Pathophysiology of Odontogenic Maxillary Sinusitis Arising from Marginal Periodontitis with Ascending Pulpitis

Ascending pulpitis refers to inflammation of the dental pulp that progresses from the apical region toward the coronal portion of the tooth. The purpose of this study is to investigate novel insights into the pathophysiology of OMS arising from marginal periodontitis with ascending pulpitis.

Five adult patients diagnosed with OMS arising from marginal periodontitis were examined. Histological analysis of the causative teeth of OMS was conducted.

No coronal lesions (e.g., dental carious lesions) were observed in the causative teeth of OMS. Histologically, the periodontal ligament of the involved teeth exhibited necrosis, confirming the presence of marginal periodontitis. Within the pulp cavity of the causative tooth, both odontoblasts and pulp cells had disappeared, and necrosis was observed in the root canal and portions of the pulp chamber, indicating ascending pulpitis and pulpal necrosis. Additionally, inflammatory granulation tissues were present at the apex, consistent with apical periodontitis.These findings of the causative teeth of OMS suggest the following pathological sequence: marginal periodontitis initiated ascending pulpitis and pulpal necrosis of the tooth; these, in turn, led to the development of apical periodontitis, which subsequently caused OMS.

In cases with absence of coronal lesions (e.g., dental carious lesions), diagnosing ascending pulpitis and pulpal necrosis is challenging and is not always straightforward. A thorough understanding of the pathophysiological progression - from marginal periodontitis to ascending pulpitis, pulpal necrosis and apical periodontitis that ultimately leads to OMS - is essential. Clinicians must maintain a high level of suspicion for this condition in daily practice.