Dental disease: a frequently unrecognized cause of maxillary sinus abnormalities?

Periodontal disease may be a frequently unrecognized cause of maxillary sinus disease. The purposes of this study were to determine if maxillary sinus disease is more prevalent in patients with periodontal disease than in an age-and-sex-matched control group and to show radiographically an association of focal maxillary sinus disease with periodontal disease.

Maxillary DentaScans (General Electric Medical Systems, Milwaukee, WI) of 84 patients (168 maxillary sinuses) with periodontal disease were retrospectively evaluated for the simple presence or absence of maxillary sinus disease. This group was compared with an age-and-sex-matched control population of 84 patients who were referred for head or neck CT scans in which the maxillary sinuses (including their inferior aspects) were visualized. For the likelihood of sinus disease in patients compared with controls, an odds ratio and a 95% confidence interval were calculated using the SYSTAT version 5.2 (SYSTAT, Evanston, IL). In the second portion of the study, the subject population alone was graded in the following fashion to establish a causal relationship: grade 0, no sinus disease; grade 1, focal sinus disease not adjacent to periodontal disease (unlikely to be caused by periodontal disease); grade 2, nonfocal sinus disease (complete opacification, air-fluid levels, or diffuse mucoperiosteal thickening; indeterminate cause), and grade 3, focal sinus disease adjacent to periodontal disease (likely to be caused by periodontal disease).

In the subject population--patients with periodontal disease who were referred for DentaScans--100 of 168 (60%) sinuses had sinus disease; in the control population, only 49 of 168 (29%) sinuses had sinus disease. The odds ratio for maxillary sinus disease in the patient population compared with controls was 3.6 (95% confidence interval, 2.3-5.6; p<.0001). The grading results of the subject population in the second portion of the study were grade 0, 68 sinuses (41%); grade 1, four sinuses (2%); grade 2, 32 sinuses (19%); and grade 3, 64 sinuses (38%).

We have demonstrated a twofold increase in maxillary sinus disease in patients with periodontal disease and have shown a causal relationship. Recognition of this relationship may have an impact on the clinical management of patients, particularly those planning implant surgery.