Tuesday, February 7, 2012

Signs of a sinus infection of odontogenic origin

Signs of a sinus infection of odontogenic origin

Since the upper jaw teeth are located close to the maxillary sinus, the sinus infection may spread to the oral cavity or vice versa. This odontogenic maxillary sinusitis is ascribed to anaerobic organisms that dominate the oral cavity. The sinusitis could be acute and chronic. The management, microbiology and pathophysiology of odontogenic maxillary sinusitis, which is unilateral, are different from that of non-odontogenic maxillary sinusitis.




Causes of odontogenic sinusitis

Odontogenic cysts

Periapical abscesses

Alveolar or dental trauma

Maxillary osteomyelitis

Perforations in the sinus while extracting the tooth

Secondary infection and irritation due to intra-antral foreign objects

Damage to the Schneiderian membrane owing to periodontal disease

Inadvertent displacement of bone graft materials, dental implants and other foreign bodies during dental surgeries and treatments

Microbiology of odontogenic sinusitis

Many similarities have been identified while analyzing microbiology of odontogenic sinusitis and a dentoalveolar abscess. Anaerobes, such as Fusobacterium, Prevotella, Porphyromonas and Peptostreptococcus, and viridians streptococci are commonly associated with both the conditions. The bacteria sitting in the nasophrynx and nasal cavity may also live in the odontogenic sinusitis' microflora. Thus, a wide range of organisms may trigger the odontogenic sinusitis.
The bacteriological analysis could not distinguish between chronic and acute odontogenic maxillary sinusitis. However, anaerobe, gram-negative bacilli- Fusobacterium sp. and Peptostreptococcus- are the primary organisms responsible for the infection. Two aerobes, S. aureus and ά-hemolytic streptococci, play major role in case of mixed infection.

Acute and chronic of odontogenic sinusitis

If the inflammation in the antral mucosa prolongs after acute odontogenic maxillary sinusitis, symptoms of chronic odontogenic sinusitis develop. The antral mucosa thickens due to fibers, leukocytes and edema during the chronic condition. In some cases, polyps may also develop.

Symptoms and signs of acute form

Malaise

Headache

Oral malodor

Pressure-like dull pain

Mucopurulent rhinorrhea

Occasional eyebrow edema

Nasal obstruction or congestion

Erythema i.e. redness of the skin

Swelling of the anterior maxilla and cheeks

Fullness or pressure near the maxillary sinus

Smelly mucopurulent material draining into the nasophrynx and the nasal cavity

If a periapical abscess is the source of the infection, swelling may occur in the buccal vestibule and gingiva.

Symptoms and signs of chronic form

Malodor

Dull headache

Nasal congestion

Constant pus from the oroantral fistula

Nasal discharge with / without postnasal drip

Tenderness in anterior maxillary area

Pain in tooth while chewing
However, signs of a sinus infection are subtle in chronic form.

Treatment of odontogenic sinusitis

As maxillary sinusitis and odontogenic infections are related, the oral cavity of the patients having signs of a sinus infection  should also be examined. Dental infections shall be treated simultaneously with maxillary sinusitis.

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