Not always sinusitis, or inflammation of the maxillary sinuses, is caused by a viral infection or hypothermia. People who have sore teeth may develop a symptomatic disease that has some distinctive features — odontogenic sinusitis. Treatment of pathology also includes specific methods, but in general, it implies the same techniques and drugs as with other types of sinusitis.
Features of the disease
Odontogenic maxillary sinusitis is an inflammatory process in the mucous membrane, the submucosal layer of the maxillary sinuses, the symptoms of which appear against the background of infection from the affected tooth. In most cases, odontogenic sinusitis is caused by diseases of the posterior teeth of the upper jaw, to which the anatomical structure of this area predisposes. Upper molars and premolars almost closely touch the maxillary sinuses, and therefore infection of the paranasal sinuses in the presence of a diseased tooth can be a matter of time.
Usually, odontogenic sinusitis occurs only in one nasal sinus – right or left, on the side where there are affected teeth. But further on, infection and a healthy sinus often occur, as a result of which a “full-fledged” bilateral sinusitis develops. Under unfavorable circumstances and weak immunity from the maxillary sinuses, the infection can get into other sinuses – wedge-shaped, frontal, ethmoid labyrinth.
The type of course of the disease is acute, subacute, chronic, chronic with exacerbations. Due to the development of emit:
- odontogenic sinusitis without perforation of the sinus floor;
- odontogenic sinusitis with perforation of the sinus floor.
Perforated sinusitis is divided into pathology with and without a foreign body.
Causes of sinusitis
The causative agents of the disease are microbes that inhabit the oral cavity, the teeth and the area of their roots – diplococci, staphylococci, enterococci, streptococci, sticks and others, more often in the form of a mixed flora. Odontogenic sinusitis occurs after infection in the maxillary sinus from pathological lesions in the mouth. But why does not everyone who has bad teeth develop the disease? The fact is that only with susceptibility and increased sensitization of the surface layer of the maxillary sinuses, they become susceptible to a pathological reaction to the introduction of bacteria. Pathology develops most frequently with general impairment of immunity, as well as with changes in the local reactivity of the nose and nasal sinuses.
Situations in which infection of the maxillary sinuses can occur and the development of sinusitis of dental origin:
- pulpitis or deep caries of the upper molars and premolars;
- periodontal disease, causing bone destruction and thinning of the septum between the roots of the teeth and the maxillary sinus;
- suppuration of a tooth cyst;
- perforation of the sinus wall during tooth extraction;
- sinus damage after resection of the apex of a tooth or removal of a cyst;
- pushing the top of the root of the tooth into the sinus during the treatment of pulpitis;
- penetration of filling material in the sinus;
- destruction of the sinus wall by a tumor of any origin;
- poor quality implants.
The risk of the appearance of odontogenic sinusitis is aggravated by such states and features of anatomy:
- the proximity of the roots of the teeth to the wall of the sinus or their ingrowth into the sinus;
- multiple dental surgeries, traumatic tooth extractions;
- somatic diseases that weaken the body’s resistance.
Thus, the main difference between conventional sinusitis and odontogenic is that the latter does not develop against the background of influenza or ARVI, and its appearance is always associated with infectious processes in the oral cavity or injuries of the sinuses during dental treatment. The reasons for the pathology often become their own inattention to the health of the teeth and unqualified actions of the dentist.
Symptoms of pathology
As a rule, before the occurrence of the disease, a person marks inflammation or pain in the alveolar process. This can occur, for example, due to the deterioration of the carious tooth, against the background of inflammation of the gums after treatment or removal of the tooth. During this period, bacteria spread to the maxillary sinus with the development of the initial stage of antritis. As the inflammation increases, edema of the maxillary sinus mucosa occurs, the exit orifice decreases in size, the outflow of mucus and air exchange are disturbed. Active reproduction of the infection leads to suppuration and the appearance of a characteristic clinical picture of the disease. The main symptoms of odontogenic sinusitis (almost all of them appear only on one side of the face):
- nasal congestion;
- violation of nasal breathing;
- swelling in the sinus area;
- headache with sinus, extending to the cheekbone, eyes, ear;
- swelling in the sinus area, swelling of the entire cheek;
- elevated temperature;
- severe malaise, lack of appetite, weakness;
- the appearance of thick mucus from the nose, later – with purulent inclusions;
- unpleasant smell from the nose and mouth;
- pain when touching the gums in the area of the affected tooth;
- the inability to chew on the inflamed side due to the sharp pain;
- lacrimation, pathological reaction to light.
If the sinusitis was transferred without adequate therapy, and the diseased tooth remained in place, or another cause of pathology was not eliminated (for example, a foreign body in the sinus), then chronic sinusitis occurs. Its symptoms are reduced mainly to the frequent pain of the tooth, general ill health, decreased performance, constant fatigue. Sometimes the patient has pus from the nasal passages, the nose is often stuffed up, the smell is disturbed. Periodically there are headaches in the temples, forehead, nose bridge. Relapse of the disease can occur after any acute respiratory viral infection, hypothermia, exacerbation of other chronic pathologies, and the symptoms will be similar to those indicated above for acute odontogenic sinusitis.
Odontogenic sinusitis can occur in the period from several days to six months after poor-quality treatment of the tooth, implant placement, tooth extraction or cyst, etc. In children, the disease is practically not diagnosed, since the roots of the baby’s teeth are small and do not reach the wall of the maxillary sinuses
Diagnosis of odontogenic sinusitis
The examination is carried out by an otolaryngologist, but if the patient has previously turned to the dentist, the latter should assume the development of odontogenic sinusitis on the characteristic symptoms and refer it to the ENT screen for further examination. Usually, during the examination, the dentist identifies the presence of a tooth with a root cyst, signs of periodontitis, notes the symptoms of periodontitis, inflammation of the tissues around the implant, etc.
After collecting anamnesis, the doctor examines the anterior rhinoscopy, during which it visualizes the edema and hyperemia of the nasal concha mucosa, the presence of mucus with pus in the middle nasal passage. Be sure to run:
- radiography or CT scan (darkening of the affected sinus is detected);
- complete blood count (detected neutrophilic leukocytosis, increased ESR);
- diagnostic or therapeutic diagnostic puncture (a purulent fluid is removed, which is sent for analysis to clarify the type of infection).
Accurate diagnosis of pathology without puncture of the sinus is provided by means of endoscopic video research conducted through the fistula. If the sinusitis is caused by perforation of the sinus wall of the teeth or a foreign body, endoscopy is performed through this hole. Differential diagnostics is performed with sinusitis of a different origin, inflammation of the facial nerve, acute pulpitis, and acute periodontitis. In the presence of chronic odontogenic sinusitis should exclude neoplasms of the upper jaw benign or malignant nature.
Treatment of odontogenic sinusitis should include not only therapeutic interventions to eliminate the infection from the maxillary sinus. If you do not sanitize the oral cavity, the bacteria will continue to infect the paranasal sinus, which will lead to chronicity and recurrence of sinusitis. In this regard, it is important to cure the causal tooth as soon as possible. Basically, an operation is performed to remove a tooth or excision of a cyst, to remove an implant, but in case of serious suppuration (periostitis, osteomyelitis) surgery will be more difficult (opening a purulent abscess to ensure drainage). After the rehabilitation of the oral cavity proceed to the treatment of odontogenic sinusitis.
If the patient asked for help at the stage when the symptoms of the pathology are pronounced, there is purulent discharge, a mini-operation is required – puncture (puncture) of the maxillary sinus. Mucus with pus is pumped out, the sinus is washed for 3-6 days using antiseptic solutions. Read more about the consequences of a puncture for sinus
Be sure to perform further drug and physiotherapy treatment of pathology:
- taking antibiotics, selected after identifying the sensitivity of microbes to drugs; Find out which antibiotics for antritis is most effective.
- taking antihistamines (Suprastin, Loratadin, Diazolin), if necessary – anti-inflammatory drugs (NSAIDs);
- rinsing the nose with a cuckoo, sinus catheter; More information about the procedure cuckoo for sinus
- instillation of vasoconstrictor drugs;
- instillation of antibacterial, antiseptic drops or irrigation of the nasal passages with antiseptics (Isofra, Bioparox, Miramistin);
- after reducing the intensity of inflammation, physiotherapy treatment is carried out in a course of 7-10 procedures to prevent chronic disease (magnetic therapy, laser irradiation, UHF).
Chronic sinusitis often requires performing an operation on the sinus itself – polypectomy, sinusitis, replacing sinus anastomosis, removing ulcers and fistulas, closing the perforation between the tooth and sinus, etc.
The danger of acute sinusitis is the possible penetration of infection into nearby tissues with the development of:
- gingival abscess;
- phlegmon orbit;
- soft tissue ulcers;
- meningitis, etc.
Chronic odontogenic sinusitis can cause the proliferation of areas of hypertrophy in the sinus (cysts, polyps) and can even provoke the appearance of cancer diseases of this area of the body. Check out the symptoms of a cyst in the nose.
Unlike other types of sinusitis, in case of a disease of odontogenic origin, the main measure of prevention is to maintain the normal condition of the teeth and gums and to regularly conduct high-quality oral hygiene. To do this, visit the dentist once every 6 months, cure all the bad teeth, and contact only qualified specialists. It is important to prevent the removal of teeth, because such an operation not only threatens the development of sinusitis, but also violates the chewing ability of the jaw. In addition, it does not hurt to perform such actions:
- avoid crowded places during ARVI and flu;
- if necessary, drink immunomodulators, vitamins;
- get rid of foci of upper respiratory tract infection;
- if possible, to prevent the development of any chronic pathologies that weaken the immune system.
In the next video you will learn how to treat sinusitis from toothache.
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