After the treatment of the tooth, the maxillary sinus became inflamed. Treatment of odontogenic sinusitis. Patient reviews. What it is? Classification: acute, chronic and other forms of sinusitis

Acute inflammation of the mucous membrane of the maxillary sinusitis can provoke inflammatory diseases of the teeth. A certain role in the development of sinusitis is played by the structural features of the cavity, the location of the roots of the teeth relative to the bottom of the maxillary sinus.

The predisposing factors of odontogenic maxillary sinusitis are the increased size of the maxillary sinus compared to the norm. On average, the maxillary paranasal sinus is located above the holes of the 5th, 6th, 7th teeth.

But sometimes the maxillary cavity is much larger and is located above the roots of the teeth, starting from the 4th and up to the 8th tooth - the wisdom tooth. The dimensions of the maxillary sinus are noted, extending to the canine - the 3rd tooth.

The thickness of the septum that separates the roots of the teeth of the upper jaw from the bottom of the maxillary sinus also contributes to the development of odontogenic sinusitis.

The thickness of the bone septum varies, is an individual feature of the anatomical structure. Sometimes the septum is thinned, represented only by the periosteum and mucous membrane, and can reach up to 1 cm in thickness.

Odontogenic sinusitis occurs when a tooth granuloma or granulating periodontitis destroys the bony septum and involves the mucous membrane of the maxillary sinus in inflammation.

On the other hand, surgical treatment of the maxillary sinus can lead to damage to the nerve that innervates the pulp of one of the teeth of the upper jaw. Too vigorous intervention can cause inflammation of the pulp, followed by necrosis of the tooth tissue.

Especially dangerous is active intervention with a thin bone septum between the bottom of the sinus and the roots of the teeth. In such a case, it is possible to perforate the bottom of the maxillary cavity, the formation of an alveolar fistula.

The extraction of a tooth can cause perforation of the bottom of the maxillary cavity. Sinusitis after tooth extraction occurs when bacteria enter the maxillary sinus from the oral cavity. This becomes possible with a thinned bone septum between the cavity and the roots of the teeth.

Stages of inflammation in dental sinusitis

Acute inflammation of the maxillary sinus begins with serous inflammation of the internal lining of the sinus, consisting of the mucosa and submucosa. The capillaries of the submucosal layer expand, overflow with blood, the mucosa swells, mucus secretion increases.

Mucosal edema blocks the outflow of mucus from the sinus, promotes congestion, creates conditions for the development of microflora and the attachment of a bacterial infection.

The activity of pathogenic microbiota leads to the transition of odontogenic serous sinusitis to purulent odontogenic sinusitis.

Acute odontogenic sinusitis with an incorrectly chosen treatment regimen becomes chronic. odontogenic sinusitis proceeds for years, aggravated with a decrease in immunity.

Symptoms of odontogenic sinusitis

Symptoms of odontogenic sinusitis differ little from sinusitis caused by other causes. As with maxillary sinusitis of another etiology, with dental sinusitis, the following are observed:

Purulent odontogenic sinusitis is characterized by high temperature, increasing intoxication, and weakness. The patient constantly feels bad breath, breathes through the mouth.

To the common symptoms of sinusitis of any origin are added pain from the teeth, often perceived as dental.

Pain in odontogenic sinusitis is usually projected on the 5th and 6th teeth (see photo). Complaints of toothache are also possible with. In this case, the pain is projected onto the 4th and 5th teeth of the upper jaw.

Often, such pains lead to an erroneous diagnosis, removal of a filling or even a tooth. In the case histories of odontogenic sinusitis, such cases are quite common.

Similar pains that radiate to the tooth can serve as harbingers of cancer of the upper jaw. Dental intervention, especially tooth extraction, provokes an acceleration in the growth of inflamed tissue, the development of cancer.

Diagnostics

Odontogenic sinusitis is diagnosed by X-ray examination of the upper jaw, maxillary sinus, teeth of the upper jaw. The diagnosis is established by radiographic images:

teeth of the upper jaw;
panoramic x-ray of the upper jaw;
maxillary sinus.

Accurate data are provided by a cone-beam tomogram of the upper jaw. A reliable way to diagnose odontogenic sinusitis is endoscopic examination. The examination is carried out through the mouth of the outlet of the maxillary sinus.

An otolaryngologist surgeon using an endoscope under visual control examines the condition of the sinus mucosa.

The miniature dimensions of the endoscope make it possible to use the device for perforated odontogenic sinusitis, to insert the endoscope into the hole in order to examine and treat the cavity under visual control.

Treatment of odontogenic sinusitis

With symptoms of acute perforated odontogenic sinusitis, the patient is treated surgically. Under general anesthesia on an outpatient basis, the patient is removed pus from the sinus.

After the intervention, the patient is prescribed to restore the condition of the mucosa, wash the nose, and physiotherapy.

According to indications, a course of antibiotics, anti-inflammatory drugs, vitamin therapy is prescribed.

In the treatment of chronic odontogenic sinusitis, a maxillary sinus puncture is performed, a drainage tube is placed, and medicinal solutions with antibacterial drugs and antiseptics are injected directly into the maxillary sinus through it.

In case of ineffectiveness of conservative measures in the treatment of odontogenic sinusitis, a surgical operation is performed on the maxillary cavity, all necrotic tissues are removed, and the maxillary sinus is sanitized.

Complications

Lack of treatment for odontogenic sinusitis can lead to phlegmon of the orbit, intracranial complications, brain abscess, sepsis.

Prevention

Regular visits to the dentist, timely sanitation of teeth, and oral hygiene are reliable prevention of odontogenic sinusitis.

Forecast

The prognosis is favorable subject to the doctor's prescriptions and regular medical examinations.

Odontogenic sinusitis is one of the most atypical forms of maxillary sinusitis. Its peculiarity is that it is not related to the respiratory and, in general, the catarrhal route of penetration of the pathogen. The infection enters the sinus not through the fistula, but through a thin bridge between the accessory chamber and the oral cavity. Treatment of odontogenic sinusitis is carried out jointly by an otolaryngologist and a dentist.

Causes of the development of the disease and its types

Odontogenic sinusitis is an inflammatory process of the mucous membranes of the accessory chambers of the nose, which develops as a result of the infection from the diseased tooth of the upper jaw. There may be several reasons:

Dentist's mistake when placing a filling. The roots of the chewing teeth of the upper jaw are often located close to the maxillary sinus, sometimes even protruding into it. Sometimes an inexperienced doctor, while cleaning and filling the dental canal, can bring part of the filling material into the air pocket through it. A filling that is outside the tooth is identified by the body as a foreign body, and a protective mechanism is triggered that provokes an inflammatory process.
Unsuccessful extraction of a diseased tooth. During tooth extraction, part of the root may break off and penetrate into the adnexal pocket. If the root protrudes into the sinus, then after removal a fistula is formed, which becomes a gateway for the spread of pathogens from the oral cavity. The same can result in poor-quality implant placement.
Poor oral care. Most people do not pay enough attention to dental care, limiting themselves to daily brushing. Because of this, dental diseases develop, which can worsen at any time. The desire to delay going to the dentist until the last when unpleasant symptoms appear can result in sinusitis, especially if the nerve is affected.

Dental diseases that can cause odontogenic sinusitis:

deep neglected caries or pulpitis of the upper premolars and molars;
suppuration of the dental cyst;
periodontitis;
periodontal disease;
osteomyelitis;
a tumor that destroys the wall of the sinus.

The causative agent is mainly a mixed microflora of the oral cavity (streptococci, enterococci, staphylococci, diplococci, various rods). The disease can be acute, subacute and chronic. Dental sinusitis with or without perforation of the sinus wall is also divided.

The disease may not develop immediately after an unsuccessful intervention by a dentist, the process can start both in a few days and six months after a tooth is removed or an implant is installed.

Stages of development and main symptoms of the disease

Adults suffer from dental sinusitis, since the tooth roots in children are small and do not reach the lower wall of the sinus. Most often, this type of sinusitis is one-sided, only the cavity in contact with the diseased tooth is affected. Before the onset of the disease, a person often feels pain or inflammation in the region of the alveolar process, which may indicate the spread of pathogenic bacteria.

This type of maxillary sinusitis goes through two stages of development:

serous, in which there is acute inflammation, vasodilation, swelling of tissues and fluid filling of cells;
purulent, when mucus accumulates, pus appears and intoxication of the body.

The disease in an acute form is characterized by such characteristic symptoms:

Congestion (usually one-sided) and complicated nasal breathing.
Discharge from the nose at first watery and transparent, later - with an admixture of pus, have an unpleasant odor.
The pain can cover both the entire head and its individual parts (gum, eye, tooth, cheek), has a dull aching character.
Fever, high temperature (up to 39 degrees), sometimes photophobia, lacrimation.
General weakness, sleep disturbances, lack of appetite.
Soreness of the teeth when chewing food.
Inflammation of the gums, the presence of small sores on them.
Putrid odor from the mouth.
Inflamed lymph nodes.
Smell disturbance.
Swelling of the cheek in the region of the affected chamber.

In the case when the treatment was insufficiently qualified, and the source of infection (affected tooth, filling material) was not removed, then a chronic form of sinusitis develops. It is characterized by frequent pain in the infected tooth, increased fatigue, decreased performance. Sometimes there are headaches, purulent discharge from the nasal passages, a deterioration in the sense of smell, a feeling of congestion. This type of disease can recur from hypothermia, respiratory diseases, and other pathologies. Often the chronic form of dental sinusitis is almost asymptomatic.

Diagnosis of Dental Sinusitis

Both an otolaryngologist and a dentist, who detects signs of periodontitis, a root cyst, or the presence of inflamed tissue near the implant, can identify signs of sinusitis, which is a consequence of problems in the oral cavity.

After questioning the patient and collecting anamnesis, the ENT performs a series of actions to establish an accurate diagnosis. At the same time, he chooses procedures based on the indications and the availability of the necessary equipment in the hospital.

Palpation of the cheek in the area of the affected sinus causes sharp pain.
Rhinoscopy shows swelling of the lower and middle parts of the nasal cavity from the side of the affected adnexal pocket, sometimes pus mixed with mucus is noticed.
X-ray (sighting or panoramic) shows blackout in the affected chamber and the diseased tooth.
Computed tomography allows you to see the presence of foreign objects in the sinus.
Endoscopy is used in cases where computer methods do not allow to recognize the true picture of the disease. A thin endoscope is inserted through the fistula or perforated bottom of the sinus and provides detailed information about the ongoing process.
Puncture (therapeutic-diagnostic or diagnostic) with subsequent direction of the contents of the chamber for bacteriological analysis.
A blood test (general) indicates an increased ESR and neutrophilic leukocytosis.

Sanitation of the oral cavity as the first stage of treatment

Treatment of odontogenic sinusitis consists of two main mandatory steps: elimination of the primary source of infection and subsequent treatment of inflammation in the air pocket. This requires the constant cooperation of specialists from the otolaryngological and dental departments of the hospital. If there is no such cooperation, then it may happen that not all the necessary measures will be taken, and there will be a threat of re-development of the disease.

First, the oral cavity is sanitized, which may include:

Excision of a cyst or granuloma from a tooth root.
Extraction of the implant.
Extraction or treatment of a diseased tooth. Most often, despite the desire of the patient to save the tooth, it is removed, since even the most modern treatment cannot guarantee the complete destruction of pathogens in the root canals, nerves and surrounding tissues. Unsuccessful treatment will cause new outbreaks of infection and prolonged retreatment.
Opening the abscess and providing the necessary drainage for osteomyelitis or periostitis.

If there is a perforation after the removal of a tooth or implant, it must be closed to prevent the passage of bacteria between the voids. As a rule, such fistulas are closed by mucous membranes from the oral cavity.

Conservative therapy for dental sinusitis

After the completion of the process of sanitation of the oral cavity, further treatment is carried out by an otolaryngologist. If the inflammatory process in the adnexal pocket is limited to swelling of the mucous membranes, then with such odontogenic sinusitis, treatment is carried out with the help of antibiotics, injections of drugs and regular washings.

Surgical methods for the treatment of odontogenic sinusitis

Often, conservative therapy for dental sinusitis does not give the desired effect. It is for this form of sinusitis that surgical intervention is characteristic for cleansing the mucous membranes and removing foreign objects.

Puncture of the maxillary sinus with dental sinusitis is needed in most cases. The puncture ensures the removal of the accumulated purulent exudate and the delivery of the necessary therapeutic solution from the antibiotic, antiseptic and enzymes directly to the address. Despite the notoriety, the puncture using a Kulikovsky needle under local anesthesia is practically painless. The patient feels only a short-term unpleasant sensation of bursting from the inside of the chamber during the injection of fluid into it. Fluid with mucous accumulations is removed through the mouth.

In most cases, several punctures combined with medical therapy are enough to defeat the disease. However, the puncture also has its weaknesses, so a number of experts are skeptical about its capabilities. With it, it is impossible to remove altered tissues (cysts, polyps), fungal masses or foreign bodies (breakaway parts of the root, filling material) from the sinus. Puncture followed by washing helps only if the mechanisms of natural sinus cleansing are preserved, otherwise a more serious operation has to be done.

Radical surgery. Removal of pathological tissues and foreign objects is performed using surgery from the oral cavity. This method in various variations has been used for more than a century, but it is very traumatic and has many complications. The patient at the same time falls out of the normal rhythm of life for a long time.

An incision is made under the upper lip from the second molar to the lateral incisor. After opening the mucous membranes, part of the sinus wall is removed. A foreign body is removed through the resulting hole, and the pathologically altered mucous membrane is scraped out with special surgical instruments. A hole is punched through the nose in the front wall of the chamber to drain the contents, gauze turunda moistened with an antiseptic is inserted into it. After completing all the manipulations, the doctor puts stitches.

Endoscopic surgery has a number of advantages over the radical method. It is carried out through a natural connecting channel (ostium) or through a hole formed during the removal of the affected tooth. Both local anesthesia and general anesthesia can be used. Thin endoscopes and special instruments make it possible to clean the sinus, practically without damaging healthy tissues, through tiny accesses. As a result, they are safer than open surgeries and much easier for patients to tolerate. Hospitalization during endoscopic surgery lasts one day, after which the patient is only regularly observed by a doctor.

Refusal of surgery for odontogenic sinusitis can lead to serious complications, such as:

inflammation of the frontal and sphenoid sinuses;
gum abscess;
the appearance in the soft tissues of abscesses;
phlegmon of the orbit of the eye;
proliferation of tissues (polyps and cysts) in the accessory pocket with their possible degeneration into malignant neoplasms;
meningitis;
purulent brain injury.

Sinusitis is an insidious disease. Numerous factors lead to the appearance of the disease: hypothermia, penetration of infections and injuries. In some cases, trouble occurs due to an unexpected reason. An example is odontogenic sinusitis. How to eliminate pathology?

Description of the disease

Odontogenic sinusitis is an inflammation of the maxillary sinus resulting from the spread of infection from the upper teeth.

The disease has symptoms similar to other forms of sinusitis, the difference lies only in the cause of occurrence.

The pathology is often called maxillary or dental sinusitis.

Classification: acute, chronic and other forms of sinusitis

According to the location of inflammation, the following types of pathology are distinguished:

unilateral (left or right) - occurs depending on the location of the diseased tooth;
bilateral sinusitis - is formed in the absence of treatment and the spread of the pathological process.

According to the type of course of the disease, 2 forms are distinguished:

acute odontogenic sinusitis - the duration of development is from several days to 3 weeks;
chronic (more than 6 weeks) - characterized by stages of exacerbation and remission.

In addition, according to pathogenesis, the following types are distinguished:

Without perforation of the sinus floor.
With perforation resulting from:
- trauma;
- destruction of the sinus floor by a tumor;
- lesions of the upper jaw;
- destruction of an odontogenic nature: after tooth extraction, cysts, resection of the upper parts of the roots.

Among the perforated forms of sinusitis, conditions are additionally distinguished in which the disease occurs due to the penetration of a foreign body:

intraosseous implant;
dentist tools;
filling material;
tooth root.

Reasons for the formation of odontogenic sinusitis: poor hygiene, bad tooth, cyst

The occurrence of odontogenic sinusitis is associated with the penetration of infection from a diseased tooth. This happens in the following cases:

Poor oral hygiene. Improper dental care and untimely visits to the dentist lead to the formation of caries, and in advanced cases, to nerve necrosis. The resulting inflammation spreads, as a result of which it penetrates into the maxillary sinus.
Poor quality seal. Some of the roots of the teeth are close to the maxillary sinus, so if it is necessary to treat deep areas, the doctor may accidentally bring the filling material into it.
Extracted tooth. As a result of the removal, a channel is formed through which infections penetrate, and if the root is located close to the sinus, then the development of inflammation is a matter of time.
Diseases. These include periodontitis, periodontitis and other pathologies. Improper treatment of pulpitis leads to the spread of infection.
Pathological formations. A common cause of odontogenic sinusitis is a cyst, especially when it suppurates.

Patients at risk include:

who have undergone many operations on the upper jaw;
having problems with the immune system.

Symptoms of sinusitis: chronic course, period of exacerbation

In most cases, patients complain of the following symptoms:

elevated body temperature;
headache;
weakness and fatigue;
deterioration of the sense of smell;
pain in the area of the sinuses;
chills;
nasal congestion;
sleep problems.

During the period of exacerbation, these symptoms intensify, and the condition worsens with the appearance of new manifestations:

pain when tapping on the affected tooth;
discomfort when pressing on the sinus area.

The chronic form is manifested by discomfort in the place of the inflamed cavity, however, an unpleasant symptom occurs periodically. The patient feels normal, deterioration of health occurs during an exacerbation - there are signs characteristic of an acute form.

With perforated sinusitis, patients complain about the penetration of fluid into the nasal cavity with the head upright during meals. Other manifestations follow.

Establishing diagnosis

During the diagnosis, it is required to distinguish the odontogenic form of sinusitis from the rhinogenic form. For this purpose, the following methods are used:

Differential diagnosis - table

Disease	Periodontitis	Pulpitis	trigeminal neuralgia
Symptoms	pain; swelling of the gums; weakness; sleep disturbance; swelling of the face; enlargement of the lymph nodes.	paroxysmal pain, often - when exposed to stimuli; increased pain at night.	spasm of facial muscles; pale skin; swelling of the face; pain depending on the affected nerve: ophthalmic nerve (bridge of nose, upper eyelid); mandibular nerve (mandible, lower lip, chin); maxillary nerve (upper jaw, upper cheek); salivation; lacrimation.

How to treat pathology: removal of the traumatic factor

The patient is treated by two specialists - a dentist and an otolaryngologist. Only a complex technique will allow you to get a positive result. In addition, it is important to get rid of the cause of sinusitis, otherwise the therapy will not lead to recovery. For this purpose, the oral cavity is sanitized and the traumatic factor is eliminated - a diseased tooth, a penetrating filling material, a cyst and other objects.

Medical method: antibiotics, antihistamines, mucolytics and other means

To eliminate inflammation and alleviate the patient's condition, the following groups of drugs are used:

Vasoconstrictor drops (Rinazolin, Nafazolin, Tizin, Naphthyzinum). Eliminate swelling of the mucous membrane and improve the outflow of exudate.
Antihistamines (Diazolin, Loratadin, Suprastin). Reduce puffiness.
Non-steroidal anti-inflammatory drugs (Ibuprofen, Analgin, Nurofen). Reduce pain and eliminate inflammation.
Antibacterial drops and preparations (Miramistin, Bioparox, Augmentin, Isofra, Sumamed, Amoxiclav). Eliminate infection. Preparations of this group should be selected after the detection of pathogenic bacteria.
Mucolytics (Mukodin, Rinofluimucil). Reduce the viscosity of mucus, providing a quick cleansing of the sinuses.

Gallery of medicines for sinusitis

Isofra - an antibacterial topical agent Rinofluimucil reduces the viscosity of mucus, which leads to a rapid cleansing of the sinuses
Diazolin reduces swelling Ibuprofen relieves inflammation and pain Nafazolin improves mucus flow

Physiotherapy

Physiotherapeutic methods of treatment improve the patient's condition and help to quickly recover from the disease. The following methods apply:

inhalations - provide penetration of medicinal substances, eliminating painful symptoms;
UHF therapy - increases the outflow of mucus;
electrophoresis - delivers therapeutic components to the focus of inflammation;
magnetotherapy - reduces swelling of the mucous membrane.

Surgery for sinusitis: puncture, endoscopic intervention

To prevent complications and eliminate the chronic form of odontogenic sinusitis, methods of surgical intervention are used. The doctor may use the following methods:

After 5-6 days after the operation, you need to start washing the sinus, but after consulting with a specialist.

Traditional medicine: is it possible to use such treatment

Folk remedies should be used as part of complex therapy - it is dangerous to use only them and ignore the methods of official medicine for the patient's condition. In addition, such recipes relieve the symptoms of sinusitis, but not the cause of inflammation.

Inhalations with propolis

Effective with sinus inhalation. To prepare the composition you need:

Heat 2 liters of water and bring to a boil.
Add propolis tincture to the container - 2 tsp.

The duration of the procedure is 10-15 minutes. During the event, you need to cover yourself with a towel, inhale through your nose. It is not recommended to use the presented method of treatment for people suffering from allergies to propolis and other bee products.

Healing ointment

To eliminate inflammation, an ointment with honey is suitable. The composition of the tool includes:

vegetable oil;

Predictions and consequences

With timely initiation of treatment, the prognosis is favorable. Lack of intervention leads to complications, which include:

cyst;
osteomyelitis of the upper jaw;
meningitis;
phlegmon of the orbit;
inflammation of the tooth socket (with perforated type).

Preventive actions

To avoid worsening the situation, you need to follow a few rules:

consult a doctor and start treatment when the first signs of inflammation appear;
strengthen the immune system and eat right;
monitor oral health and visit the dentist at least once every six months.

Features of the treatment of sinusitis - video

It is impossible to get rid of odontogenic sinusitis without eliminating the cause - an inflamed tooth, so complex treatment is required. If the doctor's recommendations are followed, a positive result is guaranteed - you can forget about the pathology for a long time.

Sinusitis is called inflammation, which is present in the maxillary sinus. It brings a lot of discomfort. Sometimes there is sinusitis from the tooth, which also negatively affects health. It is important to identify ailments and prescribe treatment. This is discussed in the article.

Kinds

Can teeth hurt from sinusitis? This pathology is considered one of the most common phenomena. Sinusitis from a tooth is called odontogenic. In this case, the infection enters from the oral cavity. There are 2 stages of the course of the disease:

Serous.
Purulent.

The acute course of the disease begins with the serous stage. With it, there is swelling, dilated blood vessels, and the cells are filled with fluid. If at this stage there is no timely treatment, then the purulent stage sets in.

In the latter case, bad breath, weakness, fatigue and headache appear. Breathing through the nose is complicated, the temperature rises. Each stage can occur in acute or chronic form.

If there is pain in the teeth with sinusitis, then you need to consult a dentist. Only a specialist can recommend effective means and procedures for the complete elimination of discomfort in the oral cavity.

Causes

Why do teeth hurt with sinusitis? It is connected with:

Improper oral care. Frequent provoking factors include a belated visit to the dentist to treat a diseased tooth. Especially increases the risk of the disease with caries at an advanced stage.
Incorrectly placed seal. It's the dentist's fault. The roots of the teeth of the upper jaw are close to the maxillary cavity. If it becomes necessary to treat a neglected tooth, followed by cleaning and filling the canals, the dentist may accidentally introduce an infection through the canal when filling. Since the filling material outside the tooth is perceived as a foreign body, this leads to nasal discharge and pain. If these symptoms appear, you should immediately consult a doctor.
Tooth extraction. In some cases, the tooth root can get into the maxillary cavity. As long as the tooth is healthy, there is no discomfort with it. But when it becomes necessary to remove it, then after the completion of the surgical intervention, a fistula develops. This is how the infection enters the maxillary sinus. Therefore, sinusitis develops after tooth extraction.

These are the main causes of upper respiratory tract disease. There may be a tooth cyst with sinusitis. This condition should not be ignored, it is necessary to consult a doctor. Only with professional treatment is improvement possible.

Symptoms

You need to see a doctor when the first signs of illness appear. Then the treatment of sinusitis from the tooth will be completed faster, and the risk of complications will decrease. With this disease, the appearance is likely:

elevated temperature;
headache;
smell disorders;
pain in the area of localization of the maxillary sinuses;
nasal breathing disorders;
chills
pain in the teeth of the upper jaw.

With purulent sinusitis, the symptoms are most pronounced. Additional symptoms appear: sharp pain when touching one of the parts of the face or pain with tapping with a spoon on the teeth, whose roots are in the painful area.

It may be that sinusitis gives in the teeth. In this case, you need to consult a doctor who will reveal why this is happening. The prescribed methods of treatment will get rid of the problem.

Diagnostics

Diagnostic measures to detect inflammation are performed in 2 stages:

Definition of a diseased tooth.
Inspection of the maxillary cavities.

X-ray diagnostics is used to identify painful teeth. The most reliable diagnostic method is endoscopy. The procedure is performed with a special device - an endoscope. If the doctor suspects perforated sinusitis, then he inserts the device through the hole that appeared after the root was removed. Due to the wide viewing angle, it will be possible to carefully check the condition of the sinus and fistula. Diagnosis allows you to determine whether sinusitis from the tooth is really taking place.

Complications

If sinusitis appears after tooth extraction, then timely treatment is needed. Otherwise, the appearance is likely:

edema;
disorders of cerebral circulation;
phlegmon of the eye.

Therapy

Treatment of sinusitis from a tooth should be performed with the help of a specialist. The first step is to eliminate the source of the infection. Then the purulent removal procedure is allowed when performing endoscopy. Before removing the pus on an outpatient basis, a local anesthetic is used. Half an hour later you can go home.

If general anesthesia is used, the patient must be in the hospital for a day under the supervision of specialists. When the source of the disease is eliminated, it is required to use vasoconstrictors for several days. This is necessary in order to restore the mucous membrane.

After the operation, the nasal cavity must be washed daily with a solution for the time set by the doctor. At their discretion, physiotherapy procedures are prescribed, and if acute pain appears, then painkillers are prescribed. If there are complications during the discharge of pus, then the doctor prescribes antibiotics. Another 30 days after the operation is required to avoid physical activity.

How is chronic illness treated?

If a tooth is removed, sinusitis appears, but there is no treatment, then the disease can become chronic. His therapy is performed by standard methods, surgery is rarely prescribed. If the tooth from which the inflammation occurred is removed, a drainage tube is located in the sinus for up to 2 weeks. Through it, the doctor introduces a solution of antibiotics and antiseptics, enzymes.

If traditional treatment does not help, surgery is prescribed. With it, the affected tissues are excised from the maxillary cavity, the anastomoses are expanded. After some time (5-6 days), you need to flush with saline.

warming up

Experts do not provide a single answer as to whether heating can be performed with sinusitis. There are general indications and contraindications for the use of heat.

Warmings are used in folk medicine. Warming up the nasopharynx with hot vapors from decoctions of potatoes and herbs is in demand. For dry warming, boiled eggs are used, wrapped in cloth and applied from both wings of the nose. These procedures are effective in the initial stages of the onset of the disease and in chronic sinusitis.

In acute purulent sinusitis, heating can lead to the growth of pathogenic microorganisms, as well as to other serious consequences. You can not warm the nose with sinusitis, if it is caused by meningococci, fungal spores and hemophilia.

Prevention

Any disease is easier to prevent than to treat. If you follow simple preventive rules, then the risk of odontogenic sinusitis is significantly reduced. They are as follows:

Twice a year it is necessary to undergo prophylaxis at the dentist.
Dental treatment should be performed at the slightest risk of a carious cavity.
You need to take care of your mouth and nose.
It is required to strengthen the immune system.
You can not delay treatment if even minor symptoms of the disease are noticeable.

Folk methods of prevention

There are no special preventive procedures for dental sinusitis. All you need to do is take care of your oral cavity and visit the dentist regularly. Prevention should be performed only after the absolute sanitation of the oral cavity. At the same time, foci of inflammation in the nasal passages and cavities are eliminated.

For this, inhalations and washings are carried out with the help of infusions of medicinal plants and vegetable oils. Traditional medicine should only be supplements to drug therapy. Only then will there be a positive effect. Treatment begins after dental procedures. If there is in the mouth (sick teeth), then self-medication will be useless.

Is self-medication harmful?

It is not necessary to eliminate dental sinusitis at home on your own. This type of inflammation needs an ambulance from a dentist and removal of the source of infection. Self-medication can cause serious consequences, manifested in the form of purulent inflammation and the spread of the disease to the upper sections of the cranium.

Elimination of toothache

Often, with sinusitis, there is also a toothache. With this disease, complex treatment is required to improve the human condition. Doctors establish 3 types of therapy that can be used:

Etiological.
Symptomatic.
Preventive.

Etiological therapy involves the rehabilitation of a diseased organ. It is important to influence the root cause of the disease. Medicines are often used, which are taken both orally and in the form of injections. During the treatment of sinusitis, non-steroidal anti-inflammatory drugs are effective. Doctors may prescribe Ibuprofen, Diclofenac, or Aspirin. Rinsing the nose with special devices, for example, a Yamik catheter, helps a lot.

Symptomatic therapy is needed to quickly relieve pain. For this, analgesics are used. It is usually recommended to take Analgin, Tempalgin, Ibuprofen and Nise. With a strong effective "Ketanov". How often you need to take medication is determined by the intensity of the pain. If the discomfort is weak, then you need to take the medicine 1 time, and in other cases, they drink drugs up to 3 times a day.

With a toothache, rinsing with hot water with salt and soda is used. In a glass of water, add an incomplete teaspoon of both components. Preventive therapy is needed to prevent the disease. It is necessary to carry out careful care of the nose and mouth, timely treat infectious diseases and diseases of the teeth. It is important to strengthen the immune system and good nutrition. With an outbreak of respiratory ailments, doctors advise taking vitamin complexes to increase the body's defenses.

Relief of the patient's condition

If a person has sinusitis, his health leaves much to be desired. To reduce the severity of negative symptoms, the following procedures are used:

Nasal lavage is required. This method can also be used at home. To do this, you need a soda or saline solution, decoctions of medicinal herbs. The nose must be thoroughly blown, then the head is tilted to one side over the container, and the solution can be poured from the rubber pear into the nostril. If everything is done correctly, then the liquid flows from the second nasal passage into the first.
The "Cuckoo" procedure is also being performed. It is performed in the treatment room of the hospital. An antiseptic solution is poured into the nostril, and it is pumped out of the other using a special pump.
It is applied With it, it will be possible to prevent the puncture of the maxillary sinus. This method is used in the treatment of sinusitis in children from 5 years. Due to negative pressure, the anastomosis opens, and pus is drawn into the syringe.

These methods are used in the treatment of sinusitis. After washing, the symptoms of the disease will be mild until purulent contents reappear in the cavity. Nasal lavage is preferably performed with the use of antibacterial medicines. Although there are many methods of treating the disease, the doctor should still choose them.

Inflammatory processes in the maxillary sinus can develop for many reasons. Some of them are associated with diseases of the oral cavity, upper gums and teeth located in it.

In this case, doctors diagnose odontogenic sinusitis, the symptoms and treatment of which should be known to two specialists - a dentist and an ENT doctor. According to statistics, odontogenic sinusitis occurs in 5-12% of those suffering from maxillary sinusitis.

Maxillary sinus - anatomical features

In the human skull, there are air spaces - paranasal sinuses that have communication with its cavity. Thanks to them:

voice tone changes
humidifies and cleans the air passing through the nose,
temperature drops that are harmful to the tissues surrounding the sinuses are smoothed out,
the load on the spine is reduced - due to a decrease in the mass of the skull.

The maxillary sinus, which is also called the maxillary or maxillary sinus, is located on both sides of the nose and resembles a triangular pyramid in shape. The top of the pyramid is directed to the bridge of the nose, medially adjacent to the nose, from above it borders on the lower wall of the orbit, and the base of the sinus is the bone in which the roots of the teeth are located. It is these anatomical relationships that determine the relationship of dental diseases with inflammation in the sinus.

Thin cavity walls. There are two types of structure of the maxillary sinus - sclerotic and pneumatic. In the second case, its walls can be very thin, so the tops of the roots of the teeth are located very close to the sinus mucosa or even penetrate into it.
Large cavity. Usually the maxillary sinus is located above the roots of 5-7 teeth, but sometimes its base is wider and covers the holes from 4 to 8 teeth, and less often from the third to the eighth.
Long tooth roots. Normally, the roots are located 1-3 mm from the inner wall of the sinus, but long roots can reach the bottom of the maxillary sinus, especially with a thin bony septum.
Sparse bone structure. It can be either genetically determined or acquired due to age or disease.

Causes of odontogenic sinusitis

The name of the disease is translated as "sinusitis from the tooth" and directly reports that its cause is dental disease.

Periodontitis. Inflammation of the tissues surrounding the tooth and its roots, including the ligaments that hold the tooth firmly in place. The bone plates that make up this hole are also susceptible to inflammation. Periodontitis often occurs with improper oral care, neglected caries, when it reaches the nerve tissue of the tooth and penetrates into the roots.
Inflammation of a cyst or granuloma located in the upper jaw, close to the roots of the teeth. In this case, the infection is capable of penetrating both along the root of the tooth and with the blood flow to the sinus mucosa.
Unsuccessful treatment or prosthetics of the tooth. If the roots of the tooth are close to the cavity of the maxillary sinus, the doctor can easily pierce the top of the tooth root with an instrument or pin during filling or prosthetics, leaving in the cavity the broken off part of the root, filling material, part of the pin or implant. The foreign body causes a natural mucosal reaction in the form of inflammation.
Tooth extraction, especially difficult and traumatic, moreover, if the tooth had long roots. In this case, the root, fragments of the tooth may also be in the sinus. In place of the hole, a fistula can form - a pathological channel between the cavities (oroantral communication).
Osteomyelitis of the upper jaw. Purulent inflammation of the bone tissue can be of traumatic or hematogenous origin. The infection easily passes to the sinus mucosa.
Inflammation of an unerupted tooth.
Jaw injury.

Types and stages of odontogenic sinusitis

This type of sinusitis tends to be prolonged and chronic, but can be divided into:

spicy
subacute
chronic.

It also matters whether the inflammation is accompanied by perforation of the sinus cavity from the side of the tooth roots due to inflammation of the root or cyst, medical manipulations, or due to tooth extraction.

Depending on the nature of the inflammatory discharge, the stages that sinusitis goes through in its development are distinguished:

serous, when swelling of the mucous membrane occurs, a lot of liquid mucus forms on its surface, blood vessels expand;
purulent begins when the outflow of fluid is blocked due to edema and hypertrophy of the mucosa, in which polyposis growths form, the mucus thickens, active reproduction of the bacterial flora begins, and pus forms.

It should be noted that in the presence of perforation, all changes in the mucosa are more pronounced.

Signs of odontogenic sinusitis

Odontogenic sinusitis can hide symptoms for a long time, posing as a dental disease. Often, patients unsuccessfully treat toothache, not suspecting that the cause of the disease is “one floor above” - in the maxillary sinus.

Along with special characteristic features, odontogenic sinusitis also exhibits symptoms inherent in any sinusitis:

headache;
difficulty in nasal breathing;
deterioration of the sense of smell;
fever, weakness, drowsiness;
discharge from the nose of a mucous, purulent nature;
pain with pressure in the sinus area;
enlargement and soreness of regional lymph nodes.

The distinguishing features are:

unilateral lesion - according to the diseased tooth;
unpleasant characteristic odor of discharge;
pain in the area of a tooth or several, which are aggravated by chewing, biting;
tapping the tool on the interested tooth is also painful;
touching the skin in the sinus area causes a sharp pain with a purulent form;
with a perforated form - the penetration of liquid food into the nasal cavity with the vertical position of the head or when it is tilted forward;
mucosal changes, as a rule, are located locally in the region of the sinus floor with a transition to the anastomosis with the nasal cavity.

The variety and brightness of the manifestation of symptoms of odontogenic sinusitis also depend on the stage of the disease and the presence of perforation of the sinus cavity - in the chronic course, sinusitis may not manifest itself at all. In the presence of perforation, the transition to the purulent stage is faster, the condition of patients is more severe and requires immediate treatment.

Diagnosis of odontogenic sinusitis

Timely diagnosis of odontogenic sinusitis depends entirely on the care of the dentist and ENT doctor. The sooner they pay attention to unusual accompanying symptoms and issue a referral to a related specialist, the sooner the patient will receive adequate medical care and the less the risk of complications will be.

Questioning the patient. During the conversation, the doctor finds out the patient's complaints and asks clarifying questions. Already at this stage, it is fashionable to suspect odontogenic sinusitis - if a dental patient has a runny nose and headaches. Or the otorhinolaryngologist finds out that before the discharge from the nose appeared, the person had a tooth removed, then, after consulting among themselves, the doctors will be able to more accurately determine the diagnosis and treatment.

Visual and ENT examination. Includes a simple visual external examination of the sinus and oral cavity and specialized, with the help of nasal mirrors.

On visual inspection, you will notice:

swelling and hyperemia of the skin in the infraorbital and paranasal region,
soreness with pressure in the sinus area,
maceration of the skin under the nose due to secretions,
sore teeth when tapping instruments,
discharge from the socket of the extracted tooth - mucopurulent.

Endoscopic examination of the nasal cavity and sinus. The most informative method for diagnosing sinusitis, as it allows you to examine the sinus from the inside, assess the condition of the mucosa, the nature of the discharge, the presence of foreign bodies, neoplasms, cysts, local suppurations.

During the examination, the specialist may:

take content for analysis
make a biopsy of the mucosa, polyp or tumor,
open the cyst
remove foreign body
rinse the cavity with an antiseptic and inject a medicinal solution.

If there is a fistula between the cavities of the mouth and the upper jaw, the sinus cavity can be examined by passing the endoscope through the fistulous tract.

Since the method provides for the special skills of the staff, the availability of special equipment, anesthesia, such an examination is carried out in most cases as the initial stage of treatment.

Radiation diagnostics. The most common way to determine odontogenic sinusitis.

Three types of x-rays are usually taken:

upper jaw - panoramic,
teeth - the alleged culprits of the disease,
maxillary sinus (it is important that it captures the area from the lower edge of the orbit to the lower edge of the teeth of the upper jaw).

In difficult cases, with osteomyelitis of the jaw, suspected neoplasms, it is advisable to conduct computed tomography, which, using modern equipment in the reconstruction mode, provides objective information about the state of the maxillary sinus and adjacent tissues.

The most accurate of the imaging methods for diagnosing odontogenic sinusitis is maxillary cone beam tomography, which presents 3D images of the region of interest.

Laboratory research

Blood tests reveal signs of an inflammatory process - the number of leukocytes increases and the ESR increases.
Bacteriological examination of sinus discharge helps to identify pathogenic bacteria and select an antibiotic to destroy them.
The study of the material taken during the biopsy allows you to determine the type of neoplasms in the sinus, the condition of the mucosa.

Diagnosis of perforations

Both dentists and ENT doctors should be able to determine perforations, since the percentage of this form of the disease among all patients with odontogenic sinusitis is quite high.

Perforations are determined when:

probing the tip of the root of the tooth or the hole of the extracted tooth with an instrument - by the absence of a bone obstacle (use with caution so as not to pierce the mucous membrane if it is not damaged);
visual observation of the release of an air bubble from the hole after tooth extraction;
complaints of the patient about the ingress of liquid food into the nose through the sinus;
air samples - the passage of exhaled air through the fistula with blocked nasal passages, the inability to inflate the cheek on the side of the lesion (tests may be false-negative in the presence of polyps that block the fistulous passage).

Differential diagnosis should be carried out with rhinogenic, allergic sinusitis, the presence of a malignant neoplasm in the sinus cavity, cysts in the sinus cavity.

Rhinogenic sinusitis is characterized by intense headache, since due to swelling of the nasal mucosa, the outflow of fluid is blocked in most cases, and on both sides (which can lead to pansinusitis, which only aggravates diffuse headaches), which is uncharacteristic of odontogenic sinusitis, when symptoms appear only with one side.

Allergic sinusitis is seasonal, occurs after contact with an allergen, and all sinuses are involved in the process. A cyst in the maxillary sinus gives its characteristic blackout on x-ray examination - smooth edges are not typical for odontogenic sinusitis.

A malignant tumor in the sinus cavity can destroy the bony septum in the area of the sinus floor, and it can be distinguished from odontogenic sinusitis by conducting radiation diagnostics - X-ray, CT or cone beam tomography. A scintigraphy will also help in the diagnosis of a tumor. The exact answer is given by the study of the biopsy material of the neoplasm.

Treatment

Treatment of odontogenic sinusitis involves the solution of two problems:

elimination of the cause of the disease;
cleansing of the infection of the cavity of the maxillary sinus.

Accordingly, the help of a dentist and an otorhinolaryngologist is required. Both specialists can apply both conservative treatment and surgery, in the hospital or on an outpatient basis. Both a diseased tooth and odontogenic sinusitis require treatment as soon as possible in order to avoid the development of complications that can be life-threatening.

Dental medical manipulations

Conservative treatment involves the treatment of caries and inflammation in the tissues surrounding the tooth. For this are used:

cleaning the carious cavity and placing a filling in it,
removal of the basal cyst in a non-surgical way by penetrating through the root of the tooth with subsequent filling,
antibiotics to suppress inflammation,
symptomatic agents to relieve tissue edema, relieve pain,
vitamins, immune boosters,
physiotherapeutic methods after the elimination of the severity of the process - to accelerate the resorption of foci of inflammation.

Surgical treatment consists of:

removal of a diseased tooth;
hole plasty after removal;
removal of an inflamed cyst, granuloma;
resection of the apex of the tooth root and retrograde filling of the canal.

Treatment by an ENT doctor

It is carried out after dental sanitation of the inflammatory focus. Conservative assistance can be provided in the acute period, in the absence of blockade of the outflow of fluid into the nasal cavity, until the process is local in nature and has not passed into the purulent stage. The sinus cavity is washed, drugs are administered, the discharge is evacuated. The arsenal for combating sinusitis consists of medicines and physiotherapy methods.

Medications:

antibiotics, selected in accordance with the results of bacteriological examination of the discharge - are used both in the form of tablets and injections, and locally in the form of solutions injected into the sinus cavity;
antiseptics, solutions of which wash the nasal cavity and sinuses;
vasoconstrictors that relieve swelling of the mucous membrane - injected through the nose, the introduction of such drugs using a nebulizer is more effective;
painkillers;
anti-inflammatory drugs - non-steroidal anti-inflammatory drugs in the form of tablets, hormonal - in the form of sprays, drops;
mucolytics in the form of syrups and tablets;
enzyme preparations - injected as a solution into the sinus cavity in order to cleanse it.

Physiotherapy can be carried out without exacerbation of the process and after surgery:

inhalations, UV-irradiation of the nasal cavity eliminate nasal congestion, disinfect its cavity;
magnetotherapy relieves swelling of the mucosa;
UHF and microwave electromagnetic waves improve blood supply to the inflammation zone;
laser therapy strengthens the immune system, promotes healing of the mucous membrane;
DDT - act as an analgesic and anti-inflammatory agent;
by electrophoresis, drugs are administered topically through the skin;
ultrasound helps to restore the epithelial membrane;
ozokerite, paraffin and mud applications, blue light is used for deep heating of tissues in the area of inflammation.

Surgery- the main and most commonly used method of helping with odontogenic sinusitis, since this disease often becomes chronic, "skipping" acute manifestations. Therefore, changes that at first seem harmless, over time, develop into a serious problem. The second reason for frequent surgical treatment is the high percentage of perforated form of odontogenic sinusitis, which requires immediate and decisive medical action in a hospital setting.

With the diagnosis of odontogenic sinusitis, surgical treatment has two options - a gentle method using endoscopic techniques and a radical operation for opening and cleansing the sinus.

Endoscopic surgery is performed in a clinic or hospital. Local or general anesthesia is used. Modern endoscopes are equipped with a mass of various attachments and tools that allow you to remove foreign bodies, polyps, open cysts, cauterize hypertrophied mucosa with a laser, clean the mucosa, rinse, and scrape off soft tissues.

An endoscope can be inserted through an anastomosis in the nasal cavity or through an opening in the bottom of the sinus at the site of an extracted tooth with a perforated form.
The advantage of this type of operation is a good opportunity to examine the sinus from the inside and perform therapeutic manipulations with little trauma. This contributes to rapid recovery in the postoperative period.
After endoscopic surgery, the patient is under the supervision of an ENT doctor for the timely removal of blood clots, dry crusts, which can block the outflow of sinus contents. The doctor prescribes a course of antibiotics and anti-inflammatory nasal drops, often with steroid hormones.

Drops must be used up to six months to surely suppress the slightest inflammation in the sinus

Radical maxillary sinusectomy is performed in a hospital, along with general anesthesia, neuroleptanalgesia is used (the patient is immobilized, but is conscious).

Operation steps:

make an incision in the mucous membrane and periosteum under the upper lip,
bend soft tissues, opening the anterior wall of the maxillary sinus (without damaging the vessels and nerves emerging from the infraorbital foramen - to avoid sensory disturbances and bleeding),
make a hole in the area of the canine fossa,
they examine the sinus, extract the pathological contents - the mucous membrane changed according to the type of hypertrophy and polyposis, foreign objects, granulations, cysts; areas of unchanged mucosa are left,
create an artificial fistula between the sinus and the nasal cavity in the lower nasal passage for a more complete outflow of the contents of the sinus,
in some cases, the sinus cavity is plugged with gauze turunda soaked in an iodine-containing solution, the end of the turunda is brought out through the nose (removed the next day),
a soft tissue flap and a periosteum are put in their original place, the mucosal wound is sutured;
a pressure bandage is placed outside the sinus.

If it is necessary to remove the "causal" tooth, it makes sense to do this before radical surgery, since intraoperative extraction may occur with perforation, and then the incision and bone hole will have to be expanded.

After a radical operation, the doctor prescribes a combination of drugs designed to suppress inflammation and help the sinus mucosa to fully recover. Dressings are performed, washing the sinus cavity with antiseptics and introducing antibiotic solutions into it. The sutures are removed in stages, in a few days, a week after the intervention.

In the postoperative period, patients may notice numbness of the upper lip and teeth on the corresponding side for some time.

Complications of odontogenic sinusitis

Acute inflammation of the maxillary sinus can spread to other accessory air cavities, causing pansinusitis.
The penetration of infection into the bone tissue causes the development of periostitis and osteomyelitis.
The location of the sinus in the infraorbital region increases the risk of infection in the orbit. The consequences of this are an abscess and phlegmon of the orbit, since the tissues here are rich in blood vessels. A lot of loose fatty tissue, prone to suppuration, the spread of purulent infection to the meninges, as a result - extremely dangerous meningitis, meningoencephalitis.
After surgical treatment with radical methods, there is a risk of developing thrombophlebitis of the veins of the face, and even thrombosis of the sinuses of the dura mater, which can be deadly.

Forecast and prevention of odontogenic sinusitis

With an adequate selection of a combination of drugs, taking into account the treatment of a diseased tooth, the disease can be cured. Also, careful surgical treatment, including the removal or cure of dental pathology and cleaning of the sinus, increases the likelihood of stopping the process of chronic inflammation. However, there are more than one or two teeth in the upper jaw, and it is very important to take preventive measures in order to prevent the diagnosis of odontogenic sinusitis, the treatment of which causes so much trouble, again. Moreover, these measures are quite simple and feasible with the skills of self-discipline and compliance with certain hygiene rules.

It is necessary to regularly and properly care for the oral cavity and teeth. To do this, you should get advice from a specialist who will tell you about the types of toothbrushes and dentifrices, how many times you need to brush your teeth, what food is bad for your teeth, how to use a brush correctly, when to change it.
Applying the knowledge gained regularly, it is important to be conscious and come to the dentist for a preventive examination every six months, even if there is no cause for concern.
If you still happen to encounter a disease of the teeth, at the first sign of trouble, you should seek treatment.
In the case of a combination of toothache with a headache and the presence of discharge from the nose, it is necessary to consult not only with a dentist, but also with an otorhinolaryngologist.
When extracting teeth of the upper jaw, one should be attentive to unusual symptoms associated with eating or exhaling air - so as not to miss the presence of a perforation of the maxillary sinus, which requires immediate medical attention.