How is sinus pressure around teeth treated?

Treatment of Sinus Pressure Around Teeth

Sinus pressure around teeth should be treated with a combination of nasal decongestants, antibiotics if infection is present, and proper evaluation of potential dental causes before considering invasive procedures.

Initial Assessment

When evaluating sinus pressure around teeth, it's critical to determine whether the source is truly sinusitis or a dental problem:

• Radiologic evaluation: CBCT imaging extending to the orbit is necessary to properly evaluate both dental structures and the osteomeatal complex of the maxillary sinus 1
• History collection: Gather information about nasal obstructions, facial trauma, sinus infections, allergic symptoms, smell/taste dysfunction, atmospheric pressure-related discomfort, and chronic respiratory diseases 1
• Location of pain: Unilateral pain in maxillary posterior teeth suggests possible sinusitis as a differential diagnosis 2

Treatment Algorithm

Step 1: Symptomatic Relief

• Nasal decongestants: Pseudoephedrine (30mg) to temporarily relieve sinus pressure and congestion 3
• Analgesics/antipyretics: For comfort and pain management 1
• Nasal saline irrigation: To improve drainage and reduce congestion 4

Step 2: If Infection Is Suspected

• Antibiotic therapy: Indicated for acute purulent maxillary sinusitis 1
  • First-line options:
    • Amoxicillin-clavulanate
    • 2nd/3rd generation cephalosporins (except cefixime)
    • Pristinamycin 1
  • For post-operative infection: Amoxicillin/clavulanic acid with metronidazole or levofloxacin 5

Step 3: Address Dental Causes If Present

• Dental evaluation: Rule out dental pathology before proceeding with extensive sinus treatment 2
• Dental treatment: For odontogenic sinusitis caused by dental caries or periapical abscess, dental treatment combined with medical management resolves approximately 67% of cases without requiring sinus surgery 4

Special Considerations

When to Refer to an Otorhinolaryngologist

• Symptoms that don't regress after 10 days of treatment 1
• Radiologic signs of radiopacity or sinus pathology 1
• Impaired nasal breathing or chronic respiratory diseases 1
• Signs of complicated sinusitis (meningeal syndrome, exophthalmos, palpebral edema, ocular mobility disorders, severe pain) 1

Risk Factors for Treatment Failure

• Smoking (33.4 times higher odds of requiring surgical intervention) 4
• Higher Lund-Mackay score on CT (more severe sinus disease) 4
• Polymicrobial infections with anaerobe-predominant microbiome 6

Pitfalls to Avoid

1. Treating dental pain without ruling out sinusitis: When patients present with pain in maxillary posterior teeth, always consider sinusitis as a potential cause 2

2. Missing odontogenic causes: Iatrogenic factors like dental implants and extractions are common causes of odontogenic sinusitis 7

3. Inadequate imaging: Standard dental radiographs may miss sinus pathology; CBCT extending to the orbit is recommended for proper evaluation 1

4. Inappropriate antibiotic selection: Odontogenic sinusitis often involves anaerobic bacteria requiring specific antimicrobial coverage 6

5. Delayed surgical referral: Early endoscopic sinus surgery should be considered for smokers and those with severe CT findings 4

By following this structured approach, most cases of sinus pressure around teeth can be effectively managed, addressing both the sinus inflammation and any potential dental causes.