These conditions underscore the interconnectedness of dental and sinus health and highlight the need for vigilance among dental professionals. Recognizing the Symptoms for an Advanced Diagnosis The symptoms of MSDO often overlap with those of nonodontogenic sinusitis, which can complicate diagnosis. Patients typically report unilateral facial pain, nasal congestion, and postnasal drip. What distinguishes MSDO is its resistance to conventional medical treatments such as antibiotics, nasal corticosteroids or sinus surgery. A foul nasal odour or taste is one of the most telling signs of an odontogenic origin. Other symptoms include facial tenderness, particularly over the infraorbital region, and persistent bad breath. Some patients experience vague complaints of sinus “fullness” without significant dental pain, making it essential for clinicians to maintain high levels of suspicion when evaluating sinus-related complaints. Dental evaluations commonly use traditional 2D radiographs, such as periapical and panoramic X-rays, but these often prove insufficient for diagnosing MSDO. Studies show that only a small percentage of sinus-related dental lesions are detectable on these imaging modalities.4 Cone Beam Computed Tomography (CBCT) imaging, in contrast, provides the level of detail required to identify subtle lesions and their relationship to the sinus. CBCT imaging allows for the visualization of periapical lesions, mucosal thickening in the sinus, and disruptions in the Schneiderian membrane. These images enable dental professionals to make accurate diagnoses and develop targeted treatment plans. Although CT scans are the gold standard when imaging the sinus, CBCT imaging is often preferred especially for diagnosing MSDO with its higher resolution and lower radiation exposure. Clinical Cases Clinical cases illustrate the impact of early recognition and treatment of MSDO. In one case, a middle-aged patient with a history of recurrent sinus infections and postnasal drip underwent CBCT imaging, which revealed a necrotic maxillary molar with a periapical lesion extending into the sinus. Root canal retreatment resolved both the dental infection and the sinus symptoms, providing long-awaited relief. In another example, a young male patient presented with complete opacification of the left maxillary sinus. CBCT imaging identified a periapical lesion associated with a molar. Endodontic therapy successfully eliminated the infection, and the patient reported significant improvement in both nasal obstruction and facial pressure. (see Photos 1–6) These cases highlight the importance of advanced diagnostics and a comprehensive understanding of MSDO in achieving successful outcomes. Treatment Strategies and Prevention Managing MSDO requires addressing the underlying dental infection while considering the potential need for adjunctive medical or surgical treatments. Root canal therapy or retreatment is often the first line of defence, particularly in cases involving untreated accessory canals. Thorough debridement and sealing of all canals are essential to eliminate the infection. When the affected tooth is non-restorable, extraction will be necessary. Where iatrogenic factors are involved, such as the extrusion of dental materials into the sinus, surgical intervention may be required to restore sinus health. Photo 1: Pre-operative radiograph, October 2023 Photo 2: Complete opacification of the left maxillary sinus, October 2023 Photo 3: Periapical osteoperiostitis or “halo” lesion surrounding the buccal roots of tooth 26. 27 Issue 3 | 2025 | Supporting Your Practice
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