Intraoral dental sinus

An intraoral dental sinus is an abnormal channel that forms between a periapical infection and the oral cavity, allowing pus to drain into the mouth. It is a common consequence of chronic odontogenic infections, typically resulting from untreated dental caries, pulpal necrosis, or failed endodontic treatment. The condition often presents as a small, erythematous nodule or an opening on the gingiva or alveolar mucosa, which may intermittently discharge purulent material. While patients may experience discomfort during the initial infection phase, pain often subsides once the sinus tract establishes drainage, leading to delayed diagnosis and persistent low-grade infection.

The etiology of intraoral dental sinuses is primarily linked to periapical abscesses, which develop when bacterial infections from the root canal system extend into periapical tissues. The path of sinus tract formation is influenced by anatomical factors such as bone density and muscle attachments, determining whether the infection drains intraorally or extraorally. If left untreated, the infection may progress to more severe complications, including osteomyelitis, cellulitis, or deep fascial space infections.

Correct diagnosis is essential, as intraoral dental sinuses can be misdiagnosed as periodontal abscesses or mucosal lesions of non-odontogenic origin. Clinicians often use radiographic imaging, such as periapical radiographs or cone-beam computed tomography (CBCT), along with gutta-percha tracing to determine the source of infection. Management involves addressing the underlying cause through root canal treatment or tooth extraction, ensuring complete resolution of the infection and closure of the sinus tract.

This review discusses the pathophysiology, clinical presentation, diagnostic approaches, and management strategies for intraoral dental sinuses, emphasizing their significance in dental practice and the importance of timely intervention.