Management of Acute Dental Problems

Brief description of condition

Sinusitis, also known as rhinosinusitis, refers to inflamed sinuses, almost always accompanied by inflamed adjacent mucosa. The most common trigger is a viral upper respiratory tract infection.

Sinusitis is a generally self-limiting condition that has an average duration of 2.5 weeks. Only around 2% of sinusitis cases are complicated by bacterial infections. Toothache arising from upper posterior teeth can be difficult to distinguish from sinusitis.

Key signs and symptoms

• Pain [facial, headache, toothache (especially upper teeth), when bending down]
• Nasal congestion / obstruction
• Decreased sense of smell
• Fever
• Fatigue
• Purulent discharge

Initial management

Recommend optimal analgesia.

Determine whether there are signs of bacterial infection: symptoms have worsened or persisted for more than a week or are severe, particularly when accompanied by fever or purulent discharge

If there are no signs of bacterial infection:

• Advise the patient to use steam inhalation (though due to risk of scalding this is not recommended for children).
• Advise the patient to see a general medical practitioner if symptoms worsen or last for more than a week.

If bacterial infection is present:

• Prescribe antibiotics (see SDCEP ‘Drug Prescribing for Dentistry’ guidance).

Subsequent Care

Advise the patient to see a general medical practitioner if symptoms worsen or persist.

Consider prescribing oral corticosteroids as an adjunct to antibiotics in symptom relief.

References

1. Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H, Williams JW, Makela M. Antibiotics for acute maxillary sinusitis. Cochrane Database of Systematic Reviews 2008, Issue 2.Art.No.:CD000243. DOI:10.1002/14651858.CD000243.pub2.
2. SDCEP. Drug prescribing for dentistry: dental clinical guidance, 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme, 2011.
3. Shaikh N, Wald ER, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.CD007909. DOI:10.1002/14651858.CD007909.pub2.
4. Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasziou PP, Rovers MM. Systemic corticosteroids for acute sinusitis. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008115. DOI: 10.1002/14651858.CD008115.pub2.
5. Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD005149. DOI: 10.1002/14651858.CD005149.pub3.