Getting To The Root Of The Problem
By Laura Freeman
“When patients present with persistent one-sided sinusitis, one of the first things to consider is whether a dental infection could be involved,” Michael J. Latshaw, Md of ENT Associates of Alabama said. “In the eight years I’ve been practicing in Alabama, I’ve seen noticeably more cases of odontogenic sinusitis than I saw earlier when I practiced in Oklahoma.”
Latshaw hasn’t been able to determine whether the increase in cases is related to changing times or geography. However, he says one thing that is clear is that achieving a good, lasting outcome is likely to take teamwork.
“Working with the patient’s dentist can help identify or confirm the source of the problem and address it.”
Sinusitis arising out of dental infections commonly presents with congestion, pressure and purulent rhinorrhea. There can be facial pain, usually on one side, and the sense of smell may be affected. Patients may also be experiencing headaches, fever and fatigue.
“We often see these infections over the molars where the bone between the mouth and sinuses is thinner, but they can also come from an abscess on the root of a tooth or diseased gums. Dental health can affect health throughout the body including the heart,” Latshaw said.
Sometimes simply extracting a bad tooth makes it possible to treat the sinus infection with lasting results. If a tooth is salvageable, the patient may need an endodontist to do a root canal or a periodontist to deal with gum problems. However, the situation can become difficult, especially when patients don’t have dental insurance, because the cost of specialized dental care, restorations, crowns or implants can quickly add up to more than some people can manage immediately.
With the sinuses so near the brain and eyes, and progression to a systemic infection possible, waiting for dental issues to be addressed may not be an option. “Sinus infections can progress rapidly and the complications can be both painful and risky. We need to start getting them under control as soon as possible,” Latshaw said.
The question of which comes first—a dental procedure or sinus procedure—has to be considered individually based on the severity of the patient’s condition and the approach most likely to be successful to protect the patient’s health given the resources available at the time.
“Although starting with the dental issues or addressing them as soon as possible is helpful, if a patient has a fever or is in a lot of pain, we may need to begin with an antibiotic and determine what we can do now to ease the discomfort and buy time,” Latshaw said.
In the office, an ENT may be able to dilate sinus passages to improve drainage and relieve pressure. Rinses and other simple measures may help a bit in cases that are caught early, but advanced cases are likely to take more. An exam, endoscopy and imaging can offer a clearer picture of the condition of tissues and whether more intervention is necessary.
“When the patient needs more extensive sinus surgery, we usually schedule an outpatient procedure where we can use anesthesia and endoscopic techniques. If there are abscesses, polyps and other damaged tissue, we clear it away to give the healthy tissue a better opportunity to recover,” Latshaw said.
Although medical care may be able to postpone the need for dental care, eventually the dental issue that caused the problem will need to be resolved to keep the sinus infection from coming back.
The reason Latshaw is seeing noticeably more odontogenic sinusitis cases now in Alabama than he was eight years ago in Oklahoma is still an open question. “Both states have populations with economic challenges that can make access to dental care difficult. With such an outstanding School of Dentistry here in Birmingham, Alabama has outstanding expertise in just about any area of dentistry you could name,” Latshaw said.
Is it a statistical anomaly or a matter of an increasing economic squeeze over time that is making more people skip regular preventive dental care? Is there a difference in culture, eating habits, environmental factors like different minerals in ground water, populations with different predisposing genetics, or could postponed dental appointments during the COVID-19 pandemic now be showing up in dental problems? These are interesting questions that may take time to answer.
Meanwhile, when patients present with chronic sinusitis, it may be helpful to consider whether a dental infection could also be involved—and enlist the help of the patient’s dentist to give treatment a better chance for lasting success.
