Odontogenic infection

Odontogenic sinusitis

Main article: Odontogenic sinusitis

Sinusitis is inflammation of the paranasal air sinuses. Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses that is the result of dental pathology, most often resulting from prior dentoalveolar procedures, infections of maxillary dentition, or maxillary dental trauma. Infections associated with teeth may be responsible for approximately 20% of cases of maxillary sinusitis. The cause of this situation is usually a periapical or periodontal infection of a maxillary posterior tooth, where the inflammatory exudate has eroded through the bone superiorly to drain into the maxillary sinus. Medical management and treatment of the underlying dental pathology remains a critical initial step in the treatment of odontogenic sinusitis, however recent literature suggests that a significant portion of patients may require endoscopic sinus surgery for successful disease resolution. Once an odontogenic infection involves the maxillary sinus, it is possible that it may then spread to the orbit or to the ethmoid sinus.

Complications of Odontogenic Infection

Odontogenic infection can be managed relatively easily if treated in the early stages of infection. However, there are some factors which need to be taken in consideration when dealing with odontogenic infection. A major complicating factor for managing odontogenic infections is the host defence mechanism which can be impaired by systemic illnesses and certain medications. The table below shows the most common causes for an impaired defence mechanism.

If treatment is delayed, odontogenic infection can spread into adjacent tissues consequently leading to life-threatening conditions. Most commonly resulting in respiratory obstruction and sepsis, and less commonly endocarditis, necrotising fasciitis, spondylitis, brain abscess, descending mediastinitis, thoracic empyema, pleuropulmonary suppuration, aspiration pneumonia, pneumothorax, mandibular or cervical osteomyelitis, abscess of the carotid sheath and jugular thrombophlebitis, hematogenous dissemination to distant organs, and coagulation abnormalities. This concern, of distant or systemic infection originating from oral pathogens, is particularly significant in neutropenic patients, whose immune system is compromised. Therefore, dental preparation aimed at eliminating odontogenic infections is recommended before cytotoxic chemotherapy, hematopoietic stem cell transplantation, or CAR T-cell therapy, in which bone marrow suppression and a decline in white blood cell count are expected.

References

References

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