Sometimes, teeth can grow in the wrong places, like in the case of tooth roots extending into the nasal cavity or the maxillary sinus.
This is rare, but it can happen, causing symptoms like difficulty breathing through one nostril, swelling on one side of the face, abscesses on the cheek, tears from the eye on the same side as the tooth, and even a hole between the sinus and the skin on the cheek.
These symptoms can be mistaken for other conditions like a foreign object in the nose. While teeth growing in unusual places is not common, it’s important to consider as a possible cause for persistent symptoms, especially when it happens in children.
Causes of tooth growing into sinus cavity
A tooth that exists in the nasal cavity or maxillary sinus is a rare form of supernumerary tooth. Supernumerary teeth are extra teeth that can appear in the mouth, and are rare, occurring in about 0.1 to 1% of the population. They can be found in abnormal locations, such as the nasal cavity, and can be single or paired, erupted or impacted, and may lie in different positions – vertically, horizontally, or upside down.
Supernumerary teeth are usually located in the upper jaw, and are most commonly found in permanent teeth rather than baby teeth. They can prevent the eruption of normal teeth and lead to their misalignment later in life, so it’s important to identify and remove them.
The cause of supernumerary teeth is not completely understood but it is thought that genetic factors and developmental disturbances can contribute to their formation. These include:
- Thin tooth buds or hyperactivity of certain cells
- Factors like crowding of teeth, infections, or developmental issues can also lead to extra teeth.
- In rare cases, osteomyelitis (an infection of the bone) in the upper jaw can cause teeth to grow in the nasal cavity.
Sometimes, ectopic teeth can cause complications, such as nasal obstruction, cheek swelling, or oroantral fistula. X-rays can be useful in detecting supernumerary teeth.
Symptoms of tooth root in sinus cavity
In the event that a tooth root has extended into the sinus cavity, you may experience the following symptoms:
- Nasal obstruction – A condition where there is a blockage or narrowing of the nasal passages, making it difficult to breathe through the nose.
- Epistaxis (nosebleeding) – This occurs when there is bleeding from the blood vessels inside the nose.
- Headaches – Pain or discomfort in the head or neck region.
- Rhinolith formation – Refers to the formation of a stone-like object in the nasal cavity due to the buildup of calcium, mucus, and other debris.
- Epiphora – Refers to excessive tearing or watery eyes.
- Sinusitis – Inflammation or infection of the sinuses, which can cause symptoms such as facial pain, nasal congestion, and headache.
- Oro-antral fistula – A communication between the mouth and the maxillary sinus, which can occur due to a variety of causes such as trauma, infection, or dental procedures. It can cause symptoms such as pain, swelling, and discharge.
Diagnosis of tooth root in sinus cavity
According to a study by Dhingra & Gulati (2015), the presence of teeth in the wrong areas, such as the maxillary sinus or nasal cavity may not reveal any symptoms for years, which is a common cause of misdiagnosis. But with proper diagnosis and subsequent treatment through extraction of the tooth (and subsequent surgery by an ENT surgeon to manage any effects), the patient may enjoy smooth recovery, as in the cases below:
Case 1:
A 12-year-old boy came to the doctor with his mother because she noticed a white lump in his right nostril that had been there for 5 months. He didn’t have any symptoms, but the lump worried her. The doctor found a tooth-like object deep in the boy’s nose, and they decided to remove it. The tooth was successfully removed, and the boy had a smooth recovery.
Case 2:
Another 12-year-old boy came to the doctor with a blocked right nostril and occasional bloody discharge for 3 years. The doctor found a tooth-like structure in the boy’s nasal cavity, and they decided to remove it. The tooth was easily removed, and the boy had surgery to clear up an infection in his sinuses. He had a good recovery.
Case 3:
A 12-year-old boy had a swelling on his right cheek with a small hole that had been there for 6 months. He had a history of injury to that area. The doctor found a cyst in his right maxillary sinus with a tooth inside, and decided to remove it. They found a tract that went from the sinus to the hole in his cheek, and they removed it as well. The boy had surgery to close up the hole, and he had a good recovery.
Diagnosis & Treatment Options
An X-ray can show if there are any extra teeth in your nose or sinuses. Another type of X-ray called an orthopantogram can show where the extra tooth is in relation to your other teeth. If the tooth is surrounded by tissue or bone, a non-contrast CT scan may be needed to see its position and how it’s impacted.
Surgical tooth extraction is usually the best way to remove extra teeth in your nose or sinuses to prevent problems. If the child is still growing, it’s better to wait until their permanent teeth have come in before removing the extra tooth. After surgery, the individual should continue to have regular X-rays to check for complications.
The tooth will be removed under local or general anesthesia. Sometimes, difficulties may arise if it’s in a bony socket or causing bleeding. In rare cases, if the tooth is too big to remove from the front of the nose, it can be pushed back and removed through the back of the nose.
There are different types of surgery to remove the extra tooth depending on where it is. Endoscopic surgery can be less invasive than conventional methods, and it’s a good option if the extra tooth is near the maxillary sinus.
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