Odontogenic sinusitis is an inflammatory process that occurs in the mucous membrane of the sinus of the upper jaw. Its appearance is caused by the spread of the pathological process from the primary infectious focus located in the same place. The disease is not uncommon - on average, it is diagnosed in 35-43% of the population.
What factors provoke its appearance? What causes the disease? What symptoms indicate its presence? And how should it be treated? Well, this will be discussed now.
Causes and pathogenesis
Odontogenic sinusitis, the symptoms and treatment of which will be described in detail below, is a complication of the inflammatory process in the tissues of the teeth or upper jaw.
In the vast majority of cases, this disease provokes pathogenic microflora: enterococci, staphylococci, bacilli, yeast fungi, diplococci and streptococci. The following conditions are usually complicated by its development:
- Diseases of premolars and molars. These include infectious lesions of the upper teeth, osteomyelitis, periostitis, purulent periodontitis and jaw cysts.
- Injuries accompanied by the formation of a hematoma or perforation of the maxillary sinus wall.
Oddly enough, but sometimes the cause of the pathology is endodontic therapy, carried out in order to treat the above diseases. The introduction into the sinus cavity of the elements of the intraosseous implant, filling material, as well as perforation of the apical opening may well become provocative factors.
Why is the infection from the primary focus spreading to the maxillary sinus cavity? Because the upper teeth from the sinus are separated only by the bone wall. If mechanical perforation or purulent fusion occurs, then infectious agents enter the sinus cavity, which causes inflammation. Then, ventilation is disturbed and purulent or catarrhal exudate begins to accumulate inside the bone cavity.
Acute form: symptoms
According to ICD-10, odontogenic sinusitis is divided into acute and chronic. There are other forms of the disease, but these two are accepted in detail from a clinical point of view.
Here are the symptoms that indicate the presence of this pathology (manifested in stages):
- Acute throbbing headache. It has the nature of attacks.
- Pain in the teeth. Similar to those that occur with pulpitis.
- Increased pain when bending or lowering the head.
- Syndrome of general intoxication: chills, weakness, general weakness.
- Temperature that can reach 39.5 ° C.
- Chewing pain.
- Impaired nasal breathing.
- Sensation as if teeth are longer than they really are.
- Loss of odor discrimination.
- The appearance of hypersensitivity to light (photophobia).
- Enhanced lacrimation.
- One-sided runny nose, accompanied by the release of purulent masses in a large volume.
Symptoms are similar to those that occur with rhinogenic sinusitis. Therefore, as part of the diagnosis, it is very important to do a CT scan and radiography. If the diagnosis after this is not confirmed, endoscopy will be required.
Chronic form: symptoms
They also need to be listed. In chronic odontogenic sinusitis, the clinical picture does not develop rapidly. Pathology proceeds undulating. Exacerbations often occur, but this usually happens after acute viral diseases or hypothermia.
According to the ICD, odontogenic sinusitis of a chronic form is accompanied by the following symptoms:
- Intense headache on one side and the feeling of heaviness felt in it.
- Discomfort felt in the maxillary region, radiating to the orbit, forehead, temples and upper teeth.
- Nasal discharge can be either scanty or copious. The character is usually either serous or purulent.
- Most nasal discharge in the morning. By evening, their volume decreases.
- When pressed to the chest of the lower jaw, suppuration increases.
It should be noted that discharge is sometimes absent. This is the case if a person develops non-purulent odontogenic sinusitis (code according to ICD-10 - J32.0). Or if the patient has fistulas.
Treatment principle
Much has been said above about the causes and symptoms of odontogenic sinusitis. And now we should also talk about treatment.
The therapy indicated for this disease is aimed at eliminating the focus of infection, which led to sinus inflammation. The patient may be offered surgery - odontic sinusitis can often be overcome by removing the causative tooth. This is necessary in order to ensure the outflow of content.
But not everyone agrees to this procedure. Do you want to save a tooth at the apex of the root of which there is a radicular cyst or granuloma? Then the doctor will offer an alternative. The tooth can not be removed, but opened. So, too, will be able to ensure the outflow. If you do not resort to one of these options, subsequent treatment will be in vain.
None of the two processes, of course, can be called pleasant, but both procedures are carried out strictly in stationary conditions and with the use of local anesthesia.
Drops
After tooth extraction, odontic sinusitis, of course, will not pass immediately. A person will need to regularly do nose washings, go to physiotherapeutic procedures and take vasoconstrictor drugs aimed at restoring the state of the mucosa. The best drops are:
- "Vibrocil." Combined drug with dimethindene and phenylephrine. It has a vasoconstrictor effect, eliminates swelling of the nasal mucosa and sinuses. It is worth noting that dimetinden is an antiallergic drug.
- "Sanorin." This tool has a quick, pronounced and lasting effect. Drops reduce exudation, flushing and swelling, as well as facilitate breathing. But after 5-7 days the body gets used to them.
- "Anallergin." It has a vasoconstrictor and antiallergic effect. Active ingredients - alpha-adrenergic agonist and blocker of H1-histamine receptors.
- Cromoglin. This drug is a mast cell stabilizer. He also prevents asthmatic reactions of a delayed and immediate type after inhalation of irritants.
- "Allergodil." The active substance is a phthalazinone derivative. It reduces the permeability of capillaries, and also has all the actions characteristic of the above drugs. Intranasal administration also reduces congestion, itching, rhinorrhea, and sneezing.
- Cromohexal. It has all of the above actions, and also blocks the flow of calcium into the mast cell. It is most effective as a prophylactic.
What kind of drops for the treatment of acute odontogenic sinusitis should be used - the doctor will tell. By the way, only “Vibrocil” and “Nazol Baby” can be used for children. If a person or child is allergic to drops or contraindications, then the doctor may prescribe the use of ointment.
Antibiotics
Treatment of odontogenic sinusitis is not complete without taking them. As a rule, the first thing the doctor prescribes is taking the following two drugs in combination with each other:
- Amoxicillin. This is a semi-synthetic antibiotic that belongs to the penicillin group. It has a wide range of effects. It is a strong antibacterial drug.
- Clavulanic acid. If you take "Amoxicillin" with it, then the spectrum of its action expands. In this combination, antibiotic activity is significantly increased in relation to many bacteria that harm the body. The acid itself is a beta-lactamase inhibitor. Many people perceive it as an auxiliary substance, however, you should know that it has its own antibacterial activity.
In the event that a person is allergic to penicillin, an alternative remedy will have to be found to eliminate the symptoms and treat odontogenic sinusitis. As a rule, antibiotics related to fluoroquinolones (Ciprofloxacin) or macrolides (Azithromycin and Clarithromycin) become a substitute.
Five days after the start of taking these medications, the doctor analyzes the effectiveness. And if no improvements have occurred during this time, then a person is prescribed an antibiotic that has a stronger effect.
On average, antibiotic therapy lasts 10-14 days. Only in exceptional cases, if the clinic of odontic sinusitis does not subside, the course is extended to 21 days.
Rinsing
They also need to be done. From pharmacy solutions, the doctor, as a rule, advises using one of the following:
- "Aqualor".
- Dolphin.
- "Aqua Maris."
- Quicks.
- Potassium permanganate.
- Furatsilin.
- Saline.
These products are specifically designed to cleanse the nasopharynx from bacteria and allergens, as well as to moisturize the mucosa.
Broths of medicinal herbs are also suitable, but then you need to choose a medicinal plant that will have both anti-allergic, bactericidal and anti-inflammatory effects. You can choose in favor of calendula, lavender, sage, coltsfoot, eucalyptus, string and chamomile (of course, if there is no allergy).
Physiotherapy
It is allowed only at the stage when the symptoms of odontogenic sinusitis have already subsided a bit. And of course, only after all the pus has been removed. Then physiotherapy is advisable - it really will benefit in the treatment of catarrhal inflammation.
But only if a person does not have such contraindications as oncological alertness, intolerance to currents and pacemaker.
The most effective procedures are:
- Ural Federal District. Some molecules in the tissues of a living organism absorb light waves, releasing biologically active substances entering the bloodstream. These stimulate the migration of leukocytes to the focus of inflammation and their enhanced fight against the causative agent of the disease.
- UHF The electromagnetic field generated by the apparatus causes local expansion of the capillaries and increases their permeability. And the anti-inflammatory effect can be achieved due to the stimulation of tissue metabolism, lymph formation, blood circulation, as well as by reducing exudation and swelling. Also, the UHF procedure inhibits the vital activity of microbes.
- Phonophoresis. This is an effective comprehensive method that combines the use of active medications and ultrasonic vibrations. In this case, hydrocortisone ointment is used.
- Electrophoresis with calcium chloride and diphenhydramine. The ions of the drug dissolved by electric current produce a therapeutic effect, accumulating in the sinuses.
As a rule, the course of physiotherapy is three weeks. Upon its completion, a person is no longer bothered by anything.
Folk remedies
Their consideration should also be given a little attention within the framework of the topic relating to the treatment of odontogenic sinusitis. The following folk remedies are recognized as effective:
- Steam inhalation with propolis. For 1 liter of water - 1 teaspoon of alcohol tincture. The main thing is not to pour boiling water, otherwise you can burn your already damaged sinuses.
- Drops of liquid honey. Making them simple: chop the celandine (1 tsp) and add an equal amount of fresh aloe juice and honey to it. Drip 2 drops several times a day.
- Rinse the sinuses with a weak solution of sodium chloride or seawater. This must be done before dripping the nose with the drug.
- Compress of bay leaves. You just need to fill them with water and boil. When the broth has cooled to a comfortable temperature, moisten a linen napkin in it and attach it to the sinuses for an hour.
- Instead of drops, you can use sea buckthorn or rose hip oil. It is allowed to bury up to five times every day. Oil not only cleans the moves, but also softens and heals damage.
- Clay compress. Dilute 50 grams of clay in warm water to make a mass that resembles plasticine in consistency. Then moisten two pieces of gauze in warm vegetable oil and put on the maxillary sinuses, and on top - warm clay. Hold for 1 hour.
- Honey ointment. Grate baby soap (50 g). In an equal amount (1 tbsp. L.) Mix milk, honey and butter, heat everything in a water bath until dissolved, pour in alcohol (1 tsp.), Cool. Lubricate the nostrils with the resulting ointment using a cotton swab.
They say that these drugs help to cope with odontogenic sinusitis. But it is better to consult your doctor before using them.
Prevention
Well, about this - in the end. Prevention of odontogenic sinusitis does not imply the implementation of particularly complex actions. All that is required of you:
- Timely treat tooth decay.
- Visit a dentist twice a year.
- Maintain immunity.
- Timely treat diseases, do not ignore their symptoms, do not put off visiting a doctor.
And in no case should you try to cure odontogenic sinusitis at home. Folk remedies, of course, can be effective, but only as adjunctive therapy. The treatment of this disease is a task that only a highly qualified doctor can cope with.