Knowledge, attitudes and practices of dental surgeons in the management of patients with odontogenic maxillary sinusitis in the city of Yaoundé

Abstract

BACKGROUND: Odontogenic maxillary sinusitis, also known as sinusitis of dental origin is a well-known but understudied form of sinusitis that requires a well codified treatment regimen. It is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. It may have several causes such as infections of antral teeth leading to the violation of the sinus membrane, pathologic lesions of the jaws and teeth, maxillary (dental) trauma, or iatrogenic causes such as complications of dental and implant surgery, endodontic treatment and maxillofacial surgery procedures. From a holistic perspective, the management of odontogenic maxillary sinusitis demands proficuous collaboration between the dentist and an ENT specialist; because odontogenic maxillary sinusitis is a border condition between otolaryngology and dental science. OBJECTIVE: The objective of this study was to assess the knowledge, attitudes and practices of dental surgeons in the management of patients with odontogenic maxillary sinusitis in the city of Yaoundé. METHODOLOGY: We conducted a descriptive cross-sectional study in some public and private hospitals, as well as private dental cabinets in the city of Yaoundé. The study was carried out over a period of four months, from January 2023 to April 2023. We carried out a consecutive non-probabilistic sampling of all registered dental surgeons working in the city of Yaoundé. The software used for data entry and analysis were SPSS 23, Excel 2013 with a significance level set at 5 %. The variables evaluated during the study using a pre-established questionnaire were socio-demographic data (age, gender, number of years in service, type of working place, domain of specialization, bucco-dental school attended), knowledge on odontogenic maxillary sinusitis, clinical and paraclinical assessment of odontogenic maxillary sinusitis, education and training in the management of odontogenic maxillary sinusitis, attitudes towards patients with odontogenic maxillary sinusitis, management and preventive practices. PRINCIPAL RESULTS: Of the 97 respondents, 31 responded through the online Google form (31.96 %), while the rest (68.04 %) responded through the printed questionnaires. Majority of our participants (82.5 %) had not received any special training for the management of OMS and 34.0 % agreed they have an information deficiency on the disease. 33.0 % of our study population said they found it difficult to diagnose OMS in their daily practice and 25.8 % said they do not feel comfortable handling OMS cases. According to most participants, the maxillary second premolar was the tooth with the highest probability of causing OMS (37.1 %), iatrogenic factors constituted the highest risk factors (96.9 %), nasal congestion was the highest clinical sign (91.8 %) and orbital cellulitis was the most common complication (92.8 %). Of the various treatment options proposed for OMS, most participants chose antibiotherapy (96.9 %) and for combined treatment options, most chose dental treatment and antibiotherapy together (67.3 %). A good number of participants (42.3 %) said they do not see any need to refer a patient to an ENT specialist once they are able to identify and treat the dental source of the sinusitis. 61.9 % knew and used the Valsalva maneuver after the extraction of an antral tooth to determine if there is oroantral communication. Only 10.3 % said they use retroalveolar X-rays before commencing treatment procedures on antral teeth and for follow up. Overall, 54.6 % of the participating dental surgeons had an average knowledge on odontogenic maxillary sinusitis, 4.1 % had a good knowledge, 33.0 % had insufficient knowledge and 13.4 % had a poor knowledge. For attitudes, 33.0 % had attitudes that fall within the average range, 4.1 % had good attitudes, 33.0 % had attitudes that fall within the insufficient range and 29.9 % had poor attitudes. For practices, 40.2 % had practices that fall within the average range, 29.9 % had practices that fall within the insufficient range, 25.8 % had poor practices and 4.1 % had good practices. CONCLUSION: This study reveals that dental surgeons have limited (average) knowledge as regards the management of odontogenic maxillary sinusitis, resulting in mediocre attitudes and practices. Very few dental surgeons have received special training for OMS management and prevention. This is why iatrogenic factors remain the leading causes of OMS. There is a need for OMS to be given serious attention in the dental curriculum of our medical faculties. Many prospective studies are needed to determine the best approach to caring for this patient population.