Dental Foci Research Articles

Bi-institutional analysis of microbiological spectrum and therapeutic management of parotid abscesses

BackgroundA parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting.MethodsA retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables.ResultsOverall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization.ConclusionThe results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.

Characteristics associated with occurrence of stroke in patients with infective endocarditis – a retrospective cohort study

BackgroundStroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms.MethodsAll patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité – Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke.ResultsThe study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35–4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06–6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21–8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04–0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14–0.72).ConclusionsStroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.

Vancomycin-Resistant Streptococcus thoraltensis: A Case Report of Bacterial Endocarditis and Review of Literature on Infections Caused by This Pathogen.

Streptococcus thoraltensis is a rare species, part of the viridans streptococcus group, found initially in rabbits and pigs, which can be vancomycin-resistant. We present the case of a 65-year-old patient, a smoker and chronic alcohol consumer with chronic obstructive pulmonary disease (COPD) and multiple dental foci who had been diagnosed with bacterial endocarditis caused by Streptococcus thoraltensis. The particular elements of the case consisted of an atypical clinical presentation with diarrheal stools, abdominal pain, concomitant damage to the aortic and tricuspid valves, the presence of large vegetations (>2 cm), and a vancomycin-resistant strain of Streptococcus thoraltensis. The evolution of the patient was unfavorable due to septic embolisms, respiratory failure requiring orotracheal intubation, and septic and cardiogenic shock. Infections with Streptococcus thoraltensis are challenging to treat because of the severity of the clinical form it causes and the pattern of antibiotic resistance in this germ. Based on our brief review, Streptococcus thoraltensis is an extremely rare human pathogen previously described as the etiologic agent of infectious endocarditis in only one case.

Personalizing dental screening and prevention protocols in dentulous patients with oropharyngeal cancer undergoing radiotherapy: A retrospective cohort study

ObjectivesPatients with head and neck cancer are routinely screened for dental foci prior to radiotherapy (RT) to prevent post- RT tooth extractions associated with an increased risk of osteoradionecrosis. We evaluated the risk factors for post-RT tooth extraction to personalise dental screening and prevention protocols prior to RT. Materials and methodsThis retrospective cohort study included dentulous patients diagnosed with oropharyngeal cancer who had undergone radiation therapy at doses 60–70 Gy and achieved a disease-free survival of ≥ 1 year (N = 174). Risk factors were assessed using Cox regression models. ResultsThe cumulative incidence of post-RT tooth extraction was 30.7 % at 5 years. Main indications for extraction (n = 62) were radiation caries (n = 20) and periodontal disease (n = 27). Risk factors associated (p < 0.05) with radiation caries-related extractions included active smoking, alcohol abuse, poor oral hygiene, parotid gland irradiation, and mandibular irradiation. A high-dose volume in the mandible was associated with periodontal disease events. ConclusionPost-RT extractions due to radiation caries were influenced by lifestyle factors and RT dose in the mandible and parotid glands. Periodontal disease-related extractions were primarily associated with the mandibular dose. During dental screening these post-RT risk factors should be taken into account to prevent osteoradionecrosis.

Management of odontogenic foci of infection (dental caries, periodontal disease and odontogenic infections) in the oral functional management of patients receiving cancer treatments: Guidelines based on a systematic review

AbstractIn cancer treatment, perioperative oral functional management is used as a part of supportive care. Its main objectives are as follows: (1) preventing and reducing adverse events, (2) maintaining or improving nutritional status, (3) improving cancer treatment outcomes, (4) maintaining or improving quality of life, (5) providing high quality medical care through comprehensive oral care, (6) controlling odontogenic foci of infection, and (7) maintaining or improving oral function. A literature search was conducted using the electronic databases of Medical Journal and PubMed. Electronic database searches were performed using various combinations of the following key words: cancer, surgery, treatment, chemotherapy, radiotherapy and dental disease, oral care, oral management, dental intervention, oral health, dental care, and dental management. The selection of literature for inclusion in the review was restricted to dental management of patients receiving cancer treatment. In the course of the literature review, hand searches were also added as needed. The guideline was developed by summarizing the results of the review. Based on a review of the literature on the management of dental foci of infection in the oral functional management of patients undergoing cancer treatment, a guideline was developed by summarizing the results of the review. This report is a secondary publication of our previous review report “J. Stomatol. Soc. 70(4): 279–289. Dec 2021.”

Do dental screening and treatments prior to heart valve interventions help prevent prosthetic valve endocarditis? A systematic review

Routine screening for infectious dental foci prior to elective heart valve replacement may help prevent postoperative Prosthetic Valve Endocarditis (PVE), a potentially fatal complication. This systematic review assesses the effect of routine screening for infectious dental foci on the incidence of postoperative PVE. The Cochrane Library, PubMed and EMBASE databases were all searched for relevant primary studies. The GRADE system was used to rate the studies. Three primary studies with a very low level of evidence were included in the review. No significant difference was found between the incidence of PVE in groups with or without routine screening for infectious dental foci prior to heart valve replacement. The results of this review do not support or disprove the need for preoperative screening for infectious dental foci to prevent PVE in patients undergoing heart valve replacement. Further research is necessary.

Persisting dental foci increase the risk for bacterial infections before and after liver transplant.

Patients awaiting liver transplant are usually assessed for presence of dental foci to prevent bacterial infection post-transplant, but evidence to support dental examination and treatment is limited. We investigated if treatment of dental foci decreased bacterial infections before and after transplant. Patients transplanted at the university hospital of Bonn were retrospectively assessed for occurrence of bacterial infections before and after transplant according to presence and treatment of dental foci. 35/110 patients showed good oral health, 39/110 patients received dental care and 36/110 patients did not receive dental care despite poor oral health. Patients with alcohol-associated liver disease presented with the highest rate of dental foci. Bleeding complications due to oral care occurred in five patients with poor coagulation. After transplant, the number of infections per patient was higher in patients with poor oral health (2.9) compared to patients after dental care (1.9) or with good oral health (1.8) (p=.02), with streptococcal infections being more frequent in patients with poor oral health. Before transplant, bacterial infections, in particular bacteraemia and spontaneous bacterial peritonitis, were also more common in patients with untreated dental foci. Streptococci and Staphylococci were more often detected in patients with dental foci. Dental treatment was associated with a reduction in bacterial infections. Presence of dental foci is associated with an increased risk for bacterial infections not only after but also before liver transplant. Dental treatment might be a safe and effective procedure to mitigate this risk.

NECROTIZING ULCERATIVE GINGIVITIS LEADING TO SEPSIS IN ONCOLOGICAL PATIENT: A CASE REPORT FOCUSED ON ORAL DIAGNOSIS

Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment. Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment.

The Potential Contribution of Dental Foci and Oral Mucositis to Febrile Neutropenia in Patients Treated With Myelosuppressive Chemotherapy for Solid Tumors and Lymphoma.

IntroductionFebrile neutropenia (FN) is a potential life-threatening complication of myelosuppressive chemotherapy, particularly when induced by infection. There is evidence that FN can originate from the oral cavity, but its contribution to FN is largely understudied in patients treated for solid tumors. The aim of this study was to assess the prevalence of FN in these patients and to evaluate its relation with dental foci and oral mucositis.Material and MethodsA prospective longitudinal observational study was conducted. Patients diagnosed with solid tumors and lymphoma scheduled to be treated with myelosuppressive chemotherapy with an intermediate risk of developing FN were included. A pre-chemotherapy dental examination was performed and patients were followed during and after chemotherapy regimen. During subsequent hospital visits for chemotherapy administration, the oral cavity was inspected and oral mucositis (OM) was scored using the CTC-AE version 3.0. When patients presented with fever, a comprehensive full body examination including laboratory/microbiological/imaging investigation was performed.ResultsEighty-eight patients were included. Pre-chemotherapy, 39 patients (44.3%) were diagnosed with a dental focus. During chemotherapy, 46 patients developed OM (53.4%), of which 15 patients had a maximum score of grade II (ulcerative mucositis). Ten patients developed FN during the follow-up period. Patients with FN more often suffered from ulcerative OM compared to patients without FN; both FN and mucositis risk was associated with the myelotoxicity of chemotherapy. However, no relation could be established between the presence of dental foci prior to chemotherapy and the development of FN (p > 0.05).ConclusionA significant relation was identified between ulcerative OM and FN, but no robust conclusions could be drawn with respect to a relationship between the presence of dental foci and FN.

Value of FDG-PET/MR in Oral Focus Assessment in Head and Neck Cancer Patients-A Feasibility Study.

FDG-PET/MR is a hybrid imaging modality used for the staging and restaging of advanced head & neck cancer (HNC) patients. Their treatment typically involves radiation therapy, which requires previous dental focus assessment. The aim of this study was to analyze if staging FDG-PET/MR is a valuable tool for oral focus assessment. For this purpose, FDG-PET/MR findings, such as metabolic activity of periapical radiolucencies and marginal periodontitis, were retrospectively compared with conventional standardized dental focus assessment, including dental radiographs and clinical assessment of 124 teeth in seven patients. Increased FDG uptake of periapical lesions was found in one out of 23 lesions. Increased FDG uptake of the marginal periodontium was recorded in one out of 34 lesions. In summary, standardized dental focus assessment by panoramic radiography and periapical radiographs may be enriched by information from FDG-PET/MR, showing active inflammation in dental foci. However, many dental foci have no correlate in FDG-PET/MR. The treatment decision for oral foci may benefit from the visualized presence or absence of metabolic activity on FDG-PET/MR.

Bilateral spontaneous abscess of the nasal septum: case report

Nasal septal abscess is a rare and serious infection, due to the complications it can cause. It is defined as a collection of pus between the septal cartilage and its perichondrium. Usually, the abscess is the result of superinfection of a poorly treated post-traumatic hematoma. Rarely, the abscess has spread to the septum either from a skin lesion, sinusitis or dental focus neighborhood but exceptionally the abscess can be spontaneous. We report a case of a 29-year-old girl who presented to the emergency room for rhinological pain associated with bilateral nasal obstruction. The swollen nasal septum completely obstructed the nasal passages. The CT scan showed an abscess of the nasal septum without sinusitis or other infectious ENT focus (spontaneous abscess). Drainage of the abscess associated with a triple antibiotic therapy allowed a favorable outcome. The objective of this case report is to show that nasal septum abscess is another cause of bilateral nasal obstruction. It is not always secondary to a local infection; it can be spontaneous as the case of our patient.

The Long Wait for Diagnosis

Bacterial parotitis is most commonly due to oral or dental focus in non-immunocompromised patients. Ultrasonography and guided aspiration are the diagnostic tools, and appropriate antibiotics and supportive medications are the treatment modality. A diagnosis of tubercular parotitis is extremely rare and can be a cause for concern with regard to delayed diagnosis and the possibility of complications. The present case report is about such a case: a young lady with no comorbidities presenting with initial diagnosis of parotid abscess. Evolution and management of the case, with relevant literature, are discussed.

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world'setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%)and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

Association between oral health and alcoholic liver disease - A cross-sectional analytical study

Background: Alcoholic liver disease (ALD) is a condition with compromised immunity and dental foci can act as a potential source of infection. Aims and Objectives: This study was conducted to assess and compare the oral health among patients with alcoholic liver disease with healthy individuals and to determine an association between oral health and alcoholic liver disease.Materials and Methods: A cross-sectional analytical study assessed 100 participants with ALD and 100 age and gender matched subjects. Demographic details, laboratory investigation results, medical, dental & family history, oral hygiene practices, information about tobacco and alcohol habits were collected. Caries, periodontal disease, oral mucosal lesions and intervention urgency were assessed using WHO (2013) criteria. Descriptive and inferential statistics were used. A p <0.05 was considered as significant.Results: Mean age of participants in ALD and control groups were 43.71 ± 6.79 and 42.82 ± 6.23 years respectively. Caries experience (DMFT) was higher in ALD group (11.55±12.29) than comparison group (8.2±8.89) (p=0.001) giving an association with age of onset of alcohol abuse. Periodontal health was poor among ALD group with more teeth with gingival bleeding, shallow or deep pockets and loss of attachment giving an association between age of onset, duration of disease since diagnosed and MELD score. Among ALD group 7% had leukoplakia. Association was found between oral mucosal lesion and duration of disease since diagnosed and MELD score.Conclusion: Oral health was poor among ALD group than comparison group. Dental caries was associated with alcohol abuse and oral mucosal lesion was associated with alcoholic liver disease whereas periodontal disease was associated with alcohol abuse and alcoholic liver disease.

Poor oral health status and short-term outcome of kidney transplantation.

This study aims to know whether poor oral health increases the risk of acute rejection and hospitalization in kidney allograft recipients. This is a prospective cohort study. The same dentist followed participants for 2 months after renal transplant for monitoring oral health (clinical evaluation, DTMF index, and CPITN index), signs of graft rejection, infection, and hospitalization. We compiled rates and reasons for hospital readmission or extended hospital stay. The CPITN had a mean score of 0.38 ± 0.71, increasing to 0.90 ± 0.84, 60 days after transplant (P<.001). No one rejected the graft in the period of study. Patients with older age (P=.009; OR: 1.07; CI 95% 1.01-1.12) were at higher risk of hospitalization at each year of age and patients presenting pretransplant dental focus (P=.001; OR: 7.23; CI 95% 2.13-24.56) had 7.23 times more chance to be hospitalized in the first 2 months after the transplant. One participant was hospitalized due to acute foci of dental infection. There was an association between dental focus and hospital readmission/stay. However, our methods do not provide conclusive proof of causality. Hospitalization due to acute dental infection was rare.

P1453 Unfortunate association between obstructive hypertrophic cardiomyopathy and infective endocarditis

Abstract Bacterial endocarditis is an uncommon, but potentially severe complication of hypertrophic cardiomyopathy (prevalence &amp;lt; 1%). We report the case of a 27-year-old woman, with low socioeconomic status, with hypertrophic cardiomyopathy, presenting with chest pain, dyspnoea at moderate effort, fever and chills. The transthoracic and transoesophageal echocardiography showed obstructive septal hypertrophic cardiomyopathy (interventricular septum of 38 mm, systolic anterior motion of the mitral valve, maximum gradient in the left ventricular outflow tract of 80 mmHg), vegetations of 10 mm, on the atrial and ventricular mitral leaflets sides, mitral valvular abcess, severe mitral regurgitation, flail of the noncoronarian aortic cusp (with a 10 mm vegetation), severe aortic regurgitation, basal SIV vegetation, pericardial effusion. The blood cultures were positive for Streptococcus mitis. The thoracic, abdominal, pelvin CT scan confirmed the diagnosis of mitral-aortic infective endocarditis , revealing also an abcess of the aortic root and multiple embolisations (spleen and right external iliac artery). The cranial CT scan was normal. At the evaluation of the foci sites, multiple dental foci were discovered and treated by multiple extractions. The endocarditis team recommended antibiotic treatment (with ampicillin), urgent bivalvular replacement (aortic and mitral valve) and septal myectomy. The surgical procedure was denied by the patient, which was after that voluntarily discharged from the hospital. The patient died from cardiac arrest (asystole) 11 days after the initial diagnosis. A severe association between obstructive hypertrophic cardiomyopathy and infective endocarditis with multiple complications can have an initial paucisymptomatic clinical presentation. The low socioeconomic status of the patient was correlated with inadequate oral hygiene, that was a negative prognostic factor in the outcome of the patient. It is possible that the integration of oral health in our national general health programs for people with low socioeconomic status, will decrease morbidity and improve the quality of life. Abstract P1453 Figure. picture clinical case

Early Steps Toward Ambulatory Antimicrobial Stewardship: Dental and Orthopedic Focus.

The article focuses on the Joint Commission (TJC) has added an ambulatory stewardship program (ASP) standard to begin in January of 2020 It mentions that inappropriate antimicrobial use is the most important modifiable factor in tackling the coronavirus crisis It also mentions that dentists often prescribed unnecessary antibiotic prophylaxis (AP) to patients with conditions such as rheumatic heart disease, coronary artery bypass graft, and mitral valve prolapse

Characteristics, diagnosis and treatment of the most common bacterial diseases of the oral cavity

Billions of microorganisms can be found in the oral cavity, from which bacteria are the most frequent. More than 600 bacterial species can be isolated. Most of them are harmless, moreover, some species prove themselves to be specifically useful. However, in the case of a weakened immune status or inappropriate oral hygiene, they may cause many types of soft and hard tissue disorders. Caries and periodontal diseases are the most common bacterial diseases of the oral cavity. In both cases, the dental biofilm gives rise to the disorder, which is caused by the insufficient oral hygiene. Dental caries are mainly caused by cariogenic streptococci and lactobacilli. In the case of serious periodontal diseases, anaerob parodonto-pathogen microorganisms play the major role. Untreated caries may result in the necrosis of the pulp, which can cause an inflammation expanding towards the parodontium. This can be characterized as a focal infection, like the untreated periodontal pockets. Dental foci may have lots of systemic consequences such as cardiovascular diseases, diabetes, pneumonia, arthritis, preterm birth and alopecia areata. When these diseases occur, dental foci should always be considered. The professional plaque control and chlorhexidine rinsing before the proposed surgeries have an outstanding role in the prevention of ventilator-associated pneumonia. Oral cancer is multicausal; more and more researchers are analyzing the role of certain bacteria in the carcinogenesis of oral cancer. In addition to the mentioned clinical aspects, we are planning to describe the relatively rare, but diverse and diagnostically challenging bacterial soft tissue disorders in another publication. Orv Hetil. 2019; 160(19): 739-746.

Subphrenic abscess secondary to cervical abscess and fasciitis from dental focus: case report

BackgroundCervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer.Case presentationA 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae.ConclusionsAggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.

Endoscopic sinus surgery plays an essential role in systematic treatment of odontogenic maxillary sinusitis

PurposeOdontogenic maxillary sinusitis (OMS) is frequently encountered in otorhinolaryngologists' clinical practice. Endoscopic sinus surgery (ESS) instead of surgeries in intraoral approach has been widely applied among OMS. However appropriate treatments due to the causes of the OMS as well as the outcome have been less investigated, meanwhile the inherent incidence of OMS may be still on the rise. This study was designed to conclude our systematic treatment within follow-up examination. Materials and methodsIn this retrospective study patients confirmed diagnosis of OMS who had systematic follow-up examinations were analyzed. Medical histories of otorhinolaryngologists and dentists were reviewed as well as preoperative examination protocols. ResultConsecutive 29 Patients (10 women, 19 men) were included. 41.4% (12/29) patients experienced facial pain as the most frequent symptom. 69.0% (20/29) patients admitted firstly to otorhinolaryngologists, 13 patients were treated with surgical procedure while 7 patients lacking of surgical indication were transferred to dentists. 31.0% (9/29) patients were advised by dentist for being suspected of maxillary sinusitis, including 7 patients suffered from sinonasal complications of dental treatment (SCDT). Conventional dental treatment (root planning, root end surgery, extraction) was the most common cause. Follow up for a mean of 15.1 (ranges from 6 to 96) months showed 29 patients maintaining open maxillary ostium on endoscopic examination or improving on CT except recurrence in one patient with SCDT. ConclusionPatients should be inspected by dentists carefully when the patient has symptoms rather than sinusitis-like symptoms, the possibility of OMS should always be considered. Dental examination can help to determine whether a maxillary sinusitis has a dental origin, periodontitis and odontogenic radicular cysts still are the most common causes comparing with iatrogenic factors. Patients treated with ESS showed better tolerance and fewer postsurgical complications. Not all patients with OMS including SDCT need definitely surgery whether ESS or intraoral approach, removing dental focus followed with antibiotics would be optimistic choice.