Sinusitis
Brief description of the 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 generally a self-limiting condition that has an average duration of 2½ 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 (see Appendix 2).
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.