Managing Sinusitis Caused by Dental Issues: Which Specialist to See?

How to manage sinusitis caused by dental issues? Which specialty should I consult?

Two years ago, I was diagnosed with sinusitis at an ENT clinic and was prescribed antibiotics, but my condition did not improve.
The biggest issue I face is post-nasal drip, with green, foul-smelling mucus, and I occasionally notice a bad odor.
Last year, I switched to a hospital for treatment and underwent sinus surgery.
However, more than six months later, I still have green pus-like nasal discharge and a bad smell.
I was then referred to oral surgery, where it was suggested that I first see an endodontist for root canal treatment, which is currently ongoing.
However, during my last visit, the endodontist mentioned that there is a 10 cm gap in the tissue of my upper back tooth, which may lead to poor outcomes after the root canal is completed.
If I still feel no improvement, I may need to return to oral surgery for tooth extraction.
I feel like I'm being shuffled around without a proper resolution.
Should I continue with oral surgery or see a periodontist? Since there is a gap in the gums, should I consult a periodontist? Previously, the oral surgeon mentioned that it was okay not to extract the last tooth, but because of the connection to the sinuses, bone grafting would be necessary, which involves lifting the gum tissue for the procedure.
This sounds really frightening to me.
I asked the doctor if there was a safer approach, and he suggested starting with root canal treatment.
What should I do at this point? Should I continue with the endodontic treatment, or should I switch to a periodontist or oral surgery? Also, is it absolutely necessary to lift the gum tissue for bone grafting? This feels really terrifying.

Vivi, 30~39 year old female. Ask Date: 2018/07/08

Dr. Zhu Guanyu reply Dentistry

Hello, what should I do about sinusitis? It is recommended to first consult an otolaryngologist (ENT) to determine the cause.
If it is a dental-related infection, you should then visit a dentist for further treatment.
Whether it is oral surgery, periodontics, or endodontics, they can collaborate on treatment, so there is no need to worry.
Regarding modern medical procedures, there is adequate anesthesia and appropriate medication management before, during, and after surgery, which can minimize pain levels.
For canine tooth cavities, it is advisable to undergo a comprehensive oral examination at the dental clinic to formulate a treatment plan.
Thank you for your inquiry! Wishing you peace and health.
Sincerely, Dr.
Kuan-Yu Chu, Chief of Dentistry, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/07/08

More Info

Managing sinusitis caused by dental issues can be quite complex, especially when symptoms persist despite various treatments. Based on your description, it seems you have been through a challenging journey with your sinusitis and dental health. Here’s a comprehensive approach to your situation.

Understanding the Connection Between Sinusitis and Dental Issues
Sinusitis can often be exacerbated by dental problems, particularly those involving the upper teeth, as the roots of these teeth are located close to the maxillary sinuses. Infections or inflammation in the teeth can lead to sinus issues, and vice versa. The symptoms you describe, such as green nasal discharge with an unpleasant odor, suggest a persistent infection, possibly linked to your dental health.

Which Specialist to See?
Given your ongoing symptoms and the treatments you've undergone, it may be beneficial to consult with multiple specialists:
1. Endodontist (Root Canal Specialist): Since you are currently undergoing root canal treatment, it’s crucial to ensure that this procedure is completed effectively. An endodontist can provide specialized care for complex cases, especially if there are anatomical challenges, such as the 10 cm gap you mentioned. They can assess whether the root canal treatment is being performed adequately and if it can resolve the infection.

2. Periodontist: If there are concerns about gum health or periodontal disease, a periodontist can evaluate the condition of your gums and the bone supporting your teeth. They can provide treatments to address any periodontal issues that may be contributing to your symptoms.

3. Oral Surgeon: If the endodontic treatment does not yield improvement, or if there are structural issues that need to be addressed (like the potential need for bone grafting), an oral surgeon may be necessary. They can perform surgical interventions if required, such as tooth extraction or bone grafting.

4. Otolaryngologist (ENT Specialist): Since you have a history of sinusitis, continuing to work with an ENT specialist is essential. They can evaluate the sinus cavities and determine if further surgical intervention is necessary, especially if there are anatomical issues contributing to your sinusitis.

Treatment Considerations
- Root Canal Treatment: Continue with the root canal treatment as advised by your dentist. If the endodontist identifies that the treatment is not effective, they may suggest alternative approaches.

- Bone Grafting: The mention of bone grafting can be daunting, but it is often necessary when there is significant bone loss. This procedure can help restore the bone structure and support the teeth, especially if they are closely related to the sinus cavity. Discuss the risks and benefits with your oral surgeon to understand why this may be necessary.

- Managing Sinus Symptoms: In parallel, ensure that your ENT is aware of your ongoing symptoms. They may recommend additional imaging or treatments to address the sinus issues directly, such as nasal irrigation, corticosteroids, or further surgical options.

Conclusion
In summary, it is essential to maintain open communication with your healthcare providers and ensure that all specialists are aware of your complete medical history and ongoing symptoms. It may be beneficial to seek a multidisciplinary approach, where your endodontist, periodontist, oral surgeon, and ENT specialist collaborate to provide comprehensive care. This way, you can address both the dental and sinus issues effectively.

If you feel overwhelmed or that you are being "passed around," consider asking for a referral to a dental clinic that specializes in treating complex cases involving both dental and sinus issues. This could provide a more streamlined approach to your treatment. Remember, your health and comfort are paramount, so don’t hesitate to voice your concerns and preferences regarding treatment options.

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