Sakit Sinus Ternyata Bisa Berasal dari Gigi: Mengenal Sinusitis Odontogenik

By: drg. Agya Nanda Prasetya, Sp.RKG

Many people experience symptoms such as nasal congestion, pain around the cheeks, or a feeling of facial pressure. These complaints are commonly associated with sinusitis, which is defined as inflammation of the sinus cavities located around the nose. In most cases, sinusitis is thought to be caused by upper respiratory infections, allergies, or prolonged flu.

However, in certain cases, sinusitis may actually originate from dental problems. This condition is known as odontogenic sinusitis, a type of sinusitis caused by infection arising from the teeth or the surrounding supporting tissues. Understanding the relationship between the teeth and the sinuses is essential, as untreated dental sources may lead to persistent or recurrent sinus symptoms despite appropriate medical treatment.

Anatomical Relationship Between Teeth and the Maxillary Sinus

The sinuses are air-filled cavities located within the facial bones. One of the largest sinuses is the maxillary sinus, which is situated in the cheekbone area, directly above the posterior upper teeth. The roots of the maxillary premolars and molars are often in close proximity to the floor of the maxillary sinus. In some individuals, the root tips may even be very close to, or nearly in contact with, the sinus cavity.

This close anatomical relationship allows infections originating from the teeth to potentially spread into the sinus. When an infection occurs at the root apex or surrounding tissues, bacteria may extend into the sinus lining, causing inflammation. As a result, the sinus mucosa may thicken, fluid accumulation may occur, and symptoms of sinusitis can develop.

Causes of Odontogenic Sinusitis

Odontogenic sinusitis may result from several dental and periodontal conditions, including:

• Periapical infection caused by untreated dental caries

• Advanced periodontal disease leading to destruction of the tooth-supporting tissues

• Complications following tooth extraction, particularly of posterior maxillary teeth

• Failure of root canal treatment

• Formation of an oroantral communication between the oral cavity and the sinus after extraction

Once a dental infection reaches the maxillary sinus, bacterial contamination may trigger inflammation of the sinus lining. This process can develop into sinusitis. Studies have shown that a considerable proportion of chronic maxillary sinusitis cases are associated with dental infections, although they are frequently overlooked.

Clinical Symptoms to Be Aware Of

The symptoms of odontogenic sinusitis often resemble those of conventional sinusitis, making early differentiation challenging.

Common symptoms include:

• Pain or pressure in the cheek area

• Nasal obstruction

• Nasal discharge

• Facial discomfort or heaviness

• Headache

• Occasional pain in the upper teeth

A characteristic feature of odontogenic sinusitis is that symptoms often occur on only one side of the face, corresponding to the affected tooth. In some cases, patients may have received repeated medical treatment for sinusitis without improvement, as the underlying dental source of infection has not been addressed.

Why Is Odontogenic Sinusitis Often Overlooked?

Odontogenic sinusitis is frequently underdiagnosed because its symptoms closely mimic those of common sinusitis. Many patients initially seek treatment for nasal congestion or facial pain without suspecting an underlying dental issue. Additionally, routine clinical dental examinations may not always clearly reveal the source of infection. Therefore, additional diagnostic tools are often required to establish an accurate diagnosis.

The Role of Radiologic Examination in Diagnosis

Advancements in medical imaging have significantly improved diagnostic accuracy in recent years. One imaging modality widely used in dentistry is Cone Beam Computed Tomography (CBCT). CBCT provides three-dimensional visualization of dental structures, jaw bones, and the maxillary sinus.

Through CBCT imaging, clinicians can more clearly assess the relationship between tooth roots and the maxillary sinus. This examination can help identify:

• Periapical dental infections

• Thickening of the sinus mucosa

• Presence of fluid within the sinus

• Direct communication between dental infection and the sinus

• Post-extraction complications

Compared to conventional radiographs, CBCT offers superior three-dimensional visualization, allowing for more accurate interpretation of anatomical structures. The role of a dental radiology specialist (Sp.RKG) is crucial in interpreting CBCT findings to precisely identify the source of infection.

Management of Odontogenic Sinusitis

The primary principle in managing odontogenic sinusitis is eliminating the dental source of infection. Without addressing the underlying cause, sinusitis is likely to recur.

Possible treatment options include:

• Root canal treatment of the infected tooth

• Extraction of teeth that cannot be preserved

• Periodontal therapy

• Sinus management when indicated

In many cases, optimal management requires collaboration between dentists and otorhinolaryngologists (ENT specialists) to ensure comprehensive patient care.

The Importance of Accurate Diagnosis

Sinusitis is often regarded as a condition related solely to the nasal cavity or respiratory system. However, in some cases, the origin of the problem lies in dental pathology. Therefore, in patients with recurrent or persistent sinusitis, dental evaluation should be considered. With the aid of advanced imaging techniques such as CBCT, clinicians can obtain a clearer understanding of the relationship between the teeth and the sinus. Accurate diagnosis allows for appropriate treatment planning and more effective resolution of patient symptoms.

Contact us

For information and make an appointment