Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball

Abstract

ObjectivesThe risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.MethodsOne hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.ResultsThere were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).ConclusionEndodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.

Clinical Characteristics of Sphenoid Sinus Fungal Ball Patients With Visual Disturbance

“…FB affects older women more frequently, with a male to female ratio of 1:2 [2,9,13]. The age distribution of our study (57%, >60 years and 76%, >50 years; mean age, 59.7 years) and the female predominance (76%) were similar to those described in a previous study [12].…”

“…The most frequently involved is the maxillary sinus followed by the sphenoid sinus. The prevalence of fungus balls is increasing rapidly in older age patients and those who have undergone endodontic treatment, particularly in the maxillary sinuses [2]. …”

The Role of Fungi in Diseases of the Nose and Sinuses

“…Many reports suggest that overfilling of maxillary cavities with zinc oxide could provide a nidus for development. 14,15 However, some patients with fungal balls have never had dental procedures and this theory would not explain sphenoid fungal balls. 16 Perhaps the simplest explanation is that fungal species deposited within the sinus via normal respiration and are inadequately cleared by mucociliary movement.…”

10.5937/mckg48-4337 = Non-invasive chronic fungal inflammation of the maxillary sinus mucosa as a cause of long-term cough: Case report

“…Kada teški metali, a naročito cink-oksid iz zubnog punjenja, dođu do šupljine sinusa, oštećuju mukocilijarni transport, čime se otežava prirodno eliminisanje gljivičnih spora koje su vazduhom dospele do sluzokože. Dalje, cink je poznat po sposobnosti da aktivira metabolizam mikroorganizama iz roda Aspergillus, da pospeši klijanje spora i ubrza rast gljivica (11,12). Studije su pokazale da u čak 84% slučajeva postoji udruženost gljivične lopte u maksilarnom sinusu i prethodnih stomatoloških intervencija na karioznim zubima (13).…”