Letter to the Editor

Abstract

To the Editor: My message is prompted by the Sinus Issue of Implant Dentistry that appeared in volume 20/number 6/December 2011, which was directed only toward the maxillary sinuses. It encouraged me to introduce our experience with diagnoses and evaluation of cases. For any given case, before any dental or implant procedure to be done, we definitely need to include the nasal cavity in our examination procedures. Through the past 5 years, and in cooperation with an ear, nose, and throat (ENT) specialist from my hometown, we noticed the following: Oral examination and panoramic radiographic evaluation of cases were not carried out in an efficient way by most dentists. Radiographically, most dentists do not even take the time to look in the nasal area. The nose, being opened all the time, is the main connecting organ of the body with the outside environment. Its normal and pathological anatomy is neglected by most dentists. However, its role in creating sinus and oral problems is huge. Clinically, many cases with hypertrophied uvula are not even noticed by both dentist and ENT practitioners. Case histories taken by dentists usually take information in a light way when related to rhinitis, and it is usually believed to be a sort of allergy! Most ENT specialists do accuse (sic) the maxillary sinuses (only), forgetting about the nasal cavity. Conventionally, they treat cases with long-term antihistamines. Patients get bored, and after they start feeling a little bit better, they quit using such medications, and the cycle starts all over again. THE NASAL PROBLEM In an extremely wide range of cases, and with a quick look at a panoramic radiograph, enlargement of the nasal turbinates and/or deviated nasal septum should be noticed. The etiology of turbinate enlargement is multifactorial involving congenital, allergic, hormonal, and environmental factors. THE NOSE AND ORAL CAVITY Mouth breathing, sinus infections, ostium stenosis, and disturbances of the gastrointestinal system are all etiologic factors for teeth, mucoperiosteal, and healing problems. However, they are caused by enlarged nasal turbinates. Many cases do have teeth problems due to these factors, and many dentists treat the teeth and forget about the cause. Placing implants with sinus lift procedures under these circumstances would definitely involve complications arising from the nose that would remain unexplained. Ostium stenosis (narrowing or closure of the sinus draining opening from the nasal cavity) is a common problem causing blockage of the maxillary sinus and subsequent thickening of the sinus mucosa. THE NOSE AND STOMACH Abnormal swelling of the nasal and sinus membranes causes the production of thick abnormal mucus. This thick mucus can drain into the back of the throat to the digestive system, causing symptoms that mimic the gastroesophageal reflux disease including repeated bouts of heartburn, difficulty swallowing, hoarseness, lump-in-the-throat sensation, and chronic cough. Moreover, a significant change in the salivary pH leads to tooth decay and calculus deposition. PROGNOSIS AND TREATMENT OF THE NOSE A wide variety of laser methods have been developed for surgery in the nose. Cases that went through restoring normal size of turbinate and/or correction of deviated nasal septum would eventually restore normal body health. Normal breathing and the stoppage of the postnasal discharge would improve patient's physiology and, accordingly, the oral cavity. In dentistry, close cooperation with ENT specialist is a must. The oral and nasal cavities work as a team. Careful nose and sinus examination is an ENT responsibility and must be requested by dentist.