Odontogenic sinusitis is a persistent infection of the sinuses that arises from a diseased upper tooth root – usually a molar. Odontogenic sinusitis comprises 5-10% of chronic sinusitis. The dental infection will cause a periapical abscess (pus collection around the root of the tooth) which is commonly located in the cheek sinus. This will cause foul-smelling, purulent unilateral drainage that usually is refractory to antibiotics. The bacteria are usually anaerobic bacteria that are common dental flora. Antibiotics do not work because there is so much pus in the sinus, they can not penetrate to the middle of the collection. Occasionally the cheek sinus infection spreads to the ethmoid and frontal sinuses. Sometimes extraction of the infected tooth can cure the infection, but usually endoscopic sinus surgery is required. Once the sinus has been opened and the diseased tooth has been removed the patient’s sinus issues resolve. Endoscopic sinus surgery is curative, by draining the sinus.
Another cause of odontogenic infections in the maxillary sinuses are dental implants. Dental implants are being used more commonly for dental restoration, and most patients do quite well. Rarely the implant can penetrate into the maxillary sinus and this results in a path for dental bacteria to travel into the sinus, resulting in a chronic sinus infection that is refractory to antibiotics. Once again, endoscopic sinus surgery will cure the infection, and the implant does not need to be removed.
Josh Meier, M.D. F.A.R.S.