Patients suffering from persistent sinus infections, facial pressure, or unexplained nasal odours often seek help from their primary care physicians or ear, nose and throat (ENT) specialists. However, these symptoms can sometimes originate from an unexpected source—a dental infection. Known as Maxillary Sinusitis of Dental Origin (MSDO), this condition highlights the close anatomical relationship between the upper molars and the maxillary sinus. Despite its prevalence, MSDO often goes undiagnosed, underscoring the critical role dental professionals play in its identification and treatment. By understanding the underlying causes, symptoms, and diagnostic tools for MSDO, general dentists and endodontists can address this condition effectively, ensuring comprehensive care and long-term relief for affected patients. Maxillary Sinusitis of Dental Origin: Diagnosis and Treatment Dr. Mary Dabuleanu is an endodontist in North York, Ontario. Anatomical Basis and Common Dental Causes of MSDO The maxillary sinus, one of four paranasal sinuses, plays an essential role in humidifying and cleansing inhaled air.1 Its location just above the posterior maxilla places it near the roots of the maxillary molars and premolars. In many cases, a thin layer of bone, or no bone at all, separates these roots from the sinus floor.2 This anatomical connection becomes more pronounced with age as sinus pneumatization, and alveolar bone loss further reduces the barrier. Dental infections can spread to the sinus via direct extension or through shared vascular and lymphatic pathways.3 Once the sinus is infected, inflammation of the Schneiderian membrane and obstruction of the sinus drainage pathways can occur, leading to symptoms that mimic primary sinusitis. The development of MSDO can indicate several dental conditions. Apical periodontitis is a frequent cause, particularly when untreated or poorly managed necrotic pulp leads to periapical lesions. Periodontal disease is another contributor, as severe bone loss provides a direct pathway for bacteria to migrate from the teeth to the sinus. Failed root canal treatments, especially those involving untreated accessory canals such as the mesiobuccal second canal (MB2) in maxillary molars, are also common culprits. Additionally, iatrogenic factors, including the extrusion of dental materials during root canal therapy or placing implants into the sinus, can lead to sinus inflammation. Dental infections can spread to the sinus via direct extension or through shared vascular and lymphatic pathways. 26 | 2025 | Issue 3
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