Bacteriology of Sinusitis of Odontogenic Origin

Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. Brook (16) studied the microbiology of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection. Polymicrobial infection was very common with 3.4 isolates/specimen and 90% of the isolates were anaerobes in both acute and chronic infections. The predominant anaerobic bacteria were AGNB, Peptostreptococcus spp., and Fusobacterium spp. The predominant aerobes were alpha-hemolytic streptococci, microaerophilic streptococci, and S. aureus.

S. pneumoniae, H. influenzae, and M. catarrhalis, the predominate bacteria recovered from acute maxillary sinusitis not of odontogenic origin (12,18), were mostly absent in acute maxillary sinusitis that was associated with an odontogenic origin. In contrast, anaerobes predominated in both acute and chronic sinusitis.

The microorganisms recovered from odontogenic infections generally reflect the host's indigenous oral flora. The association between periapical abscesses and sinusitis was established in a study of aspirate of pus from five periapical abscesses of the upper jaw and their corresponding maxillary sinusitis (15). Polymicrobial flora was found in all instances, where the number of isolates varied from two to five. Anaerobes were recovered from all specimens. The predominant isolates were Prevotella, Porphyromonas, Peptostreptococcus spp., and F. nucleatum. Concordance in the microbiological findings between periapical abscess and the maxillary sinus flora was found in all instances. The concordance in recovery of organisms in paired infections illustrates the dental origin of the infection, with subsequent extension into the maxillary sinus. The proximity of the maxillary molar teeth to the floor of the maxillary sinus allows such a spread.

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