Odontogenic causes complicating the chronic rhinosinusitis diagnosis.

OBJECTIVES: Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS. MATERIALS AND METHODS: Patient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred. RESULTS: Although 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27-4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples). CONCLUSIONS: Odontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient's dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory. CLINICAL RELEVANCE: Dental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.

Dental findings frequently overlooked in sinus computed tomography reports.

OBJECTIVES: Computed tomography (CT) and cone beam computed tomography (CBCT) represent the main imaging modalities used in rhinosinusitis patients and are also important in odontogenic sinusitis (OS) diagnostics. Reports, however, often lack information on dentition. Here, we aimed to determine how maxillary dentition is initially interpreted in rhinosinusitis patients' CT/CBCT reports and which dental findings in particular are potentially missed, thus needing more attention. STUDY DESIGN: CT/CBCT scans and radiological reports from 300 rhinosinusitis patients were analysed focusing specifically on dental findings. An experienced oral and maxillofacial radiologist re-evaluated the scans and the assessment was compared to the original reports using the McNemar test. RESULTS: From the 300 original reports, 233 (77.7%) mentioned the maxillary teeth. The most frequent statement (126/300, 42.0%) was 'no apical periodontitis'. Apical periodontitis and severe alveolar bone loss were significantly overlooked (p < 0.001). Amongst the 225 patients for whom the CT/CBCT report initially lacked information on dental pathology, 22 patients were diagnosed with apical periodontitis and 16 with severe alveolar bone loss upon re-evaluation. CONCLUSIONS: Dental pathology remains underreported in rhinosinusitis patients' CT/CBCT reports. Because these reports affect OS diagnostics, a routine and structured review of the maxillary teeth by a radiologist is necessary. Such examinations should encompass the maxillary teeth.

Acute rhinosinusitis - are we forgetting the possibility of a dental origin? A retrospective study of 385 patients.

Background: Odontogenic sinusitis (OS) is a common but underdiagnosed form of acute rhinosinusitis (ARS). OS carries no specific characteristics, but unilateral symptoms and certain microbiological as well as radiological findings indicate odontogenic origin. Aims/objectives: We studied the proportion of OS in ARS patients, the presence and associations of unilateral symptoms, and possible OS microbial and radiological findings. In addition, we investigated how this condition is recognised among ear, nose and throat specialists and radiologists. Materials and methods: All 676 ARS patients treated in the Department of Otorhinolaryngology at Helsinki University Hospital in 2013 were retrospectively enrolled. The data were collected from patients' hospital medical records, the laboratory database and radiological reports. Results: Odontogenic origin of ARS was suspected in 59 (15.3%) patients. Altogether (29.9%) 115 patients complained of unilateral symptoms and these were found to associate with probable oral microbial findings (p < .001). These findings covered 20.2% of isolates. Teeth were mentioned in 89.6% of the radiological reports. Conclusions and significance: OS is common among patients with ARS, and good diagnostic tools already exist in routine practice. Microbial and radiological findings should be carefully evaluated, especially in cases of unilateral symptoms.