Maxillary sinusitis: treatment and symptoms

Maxillary sinusitis is an inflammation of the sinuses located on either side of the nose, known as the maxillary sinuses.

There are four pairs of paranasal sinuses in the facial and skull bones: the maxillary sinuses (located behind the cheeks), the ethmoid sinuses (between the nose and the eyes), the sphenoid sinuses (behind the eyes) and the frontal sinuses (above the eyebrows).

The paranasal sinuses are, in fact, air-filled cavities lined with a mucous membrane and communicate directly with the nasal cavity, playing a role in filtering, warming and humidifying the inhaled air. 

Maxillary sinusitis is an inflammation of the lining of the maxillary sinus caused by bacterial, viral or fungal infections, as well as by various dental conditions.  

If the inflammation of the maxillary sinuses is caused by dental problems, such as tooth infections or dental trauma, we refer to it as odontogenic sinusitis, i.e. maxillary sinusitis of dental origin.

Like any other condition, maxillary sinusitis (odontogenic sinusitis) can be acute or chronic.

“We can speak of acute maxillary sinusitis if the patient presents with severe symptoms lasting up to 4 weeks. This type of sinusitis can be caused by a virus, a common cold, or bacterial infections. Usually, the symptoms present in acute forms prompt the patient to seek specialist consultation promptly, unlike chronic forms, which are detected only through radiological examination,” says Dr. Marina Băjinaru, a specialist in Dento-Alveolar Surgery at the DENT ESTET clinics.

Chronic maxillary sinusitis is a form of this condition that persists for a much longer period of time, lasting several months. The patient may not exhibit any symptoms, and the condition goes unnoticed for a very long time, only becoming apparent following a specialist consultation or radiological examination. In the case of odontogenic sinusitis, the chronic form is common, as the dental cause may persist if left untreated, and symptomatic treatment alone does not resolve the underlying cause. 

The symptoms of maxillary sinusitis are varied and must be carefully assessed in order to correctly distinguish between maxillary sinusitis, odontogenic sinusitis or other conditions such as the common cold or nasopharyngitis.

The main symptoms of maxillary sinusitis:

Nasal congestion

Most often, the symptoms of acute maxillary sinusitis are confused with those of respiratory infections. Among the first signs of the condition are nasal discharge, nasal congestion and fever. Another symptom may be a sensation of pressure or fullness in the face, particularly in the cheeks and cheekbones.  

Nasal congestion is caused by nasal discharge, which may be clear or purulent. If the discharge is significant, pain may occur in the maxillary sinuses.

Facial pain  

Facial pain is another symptom of maxillary or odontogenic sinusitis. The pain in the face may radiate to the forehead or jaw area.  

The pain is aggravated by head movements (bending forward). If the sinusitis is caused by a tooth infection, then the purulent nasal secretions will be in one nostril, and the nasal obstruction will also be in one nostril.

Toothache vs odontogenic maxillary sinusitis

Although toothache and the pain caused by maxillary sinusitis may be similar, there are nevertheless some important differences between them.

Toothache can be exacerbated by hot or cold food and drink, biting, and pressure on the affected tooth, whereas the pain from sinusitis is localised in the cheeks, under the eyes, and in the nose, and worsens when bending the head or when there is a change in pressure.

“According to specialists, the impact of maxillary sinusitis symptoms on quality of life is comparable to that of angina pectoris or chronic obstructive pulmonary disease. Unfortunately, there are situations where patients believe that self-medication or taking antibiotics is the solution, but our recommendation is to see a specialist, an ENT doctor or a dentist if the pain has dental causes,” explains Dr. Marina Băjinaru. 

As we have already seen, maxillary sinusitis can have many causes.

Infectious and inflammatory causes

The most common causes of maxillary sinusitis are upper respiratory tract infections (particularly viral and bacterial) and allergic rhinitis.

The most common bacteria that can lead to maxillary sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Among viral infections, we mention rhinoviruses, coronaviruses and influenza viruses.

Allergic reactions can also contribute to inflammation of the sinus mucosa.

Odontogenic causes (odontogenic sinusitis)

As the maxillary sinus is located in close proximity to the upper posterior teeth, approximately 10% of cases of maxillary sinusitis may have an odontogenic cause:

• Untreated dental infections in the upper molars and premolars, such as deep caries, pulp necrosis or the formation of an apical granuloma/cyst.
• Severe periodontal disease, which can lead to communication between the oral cavity and the maxillary sinus.
• Complications from dental treatments: traumatic extractions, faulty endodontic treatments, incorrect implant placement or perforation of the sinus membrane.

Risk factors for maxillary sinusitis

The triggers of maxillary sinusitis are divided into two groups: predisposing and determining factors.

One of the key factors in promoting the development of maxillary sinusitis is smoking. It is well known that chronic smokers develop inflammation of the sinus mucosa, whose ability to regenerate and clear mucus is progressively diminished.

Of paramount importance, the determining factors are linked to infections of the lateral teeth, i.e. untreated dental infections. Determining factors may also include respiratory viruses, bacteria (superinfection following a viral infection), fungi, nasal polyps, foreign bodies (in children) and allergies. 

People experiencing symptoms associated with odontogenic (dental) sinusitis should consult a dentist for diagnosis and treatment. The diagnosis is made on the basis of symptoms, X-rays and further investigations.

To establish a correct diagnosis of maxillary sinusitis, radiological images, CT scans or, performed by an ENT specialist, anterior rhinoscopy, sinus endoscopy or sinus puncture may be used. 

The treatment of maxillary sinusitis is complex and requires collaboration between an ENT specialist and a dentist, should the inflammation be caused by a dental issue.

The first step in treating maxillary sinus inflammation is to eliminate the cause that led to the condition.  

In odontogenic (dental) sinusitis, the dentist will recommend treating the dental condition. This may involve endodontic treatment of the affected tooth or surgical procedures.

The next step is the medication prescribed by the doctor, which includes antibiotics, anti-inflammatory drugs and painkillers (to reduce symptoms).

In the case of bacterial infections, antibiotics are recommended, but please note: antibiotic treatment alone is not sufficient if the dental source persists; dental intervention is mandatory.

In any of these situations, the patient will return for check-ups to monitor the healing process and prevent any recurrence.

Prophylactic treatment involves early treatment of the causes of maxillary sinusitis and the avoidance of dental problems. Regular dental check-ups are useful for preventing or limiting dental conditions. Adequate hydration and rest, avoiding allergens and smoking help to prevent maxillary sinusitis. 

Natural remedies and symptomatic treatments

• Nasal decongestants (drops or sprays) – for short-term use, to reduce congestion and facilitate drainage;
• Saline sprays or nasal irrigation with isotonic saline solution – to clear secretions;
• Topical nasal corticosteroids – to reduce inflammation of the mucous membrane (for limited use);  
• Analgesics/anti-inflammatories (e.g. ibuprofen, paracetamol) for pain, fever and discomfort;
• Steam inhalation – as an adjunct to moisturise the airways;
• Hydration, rest, avoiding smoking, avoiding allergens – general supportive measures.

Surgical intervention (operation) for maxillary sinusitis

Surgery is resorted to in cases where conservative treatment is unsuccessful.

The optimal treatment option is a combination of dental and ENT treatment, as ENT therapy alone (without treating the dental source) often leads to recurrence.

“The American Association of Endodontists (AAE) promotes the idea that the correct detection and treatment of the dental source is essential for the success of sinusitis treatment; otherwise, sinusitis may persist despite intervention on the sinus. The AAE also warns that an isolated approach to sinusitis (with antibiotics or sinus surgery) without treating the dental source frequently leads to recurrence or failure,” explains Dr. Marina Băjinaru. 

• Sinusitis, although often regarded merely as an ENT condition, can have a dental origin (odontogenic sinusitis) – a phenomenon that is frequently underdiagnosed;
• Modern imaging, particularly computed tomography (CBCT), plays a key role in detecting subtle anatomical changes and establishing the relationship between the tooth roots and the sinus;
• Treatment must be integrated: addressing the cause (dental treatment) + sinus management. Isolated ENT therapy (sinus surgery, antibiotics) without comprehensive dental treatment risks failure, leading to recurrence;
• In practice, a case of recurrent unilateral sinusitis or one that does not respond fully to treatment should be assessed from the perspective of a possible dental aetiology.

“My recommendation is to attend regular dental check-ups, even if there is no pain. Sometimes dental infections can be ‘silent’ and go unnoticed until they affect the sinus, becoming the source of sinusitis. Furthermore, self-medication is not advisable, as antibiotics taken without a prescription can mask the symptoms without addressing the source of the infection,” explains Dr Marina Băjinaru. 

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