since the maxillary sinuses are located close to anatomically important structures, severe complications can arise:
- Orbital The upper wall of the sinus is in contact with the lower wall of the eye orbit. The infection spreads into the orbit with the formation of an abscess and phlegmon. As a result, optic nerve neuritis develops, deterioration or complete loss of vision.
- Intracranial The most dangerous complications associated with the penetration and impact of infection on the brain. Meningitis, encephalitis, and abscess develop. If detected and treated untimely, irreversible consequences, including death, can occur.
Foci of infection provoked by the presence of a foreign body can cause a precancerous condition.
What dangerous consequences does a foreign body lead to?
A foreign object in the maxillary sinuses can lead to the following complications:
- bacterial or fungal sinusitis;
- encapsulation in the form of a cyst or other benign disease;
- granuloma formation.
In more complex cases, suppurative processes in the maxillary sinuses cause the development of the following complications:
- frequent colds and inflammation of the nasal cavity and sinuses;
- meningitis;
- hypertrophy of the mucous membrane;
- damage by coccal flora to other organs and systems (for example, heart muscle).
A particularly dangerous complication is inflammation of the meninges. When meningitis develops, the patient develops the following symptoms:
- significant increase in temperature;
- headache in the forehead;
- frequent vomiting that does not bring relief;
- rash on palms and soles.
If these symptoms appear, you should immediately consult a doctor!
And the possible consequences of getting filling materials can only be prevented by timely consultation with a doctor and regular preventive examinations in the mode prescribed by the doctor.
Why you should entrust treatment to the ENT department of dentistry
ENT dentistry is a symbiosis of two medical areas, a multidisciplinary approach to the treatment of inflammation of the maxillary sinuses of odontogenic origin. Only an experienced maxillofacial surgeon with ENT training can make an accurate diagnosis and create a sound rehabilitation plan.
As a rule, odontogenic causes of sinusitis are simply ignored during routine examination by an otolaryngologist. Treatment in a city clinic without high-quality diagnostics or in the absence of it at all turns into a multi-part series with monthly visits to an ENT doctor, dragging on for many years, causing inconvenience and worsening the quality of life.
Unified drug therapy or traumatic sinus punctures are prescribed, which, if they bring relief, are for a short time. Inflammation from the acute stage becomes chronic with periodic exacerbations. A person runs from one doctor to another to no avail, but without identifying and eliminating the cause, odontogenic sinusitis cannot be cured !
Preventive actions
Prevention of perforations of the floor of the maxillary sinus consists of:
- in a full examination of the patient before complex dental procedures;
- in the correct assessment of the anatomical and topographical characteristics of each person;
- in strict adherence to the technology of therapeutic manipulations.
Timely detection of signs of perforation and its adequate treatment is the key to a favorable outcome for the patient. Incorrect therapeutic tactics or self-medication can aggravate the course of such a complication and cause the development of severe negative consequences.
Diagnostics
The odontogenic form of sinusitis often remains undetected by ENT specialists due to the lack of highly accurate diagnostics and banal ignorance of the “dental” cause of the disease. Such gaps lead to the fact that even after medical and surgical treatment the person continues to suffer.
Differential diagnosis is extremely important, which allows you to determine the form of sinusitis and select the appropriate treatment.
Only computed tomography provides informative 3D images for visualizing bone and adjacent soft tissues, the condition of the teeth, the presence of foreign bodies and neoplasms in the sinus.
In our Center, CT scans are performed on a Sirona Gallileos dental tomograph with ENT mode settings.
In some cases, it will be necessary to study the microbial composition of the sinus lining to rule out a malignant process.
Diagnosis
At the time of a dental operation that led to perforation of the maxillary sinus, the doctor draws a conclusion about a new problem based on the signs described above. If perforation is questionable, the dentist's findings are rechecked using the following methods:
- probing with a thin probe;
- radiography - shows dark accumulations of blood, tooth root fragments and filling cement located inside the maxillary sinus, can be done with the preliminary administration of a contrast agent;
- CT scan;
- general clinical blood test - necessary when identifying an old problem to make sure there is an infection in the body.
Stages of treatment
We strive to carry out all activities comprehensively in one day, so as not to delay the patient
- Sanitation of the oral cavity Preparation to maintain sterility during surgery to avoid secondary infection - retreatment of compromised teeth, hygienic cleaning.
- The operation is performed by a maxillofacial surgeon in a sterile operating room of the ENT department - “in your sleep”, according to the selected access protocol. A follow-up CT scan after surgery is required.
- Prosthetics If the protocol requires the removal of teeth, we install temporary orthopedic structures to close the aesthetic defect so as not to leave the patient without teeth.
Recovery after surgery
No hospitalization
A hospital stay for 2-3 days after surgery (as happens in city hospitals) is not required.
Gentle surgical protocols, the use of modern functional equipment and a microscope allow treatment to be carried out as delicately as possible .
All operations are performed in a controlled, drug-induced sleep - this is not general anesthesia ! Recovery from the state is easy, without dizziness, memory loss or clouding of consciousness. The drugs are absolutely safe for the body and are eliminated naturally 40 minutes after stopping the supply.
For patients with vascular and cardiac problems, a day hospital , where you can calmly recover and recover under the supervision of our anesthesiologist-resuscitator.
Accelerated rehabilitation
Recovery after the intervention occurs within a week. For those who want to speed up the process, our Center provides a set of procedures to reduce pain, resolve hematomas and swelling - carried out on the day of surgery.
Home care
Medications are prescribed - antibiotics, painkillers and decongestants. To prevent the patient from running to pharmacies in a postoperative state and to avoid purchasing counterfeit products “on the side,” the entire package of drugs is collected and given out free of charge .
The package contains all the necessary medications for taking and caring for the surgical area.
Please follow the recommendations and do not skip taking medications to avoid complications. The instructions are in the medicine package.
If you suspect a worsening condition, contact the clinic immediately. The telephone number for the 24-hour patient support service is listed in the memo.
