Odontogenic Sinusitis Research Articles

Одонтогенный синусит – мультидисциплинарная проблема

Chronic focal infection is pathologically closely associated with internal pathology and is a serious factor in its aggravation. Systemic inflammatory reactions are associated with metabolic changes, such as oxidative stress, impaired regulatory participation of macro- and microelements with an imbalance in their distribution in biological media. The resulting homeostatic imbalances cannot be ignored by the attraction of chronic foci of infection, such as odontogenic sinusitis. The aim of the study was to substantiate complex approaches to the supervision of patients with chronic odontogenic sinusitis against the background of comorbid multiple chronic focal infection (MCFI). Materials and methods. In patients with chronic odontogenic sinusitis against the background of multiple chronic foci of infection, the activity of systemic inflammatory factors was studied. Levels and ratio of pro- and anti-inflammatory cytokines – interleukins 2, 6, 10, TNF alpha, C-reactive protein in comparison with the oxidation activity of lipids, proteins, low molecular weight thiols, assessment of Zn, Cu, Fe parameters in biological media and hepcidin in blood. In patients with chronic odontogenic sinusitis against the background of MCFI, an increase in the level of pro-inflammatory (TNF alpha, interleukin 6) was found with an imbalance in the distribution of Zn, Cu, Fe with a deficiency of these elements in the intracellular media. Expressed correlations of these changes with the activity of lipid peroxidation and free radical oxidation of thiol compounds were revealed. The data obtained serve as a rationale for the use of antioxidant and mineral replacement therapy in the complex treatment of patients with MCFI.

Characteristic of iatrogenic odontogenic sinusitis

The aim of the study was to study the structure of odontogenic sinusitis and identify iatrogenic etiological factors. A retrospective analysis of the case histories of patients operated from 2015 to 2019 with a diagnosis of «Sinusitis» in the Clinical City Emergency Hospital in Tashkent, Republic of Uzbekistan in the department of emergency maxillofacial surgery was carried out. The total number of patients was 333 people: 105 (31.5%) men and 228 (68.5%), the average age of patients was 39.4 years. When analyzing the reasons for the development of sinusitis, in 73% of the total number of operated patients, there was an associated lesion of the teeth. When detailing the sources of odontogenic infection, it was determined that periapical foci of inflammation (granulomatous, granulating periodontitis, cystogranulomas) accounted for 26%, foreign bodies (teeth, roots of teeth, filling materials removed into the maxillary sinus during endodontic treatment) 31%, fistulous passages after removal teeth and attempts to eliminate perforation by surgery 43%. Other etiological factors were found: chronic polypous rhinosinusitis 14%, benign tumors 8%, allergic fungal sinusitis 5%. Clinical analysis showed that the development of most cases of odontogenic sinusitis is associated with the mistakes of dentists and is of iatrogenic origin. To prevent the development of odontogenic iatrogenic sinusitis, prior to dental interventions on the teeth of the upper jaw, it is necessary to carry out a topical diagnosis of their ratio with the maxillary sinus.

Индекс одонтогенности синусита (OSI)

The criteria for «odontogenic sinusitis» (OS) with the highest values of specificity and sensitivity were identified. An integral odontogenicity sinusitis index (OSI) was developed based on the identified criteria. To measure the sensitivity and specificity of the criteria, a group of 261 patients was selected (113 women (43.29%), 148 men (56.70%), the average age of the patients was 36 years), consisting of 150 known to have OS and 111 patients who were known to be without OS. As a result of data analysis, the values of sensitivity and specificity were obtained for all 13 criteria. Based on the sensitivity and specificity values, all criteria were combined into an odontogenicity sinusitis index (OSI) and divided into «minor» and «major». The “large” criteria were assigned a significance point of 2, and for the “small” criteria, a significance point of 1. The determination of the odontogenic nature of sinusitis was carried out by a simple summation of the points assigned to patients during the survey, examination, and analysis of CT criteria. An odontogenic cause of sinusitis is recognized if there is a minimum of 4 points of significance, for example, one “large” (2 points) and two “small” (1 point each) criteria. The general sensitivity of the integral OSI index was 93%, the general specificity was 94%. These rates are high enough that OSI can be used to determine the «odontogenic» nature of sinusitis.

Odontogenic Sinusitis: A Comprehensive Review from the Current Literature

Odontogenic Sinusitis: A Comprehensive Review from the Current Literature

A rare case of combined orbital and intracranial complications of purulent odontogenic maxilloethmoidal sinusitis

A rare case of combined orbital and intracranial complications of purulent odontogenic maxilloethmoidal sinusitis

Choosing a method of surgical treatment in patients with chronic odontogenic maxillary sinusitis

Choosing a method of surgical treatment in patients with chronic odontogenic maxillary sinusitis

Постимплантационный верхнечелюстной синусит: профилактика и диагностика

According to the data of domestic and foreign authors, the incidence of maxillary sinusitis has doubled over the past 10 years, and the proportion of patients hospitalized in ENT hospitals is increasing annually by 1.5–2.0%, moreover, rhinology and rhinosurgery are the main areas of work of the ENT hospital currently. An important role in the occurrence of chronic maxillary sinusitis is played by the condition of the nasal cavity, especially the area of the ostiomeatal complex. For more than 30 years, rehabilitation of patients with complete or partial absence of teeth using subantral grafting and dental implantation has been widespread in Russian dental practice. Odontogenic maxillary sinusitis is increasingly found as a complication of dental implant treatment in the upper jaw. Patients usually get consultations with an otorhinolaryngologist already with the appearance of complications, and this reduces the effectiveness of dental operations. The question of diagnosis of maxillary sinusitis and insufficient preoperative preparation before implant treatment at the dentist remains open. When preparing a patient for implant treatment at the dentist, important components are the otorhinolaryngological examination and computed tomography of the paranasal sinuses, which can reveal a violation of the architectonics of the nasal cavity, the ostiomeatal complex and the pathology of the maxillary sinuses.

The Prevalence of Odontogenic Pathology in Patients With Bilateral Rhinosinusitis.

ObjectiveWe investigated cases with opacification on maxillary sinus computed tomography (CT) among patients with rhinosinusitis with opacification in both paranasal sinuses (bilateral rhinosinusitis) to confirm the involvement of odontogenic infections.MethodsThis study included 75 patients who were diagnosed with bilateral rhinosinusitis based on clinical examination and evident opacification on at least one side on maxillary sinus imaging with computed tomography CT. The definition of odontogenic sinusitis was determined by examining EPT and oral findings, in addition to the CT and orthopantomography (OP), by one oral surgeon and two otolaryngologists.ResultsWe found that 45.3% of patients had odontogenic infections, which were associated with multiple infected teeth in some cases. Odontogenic infection was observed in both sinuses in some patients. Sinusitis with polyps was frequently associated with dental infection, and some cases were also associated with mycosis. Almost no oral symptoms were observed.ConclusionsThe results suggest that clinicians should consider odontogenic infection in patients with bilateral rhinosinusitis with opacification, on at least one side on maxillary sinus imaging. This means that accurate diagnosis may be challenging for otolaryngologist or dentists alone, suggesting that a collaboration between the two would be suitable for this task.

Preoperative antibiotic prophylaxis of odontogenic maxillary sinusitis, as a result of the formed oroantral joint

The article describes clinical research methods as an assessment of the effectiveness of preoperative antibiotic prophylaxis in operations on the alveolar process of the upper jaw.
 Methods.70 patients underwent a tooth extraction operation, complicated by perforation of the Schneider membrane in the period 2018-2019. These patients are conditionally divided into two homologous groups (body weight, gender, age, information from the medical history). Group I (34 patients) is scheduled to prescribe antimicrobial agents as preoperative antibiotic prophylaxis. In group II (36 patients), standard seven-day antibiotic therapy was performed.
 Results.Infectious and inflammatory complications in group 1 occurred in 5.4% of cases, in group 2 in 6.2% of cases, the difference in the occurrence of infectious and inflammatory complications was 1.2%.

Preoperative antibiotic prophylaxis of odontogenic maxillary sinusitis, as a result of the formed oroantral joint

The article describes clinical research methods as an assessment of the effectiveness of preoperative antibiotic prophylaxis in operations on the alveolar process of the upper jaw.
 Methods.70 patients underwent a tooth extraction operation, complicated by perforation of the Schneider membrane in the period 2018-2019. These patients are conditionally divided into two homologous groups (body weight, gender, age, information from the medical history). Group I (34 patients) is scheduled to prescribe antimicrobial agents as preoperative antibiotic prophylaxis. In group II (36 patients), standard seven-day antibiotic therapy was performed.
 Results.Infectious and inflammatory complications in group 1 occurred in 5.4% of cases, in group 2 in 6.2% of cases, the difference in the occurrence of infectious and inflammatory complications was 1.2%.

Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review.

Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.

ПРОБЛЕМА РАЗВИТИЯ ВЕРХНЕЧЕЛЮСТНЫХ СИНУСИТОВ ПОСЛЕ ПРОВЕДЕНИЯ СИНУС-ЛИФТИНГА

Subject. In some clinical cases maxillary sinus lift is a nessesary surgery preparing for dental implantation in the distal parts of the upper jaw. However, despite the widespread using of this type of surgery in clinical practice, the percentage of postoperative complications leading to the development of odontogenic maxillary sinusitis after sinus-lifting surgery does not decrease from year to year. Among the complications of sinus lifting, the following main ones are distinguished: perforation of the maxillary sinus mucosa and nasal cavity; rejection of a previously installed dental implant; migration of the implant and/or bone material to the maxillary sinus; bleeding; acute maxillary sinusitis.
 The aim is to conduct a systematic analysis of domestic and foreign literature sources to determine the main factors of development of postoperative odontogenic sinusitis, as well as features of diagnosis and prevention of this complication. 
 Methodology. The review of research allows us to consider the etiology of odontogenic maxillary sinusitis after sinus-lifting surgery and the pathogenesis of the disease, to draw conclusions about possible ways to prevent its development. 
 Results. Odontogenic sinusitis that developed after the sinus-lifting operation is very common in clinical practice, despite the widespread use of this type of bone augmentation and proven methods of surgical intervention. The reason for this can be both anatomical prerequisites and iatrogenic factors, as well as insufficient diagnosis of pathologies of the paranasal sinuses in the preoperative period. 
 Conclusions. The development of postoperative sinusitis can be avoided with careful planning of the operation, necessarily with computer tomography (preferably, cone-beam (dental) computed tomography, which is characterized by a relatively low load for optimal visualization of the maxillofacial tissues). Pathological changes in the sinus cavity and paranasal structures should be eliminated as planned before the sinus-lifting operation.

Modern aspects of diagnosis and treatment of odontogenic perforated sinusitis

The article discusses the most common causes of maxillary sinus perforation and odontogenic perforated sinusitis in modern conditions. Perforation of the bottom of the cavity of the maxillary sinus is one of the most common complications arising directly during the operation of tooth extraction. The resulting communication between the oral cavity and the nasal cavity should be eliminated as soon as possible in the most optimal way. Rational diagnostics, treatment and methods of prophylactic activities of mentioned above complications were also suggested.

ПРИМЕНЕНИЕ СУБЭПИТЕЛИАЛЬНОГО ВАСКУЛЯРИЗИРОВАННОГО НЕБНОГО ЛОСКУТА И PRF В КОМПЛЕКСНОЙ ТЕРАПИИ ОСТРОГО ОДОНТОГЕННОГО ПЕРФОРАТИВНОГО ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА

Subject. The article presents the results of a comprehensive method for the treatment of acute perforated maxillary sinusitis using the developed surgical method for eliminating perforation with a subepithelial vascular palatal flap with simultaneous use of PRF. The effectiveness of the proposed method of treatment was confirmed by x-ray data characterizing the intensity of the inflammatory reaction caused by surgery, morphological parameters of soft tissues in the alveolar process of the upper jaw in the area of intervention and the state of the maxillary sinus before and 3 months after surgery. The aim of the study was to evaluate the effectiveness of the use of subepithelial vascular palatal flap and PRF in the complex treatment of acute odontogenic perforated maxillary sinusitis. Methodology. An assessment and comparative analysis of the activity of the inflammatory process caused by surgery, as well as the study and comparison of the morphological parameters of the alveolar ridge (the depth of the vestibule of the oral cavity, the width of the keratinized gums, and the thickness of the mucous membrane), the X-ray data evaluating the state of the maxillary sinus, before and after 3 months were carried out. after surgical procedures. The study involved 50 patients with acute perforated maxillary sinusitis (J01.0), who were divided into two groups: the main and comparisons. In the main group (25 people), a new developed method of surgical treatment was used (a method of subepithelial vascularized palatal flap with simultaneous use of PRF), in the comparison group (25 people), the traditional method of complex treatment, including a mobilized mucoperiosteal cheek flap to eliminate perforation of the maxillary sinus . Results. Based on the analysis of the data, pronounced manifestations of the inflammatory process of the postoperative period and negative treatment results using the traditional technique, which were absent in the treatment of patients with the developed surgical method, were revealed. Findings. An analysis of the results obtained during the study revealed the high efficiency of the developed method in comparison with the traditional one.

Pathophysiology of current odontogenic maxillary sinusitis and endoscopic sinus surgery preceding dental treatment

ObjectiveThe successful management of odontogenic maxillary sinusitis (OMS) involves a combination of medical treatment with dental surgery and/or endoscopic sinus surgery (ESS). However, there is no consensus for the optimal timing of ESS. Although several studies have emphasized dental surgery as the primary treatment modality for OMS, there is recent evidence to suggest that ESS alone may be an effective treatment approach.The purpose of this study is to retrospectively investigate the pathophysiology of the current intractable OMS and the role ESS, especially ESS preceding dental treatment, plays in its pathophysiology. MethodsNinety-seven adults (60 males and 37 females, 48 ± 12 years) who underwent ESS for intractable OMS were retrospectively examined. ResultsIn a great deal of the cases (85 cases, 87.6%), causative teeth of OMS were periapical lesions after root canal treatment (endodontics). The root canal procedures were not sufficient; hence, the root-canal-treated teeth had periapical lesions causing OMS.In postoperative nasal endoscopy and cone-beam CT scans for all patients, the natural ostiums and the membranous portions of the maxillary sinuses were enlarged and the ostiomeatal complexes remained widely open. The ventilation and drainage of all patients’ maxillary sinuses seemed to be successfully restored.Temporary acute sinusitis recurrence after primary ESS for OMS was observed in 10 cases (11.8%) when the patients caught a cold. However, since the natural ostium and the membranous portion of the maxillary sinuses and the ostiomeatal complexes remained widely open, antibiotic administration alone without dental treatment cured the temporary acute sinusitis.Regarding the causative teeth (endodontic treated teeth), in 83 out of 85 cases (97.6%), causative teeth were able to be preserved with only antibiotic treatment and without dental retreatment. In two cases, extraction of the teeth was necessary because the teeth became mobile. Regarding the causative teeth after dental restoration, in 2 out of 2 cases (100%), causative teeth were able to be preserved with antibiotic treatment alone. ConclusionESS is highly indicated for OMS requiring surgery. The treatment results of intractable OMS are exceptionally good once the ventilation and drainage of the maxillary sinus is successfully restored after surgery. Consequently, ESS can be considered the first-line therapy for intractable OMS caused by root canal treatment (endodontics) and dental restoration, followed by close dental follow-up and dental treatment when necessary.

The frequency of the development of a maxillary odontogenic sinusitis acording to various sings and standarts

According to statistics, among sinusitis of various etiologies, the frequency of odontogenic maxillary sinusitis averages from 26 to 40%. This disease affects mainly people of working age and occupies a signiticant place in the practice of a dental surgeon. Aim of the study was to analyze the frequency of occurrence of odontogenic sinusitis in the practice of a dentist- surgeon, tactics and principles of treating patients in an inpatient setting. Materials andmethods. The article presents the results of a retrospective epidemiological analysis of the incidence according to the case reports (70 case reports of inpatients) and records of surgical intervention of the Department of Maxillofacial Surgery in the Ivanovo Regional Clinical Hospital from 2016 to 2019. Results . In total, during the study period, 21 patients addressed chronic odontogenic sinusitis in the exacerbation stage and out of exacerbation, among them 12 (57%) men and 9 (43%) women. This pathology mainly affects men aged 40 to 50 years. The highest percentage of occurrence as a causative tooth was 1 molar - 76 ± 0.25%, 2 premolar, 2 and 3 molars, respectively in 5 ± 0.23%, 9 ± 0.20%and 10 ± 0.26% of cases (p < 0.001). The quantitative indicator of the period of hospitalization of patients in the hospital averaged 9.4 bed days. A total of 22 patients referred to chronic perforated sinusitis, among them 10 (45%) men and 12 (55%) women. Pathology is prevalent mainly among women 5060 years old. When analyzing causal teeth in the development of chronic perforated sinusitis, the highest percentage of occurrence as a causative tooth of 1 molar was also recorded - 67 ± 0.21%, the hospitalization period in the hospital is on average 9.95 bed days. All patients underwent radical maxillary sinusotomy on the right/left, plastic tistula. About 27 maxillary cysts related to the maxillary sinus, 27patients, among them 16 men and 11 women, came. Moreover, 22 (81%) patients had a root cyst, 4(15%) had a follicular from the third molar, and 1 (4%) had a malformation. The examined patients had Hxed teeth whose roots stand in the cavity of the cyst. Cysts occur in patients at almost any age, more often men suffer, the hospitalization period in the hospital averages 8.8 bed days. Conclusions . Women aged 50 to 60 years are more likely to suffer from chronic perforated sinusitis, and men from 30 to 60 years old are most prone to the formation of cysts that have grown into the maxillary sinus. In most cases, for all 3 nosological forms of the disease, the tirst molar was the causative tooth. When the maxillary sinus was involved in the inflammatory process, a radical sinusotomy was predominantly performed, significantly reducing the frequency of relapses.

Odontogenic sinusitis and sinonasal complications of dental treatments: a retrospective case series of 480 patients with critical assessment of the current classification.

SUMMARYThe term odontogenic sinusitis (OS) has proved less and less suitable to describe a series of pathological conditions related to dental procedures. We have introduced the term and classification ‘sinonasal complications of dental disease or treatment’ (SCDDT). This study aimed to review our cases and evaluate whether the classification used is applicable to everyday clinical practice. The sample was composed of patients treated for SCDDT from 2002 to 2018 in our Department of Otorhinolaryngology. All presented signs and symptoms of sinusitis and had a recent history of dental disease or treatment. All patients underwent multidisciplinary evaluation, flexible endoscopy and computed tomography (CT) scan. Patients were allocated into three groups depending on the aetiology of the complication, following the classification proposed by Felisati et al. The sample comprised 480 patients (44% men, 56% women) with a mean age of 52.36 years. Of these, 43 patients (9%) belonged to group 1 (class A), 105 (21%) to group 2 (50, 2A; 5, 2B; 27, 2C; 23, 2D) and 332 (70%) to group 3 (119, 3A; 213, 3B). A total of 454 patients (94.5%) had unilateral maxillary opacification, while only 26 cases (5.4%) started as bilateral inflammation. Nine of the latter cases (34.6%) presented a bilateral odontogenic focus, while the other 17 (65.4%) had a history of unilateral dental pathology. The results of this study suggest that SCDDT is a complex entity that needs a careful diagnostic approach based on CT scans and presurgical endoscopy.

Treatment Strategy for Odontogenic Sinusitis.

The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment. The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early. A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups. Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment. Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.

Combined approach by middle and inferior antrostomy for endosinusal inclavated tooth root

Abstract In the recent years, the development of stomatology with emphasis on dental implants procedures has led to an increase in the number of sinonasal complications. Sinonasal complications of dental disease and treatment are an important cause of sinus pathology, being responsible for 10-12% of all causes of chronic maxillary rhinosinusitis. The main etiological factors involved in odontogenic sinusitis are represented by dental fillings, tooth roots in traumatic extraction, dental implants displacement and parts of broken instruments. The diagnostic work-up includes evaluation of the symptoms, history of dental treatment, dental examination, CT scan and nasal endoscopy. The treatment is surgical and can be represented by transnasal endoscopic technique performed by the otorhinolaryngologist or a transoral technique performed by the maxillofacial surgeon when oro-antral fistulas are present. The endoscopic approach is preferred but has its limits when the tooth root is placed in the alveolar recess, or at the level of the anterior, medial and lateral wall of the maxillary sinus. Concurrent middle and inferior antrostomy provides a better view of the sinus and increases effectiveness of the surgical treatment with minimal physiological damage.

Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis.

Bacterial odontogenic sinusitis (ODS) is distinct from other forms of rhinosinusitis. Diagnosing ODS can be challenging because of nonspecific clinical presentations and underrepresentation in the literature. The purpose of this study was to compare maxillary sinus bacterial cultures between patients with ODS and chronic rhinosinusitis (CRS), to determine whether certain bacteria are associated with ODS. This was a retrospective case-control study of 276 consecutive patients from August 2015 to August 2019 who underwent endoscopic sinus surgery (ESS) for bacterial ODS, CRS without nasal polyps (CRSsNP), or CRS with nasal polyps (CRSwNP). When present, pus was sterilely cultured from maxillary sinuses after maxillary antrostomy, and aerobic and anaerobic cultures were immediately sent for processing. Demographics and culture results were compared between ODS and CRS patients, and then separately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different dental pathologies (endodontic vs oroantral fistula). The following bacteria were significantly more likely in ODS compared to CRS: mixed anaerobes, Fusobacterium spp., Eikenella corrodens, Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus. Staphylococcus aureus and Pseudomonas aeruginosa were inversely related to ODS. There were no significant differences in cultures between the different dental pathologies. Certain bacteria were more likely to be associated with ODS compared to CRS when purulence was cultured from the maxillary sinus. Physicians should evaluate for an odontogenic source of sinusitis when these ODS-associated bacteria are identified in maxillary sinus cultures.