Are We Missing Something in the CT-PNS Report? – an Observational Study on the Rate of Reporting the Presence of Dental Disease and the Probable Etiology of Sinusitis on CT Scans

OBJECTIVES: To (i) identify the prevalence of dental disease, (ii) identify the proportion of sinusitis cases that could be considered odontogenic in origin and, (iii) audit the rate of diagnosis of incidental dental disease and odontogenic sinusitis in radiology reports on CT scans covering the maxillary teeth and sinuses. MATERIALS AND METHODS: Images and reports of CT studies performed in our institution that covered the paranasal sinuses and maxilla were retrospectively audited for documentation of findings pertaining to maxillary sinusitis and maxillary dental disease. Trauma cases, edentulous and pediatric patients and patients without maxillary sinusitis or dental disease were excluded. The etiologies of maxillary sinusitis was defined as likely odontogenic, indeterminate and rhinogenic sinusitis. Only molar and pre-molar tooth disease were considered as these are most commonly in direct contact with the floor of the maxillary sinus. RESULTS: One-hundred sixty CT studies were reviewed. The prevalence of dental caries and periapical lucency was 80.6% and 15.0%, respectively. The cause of sinusitis was determined to be likely odontogenic in 30.0%, rhinogenic in 33.1% and of indeterminate origin in 36.9%. The rate of reporting dental findings or raising the suspicion of odontogenic sinusitis was 8.5% (n = 14). CONCLUSIONS: Under-reporting of dental disease and odontogenic sinusitis is common. Early recognition results in higher chances of salvaging the diseased tooth, preventing complications and providing appropriate treatment. An urgent and collective effort by the radiological fraternity is warranted to recognize the significance of reporting of dental pathologies, even in CT scans done for other indications.