Chronic Rhinosinusitis as Source of Dental Pain on Tooth Evaluation

A 75-year-old male was referred for evaluation of spontaneous pain around tooth #2 that had persisted for approximately two years. Upon full-volume review of the CBCT, the radiologist found no significant overt odontogenic pathology on tooth #2 or the adjacent teeth. However, the radiologist identified partial soft tissue opacification with an air-fluid level and frothy secretions in the visualized portion of the right maxillary sinus, along with thickening and sclerosis of the cortical borders and suspected sinus tracts. The findings were consistent with a suspected acute exacerbation of chronic rhinosinusitis of the right maxillary sinus, which required further clinical evaluation and diagnosis. The radiologist noted that the adjacent sinus was a likely source of the patient's pain rather than the dentition, which, if confirmed clinically, would change the treatment approach from dental intervention to sinus management. This case illustrates how full-volume review and 3-D imaging can help differentiate between adjacent structures in the area of chronic pain, which may not be fully appreciated on 2-D imaging alone.