Page 12 - GP Spring 2024

Discussion:
Given the superior imaging opportunities with CBCT, the modality
should be considered when symptoms of sinusitis are reported, and
traditional 2D imaging and vitality tests are ambiguous. Taking
a history from a patient who has had chronic sinusitis can lead
a practitioner astray in that a recent acute episode might be dis-
regarded, given the chronic condition of the sinusitis. Clinicians
should investigate the vitality of maxillary posterior teeth when
new sinusitis symptoms are reported.
What we can do:
Routinely screening patients for Maxillary Sinusitis of Endodontic
Origin (MSEO): 5

1. History of (acute) unilateral sinusitis treated with antibiotics
(that persists)
2. History of past prescriptions for nasal sprays, saline lavages
3. History of previous diagnoses of deviated septum or allergies
4. History of post-nasal drip or nasal obstruction (can be detect-
ed clinically by reclining the patient and check for drip down
the back of the throat. The patient will usually have the urge
to close and swallow to clear the back of the nasopharynx.)
5. History of poor sleep patterns (associated with sleep apnea-
to clear the airway)
6. Nasal tonality (due to clogged sinus)
In cases with patients who are actively in treatment with ENT a
Figure 9. CBCT axial and cross sectional views of tooth #14. referral note summarizing the findings may help to coordinate
treatment decisions and certainly if a CBCT finds dental disease.
Patients are often keen to determine the cause of
their chronic condition and will consent to imaging if
there is a possibility that it will produce an actionable
diagnosis. Development of a treatment plan in the
presence of dental disease becomes a matter of either
initial endodontic or re-treatment, if possible, or exo-
dontia and possible prosthetic restoration.
The resolution of the sinus inflammation may require
several months and possible intervention by the ENT.
But, certainly, the removal of the dental etiology is
the primary path to resolution.

References:
1.https://www.aae.org/specialty/wp-content/uploads/
sites/2/2018/04/AAE_PositionStatement_MaxillarySinus-
Figure 10. CBCT axial zygoma tooth #14. Extension of periapical pathology itis.pdf. Accessed 31 Dec 2023.
into the lateral wall of the sinus and superiorly to the zygoma. 2.https://www.aae.org/specialty/wp-content/uploads/
sites/2/2018/04/AAE_PositionStatement_MaxillarySinus-
itis.pdf Accessed 31 Dec 2023.
ture of the defect into the sinus, which was not detected by the 2D 3. Bauer WH. Maxillary sinusitis of dental origin. Am J Or-
views of the panoramic or PA’s. tho Oral Surg. 1943;29(3):133-151. Accessed 31 Dec 2023.
4. Abrahams JJ, Glassberg RM. Dental disease: a frequent-
The CBCT demonstrated a disrupted cortical plate over the apices ly unrecognized cause of maxillary sinus abnormalities?
of teeth 2, 3, and 14 and a thickening of the lining of the maxillary AJR Am J Roentgenol. 1996;166(5):1219-1223. Accessed
sinus membrane consistent with maxillary mucositis. Furthermore, 10 Dec 2023.
the left lateral sinus wall demonstrated trabecular disorganization 5. RealWorldEndo. 4 Apr 2016. Maxillary Sinusitis of End-
extending from the lateral wall of the maxilla to the zygoma and odontic Origin A Call to Action Part 2 of 2. Video. Youtube
https://www.youtube.com/watch?v=prOEmRXj_XM.
terminating at the maxillary-zygomatic suture.
The patient was counseled on endodontic or exodontia/implant Dr. Joseph DiDonato, III is in private practice
treatment options. Definitive treatment included the extraction of in Rochester, NY. He received his dental degree
teeth 2, 3, and 14 with bone grafts to preserve the ridge, resulting from New York University College of Dentistry.
in the resolution of sinus and headache symptoms. He has served as President of the New York State
Academy of General Dentistry and currently
serves as treasurer.

www.nysagd.org l Spring 2024 l GP 12