Endodontics and Sinus Issues – Mark Allen COLTENE

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  Posted by: The Probe      20th February 2019

Endodontic treatment is frequently used to save teeth that have become damaged due to decay or infection. As a means of combatting and eliminating infections of the root canal system, endodontic treatment is highly reliable with a success rate of around 90%.[i]However, sinus problems remain an unpleasant potential complication for patients.

To date, a truly comprehensive study of sinonasal complications arising from dental treatment has yet to be completed,[ii]but when a simple web search of a term like “root canal sinus problems” returns over 1.5 million pages we can see that this is at the very least a concern, if not a pressing issue for many patients.

Sinusitis is a swelling of the sinuses resulting from bacterial or fungal infections causing the sinus to no longer drain properly (there are other causes but these are not thought to be due to dental work). Symptoms can include excessive mucus, pain, tenderness, toothache and headaches. Without treatment sinusitis can become a chronic condition in some cases, and acute infections can be damaging (in rare instances resulting in severe consequences like blindness or a thrombosis forming in the sinus which can potentially break free).[iii]That this area can cause issues is unsurprising, as the roots of teeth are in very close proximity to sinuses, with only a thin layer separating the two. In some cases the roots even protrude into them.

There are several indicators of sinusitis that can quickly be discerned: the presence of nasal blockage and or discharge, tooth pain that is not localised to a single tooth, and using a light to gauge whether the mucosa is congested or swollen (allowing less light through making the area appear darker). Pain caused by sinus problems is also said to be more consistent and dull than that of other dental causes, which can vary from sudden sharp pain to protracted severe pain, or manifest as sensitivity to temperature. Once suspected, ultrasound, CT or MRI scans are very useful for diagnosis and evaluation.[iv]Treatment depends on the specific cause, in many cases antibiotic therapy is sufficient, but surgery can be required.

Some timeworn advice for patients in the days following the operation can also help to avoid sinus complications, namely to refrain from blowing their nose and if sneezing to not close their mouths. Of course, after a lifetime of sneezing as politely as possible, patients may find the latter in particular difficult not to lapse into.

The main risks for sinus issues arising from endodontic treatment itself are from misjudging the amount of obturation material required (over or underfilling), damage to the maxillary sinus or sinus mucosa through chemical or physical trauma during treatment, and the introduction of fungus, bacteria or foreign material into the sinus.

Filling materials can extrude during treatment into the sinus resulting in inflammation and potentially providing a vector for infection. In particular, root-filling materials containing zinc have been linked to promoting the growth of Aspergiollosis fumigates, resulting in fungal ball formation.[v]Even filling materials that are regarded as relatively bioinert may cause chronic sinusitis when overfilled.[vi]

A dental abscess describes the accumulation of pus in the alveolar bone at the root apex of the tooth. Dental abscesses can allow microorganisms to infest the root canals, resulting in the formation of biofilms. Left untreated these can lead to sinus issues and in serious cases septicaemia, shock and brain abscesses. Early diagnosis can unfortunately be frustrated due to the vagueness of early symptoms. Dental abscesses can be caused by, among other things, a failed root canal.[vii]While antibiotics are still the frontline treatment for bacterial infections of all sorts, antibiotic resistance is a growing threat and is expected to become an ever more serious threat in the foreseeable future.

While sinus problems arising from dental work can be successfully treated in the vast majority of cases once the irritant has been isolated,[viii]obviously it is in the interest of patients and practitioners to avoid this complication as much as possible. The biggest addressable factor here is accurate measurement; over and underfilling, and to some extent damage during treatment can be minimised or avoided entirely through precise measurement.

To assist with defining and confirming the working length, the CanalPro Apex Locator from COLTENE is highly recommended. Utilising electrical resistance to provide an excellent level of precision, the CanalPro Apex Locator is both highly accurate and easy to use. Providing audio feedback, you are free to verify canal length quickly and easily as often as required.

 

While no procedure is totally risk-free, with careful technique and guided by reliable tools you can help ensure your patients do not suffer from complications like sinusitis.

 

To find out more visitwww.coltene.com, email info.uk@coltene.comor call  01444 235486

 

 

 

REFERENCES

[i]Friedman S., Mor C. The success of endodontic therapy – healing and functionality. Journal of the California Dental Association. 2004; 32(6): 493-503. Available at http://www.endoexperience.com/documents/SuccessHealingFriedman.pdfAccessed August 9, 2018.

[ii]Felisati G., Chiapasco M., Lozza P., Saibene A., Pipolo C., Zaniboni M., Biglioli F., Borloni R. Sinonasal complications resulting from dental treatment: Outcome-oriented proposal of classification and surgical protocol. American Journal of Rhinology & Allergy. 2013; 27(4): 101-106. Available at https://www.researchgate.net/publication/251877687_Sinonasal_complications_resulting_from_dental_treatment_Outcome-oriented_proposal_of_classification_and_surgical_protocolAccessed August 9, 2018.

[iii]Siqueira Jr. J. Microbiology and treatment of acute apical abscesses. Clinical Microbiology Reviews. 2013; 26(2): 255-273. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623375/Accessed August 9, 2018.

[iv]Hauman C., Chandler N., Tong D. Endodontic implications of the maxillary sinus: a review. International Endodontic Journal. 2002; 35: 127-141. Available at https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.0143-2885.2001.00524.xAccessed August 9, 2018.

[v]Park G., Kim H., Min J., Dhong H., Chung S. Endodontic treatment: a significant risk factor for the development of maxillary fungal ball. Clinical and Experimental Otorhinolaryngology. 2010; 3(3): 136-140. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950265/Accessed August 9, 2018.

[vi]Kim J., Cho K., Park S.H., Park S.R., Lee S.S., Lee S.K. Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II. Restorative Dentistry & Endodontics. 2014; 39(1): 63-67. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916508/Accessed August 9, 2018.

[vii]Prakash S., Prakash S.K. Dental abscess: a microbiological review. Dental Research Journal. 2013; 10(5): 585-591. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858730/Accessed August 9, 2018.

[viii]Felisati G., Chiapasco M., Lozza P., Saibene A., Pipolo C., Zaniboni M., Biglioli F., Borloni R. Sinonasal complications resulting from dental treatment: Outcome-oriented proposal of classification and surgical protocol. American Journal of Rhinology & Allergy. 2013; 27(4): 101-106. Available at https://www.researchgate.net/publication/251877687_Sinonasal_complications_resulting_from_dental_treatment_Outcome-oriented_proposal_of_classification_and_surgical_protocolAccessed August 9, 2018.

 


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