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.^[1] The condition often presents as a small, erythematous nodule or an opening on the gingiva or alveolar mucosa, which may intermittently discharge purulent material.^[2] 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.^[3]

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.^[4] 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.^[5] If left untreated, the infection may progress to more severe complications, including osteomyelitis, cellulitis, or deep fascial space infections.^[6]

Correct diagnosis is essential, as intraoral dental sinuses can be misdiagnosed as periodontal abscesses or mucosal lesions of non-odontogenic origin.^[7] 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.^[8] 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.^[9]

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.