When should a sinus infection be treated by a dentist?

When it’s really an MSEO.

It is commonly acknowledged in dental and medical literature that there is a relationship between dental infections and sinus disease. It is critical to correctly identify maxillary sinusitis of endodontic origin (MSEO), since failure to do so—and subsequent failure to manage the endodontic source pathology—may result in the persistence of sinus disease, the subsequent inadequacy of medical sinus treatment, and the potential development of more serious and possibly life-threatening craniofacial infections.

An endodontic infection manifesting in the maxillary sinus, MSEO is a common, yet underestimated disease process. MSEO refers specifically to sinusitis caused by endodontic infection, excluding sinusitis secondary to other dental etiologies. But diagnosing MSEO can be thorny because patients with this condition experience a wide variation of dental and sinonasal symptoms—or may have no symptoms at all. Common sinonasal symptoms include congestion, rhinorrhea, facial pain, and bad breath. Interesting to note that typical endodontic symptoms such as thermal pain, periapical sensitivity, swelling, and/or draining intraoral sinus tract are often not present with MSEO.

Endodontic disease is characterized by pulpal bacterial infection and subsequent inflammatory response in the adjacent periapical tissues. Endodontic infections that develop can easily spread into the maxillary sinuses, causing unique pathological effects and radiographic appearances that are often unrecognized in clinical practice. Failure to diagnose or properly manage endodontic infections in this region can lead to unresolved chronic sinus disease and impairment for these patients.

This condition is also frequently overlooked in general dental practice due to a lack of dental symptoms. Patients with sinonasal symptoms and without localized dental pain will often seek care from their primary care physician or ear, nose, and throat (ENT) specialist who may misdiagnose and treat MSEO as a rhinogenic sinus infection. Odontogenic sinus infections—infections that originate within a tooth or in the closely surrounding tissues—may be overlooked during routine ENT examinations and by radiologists reading sinus CT imaging. In addition, current ENT clinical guidelines for the management of sinusitis offer no guidance in this area and make no mention of dental infections as a potential etiology for sinus disease, despite evidence in the medical literature of its high incidence. MSEO is also frequently overlooked in general dental practice due to its lack of dental symptoms, as noted above, and an obscured or atypical radiographic presentation. Ultimately, clinical endodontic examinations are essential to an accurate diagnosis. Being able to recognize MSEO is important, as failure to identify and properly manage the endodontic source pathology will result in the persistence of sinus disease.

The objectives for treatment of MSEO are removal of the pathogenic microorganisms, their by-products, and pulpal debris from the infected root canal system that are causing the sinus infection and preventing reinfection. Antibiotic therapy may offer temporary relief of symptoms by improving sinus clearing but is generally unwarranted in the treatment of MSEO and ineffective as a definitive solution. Similarly, surgical intervention of the maxillary sinus that is focused strictly on removing diseased sinus tissue and establishing drainage is inadequate if the endodontic component is neglected. It is well documented that neglecting the dental etiology and focusing only on medical and surgical therapies of the ostiomeatal complex (OMC) will not resolve MSEO.

It is important to bring awareness to the medical community of MSEO and its frequently unrecognized disease process. Since MSEO is an endodontic disease, dental literature provides numerous case reports showing full resolution of MSEO following endodontic treatment. Endodontists are uniquely trained and equipped to diagnose and properly manage endodontic disease that manifests in the maxillary sinus.

A joint effort including an open referral relationship and communication between general dentists, endodontists, and ENT specialists is essential to achieve the best outcomes for patients diagnosed with MSEO.

When facing a situation that may be MSEO-based, we invite you to consult with us at your earliest opportunity. At Professional Endodontics, we have developed an MSEO protocol that ensures a proper diagnosis, appropriate treatment and follow-up, and a constructive outcome. Contact us to learn more and see how we can collaborate with you to care for your patients.

About Professional Endodontics

Professional Endodontics has been exceeding the standard of care in Wayne and Macomb counties for over 50 years.  The team specializes in treating issues with the inside of the tooth and goes out of its way to provide a safe easy environment for patients. Each member of the practice is dedicated to providing excellence in patient care and values high-quality relationships with referring dentists and specialists.  Each endodontist at Professional Endodontics has been individually chosen as Hour Detroit Magazine’s Best Dentists.  Thanks to contemporary advances in endodontics, Professional Endodontics is able to use innovative technology to treat and save teeth that have suffered damage to the soft tissue within the roots of the tooth.

Professional Endodontics offers state-of-the-art facilities in Clarkston, Clinton Township, St. Clair Shores, and Southfield.  All locations offer the latest in advanced dental delivery systems, microscopy, and digital radiography.

6803 Dixie Highway
Suite 3
Clarkston, MI 48346
(248) 358-2910

29201 Telegraph Road
Suite 110
Southfield, MI 48034
(248) 358-2910

Clinton Township
Henry Ford Hospital Medical Pavilion
16151 19 Mile Rd, Suite 101
Clinton Township, MI 48038

St. Clair Shores
St. Clair Professional Plaza
23829 Little Mack, Suite 300
St. Clair Shores, MI 48080