Among the 28,761 participants in KNHANES from 2008 to 2012, maxillary periodontitis was significantly associated with CRS, showing a high OR in multivariable logistic regression analysis. An analysis of 14,657 participants found that this trend was more prominent in the drinking group than in the non-drinking group. Due to the small sample size, statistical analysis of the association between CRS and periodontitis in smokers was not performed.
This is the first CRS study using the nationwide large-scale KNHANES, which represents the health and nutritional status of the general population in Korea.number 17. Although the association between CRS and periodontitis has been analyzed before, this study is meaningful because both dentists and otolaryngologists were involved in the diagnosis of participants’ current condition and did not rely on self-questionnaires or diagnostic codes. Therefore, participants in this study were diagnosed by experts, and the diagnostic criteria for CRS were based on the EPOS 2020 guidelines.
Odontogenic sinusitis is an inflammatory disease of the sinus mucosa caused by dental pathology, usually due to inflammation of the maxillary sinus due to previous dental surgery or traumaeleven.The most common cause of odontogenic CRS is iatrogenic damage to the mucoperiosteum or Schneider’s membrane, which allows mechanical spread of inflammation into the maxillary sinus.18. This cause accounts for approximately 65.7% of odontogenic sinusitis cases19. Therefore, odontogenic sinusitis has been a focus of attention when studying the impact of iatrogenic trauma to the upper dental region on the development of CRS. We hypothesize that not only direct trauma from iatrogenic dental procedures but also the spread of inflammation caused by periodontitis can indirectly cause microstructural changes in Schneider’s membrane. Because the participants with periodontitis in this study included not only those with iatrogenic injury but also those with dental inflammation, the findings suggest that periodontitis not related to iatrogenic injury may also be Influence the occurrence of CRS.
Inflammatory conditions in the bone compartment may explain the association between CRS and periodontitis. Osteomyelitis is an inflammation of the bone that begins in the medullary cavity and extends to the cortical bone.Patients with chronic periodontitis are more likely to develop osteomyelitis20,21.The proposed cause is biofilm produced by oral anaerobic bacteria, which can even affect inflammation of distant bones such as the femur via the bloodstreamtwenty two. In addition, periodontitis can easily cause lesions in adjacent tissues of the mouth (such as the maxilla), leading to chronic inflammation of the paranasal sinuses.
Anatomical proximity may also explain the association between chronic sinusitis and periodontitis. A similar mechanism is present in deep neck infections, which are characterized by cellulitis or abscesses in the cervical spaces and fascial planes.twenty three.The most common cause of deep neck infection is dental infection, which spreads along the connective tissue from the mouth to the adjacent cervical spacetwenty four. Likewise, the proximity of the maxillary gingiva and sinuses to the maxillary bone allows inflammation to easily spread from one structure to another through the maxillary bone. We speculate that commonality and anatomical proximity of inflammatory conditions may establish a link between chronic sinusitis and periodontitis.
In a previous study, chronic alcohol consumption was found to have systemic effects and induce multifocal osteonecrosis25.Osteonecrosis refers to the destruction of bone compartments such as bone cells and bone marrow, resulting in a significant chronic inflammatory state26.According to some studies, osteonecrosis causes synovial inflammation and activates immune cells in the joints, even in patients without the confounding symptoms of arthritis27. Since the oral mucosa of the upper jaw is in direct contact with alcohol, necrotic changes in the bony structure or mucosa, including Schneider’s membrane, are more likely to occur. Alcohol-induced changes in maxillary osteonecrosis may cause a CRS-like inflammatory response, which is similar to the pathogenesis of arthritis, thereby inducing immune cell responses in the joints of patients with systemic osteonecrosis.
Meanwhile, place of residence, education level, and household income showed statistically significant differences between CRS participants and control participants in the analysis of baseline characteristics, although they did not contribute independently in the multivariable logistic regression analysis.International guidelines examine the exacerbating or contributing role of demographic factors and note that causation cannot be clearly established28. In the case of our data from KNHANES, the effects of atmospheric exposure may be more pronounced among participants living in rural areas than among those living in urban areas. Several studies have reported that air pollutants such as particulate matter with an aerodynamic diameter ≤ 10 µm (PM10) in the atmosphere associated with CRS29.30. From the results of this study, it is difficult to determine the exact causal relationship between CRS and baseline demographic factors. However, multivariable regression analysis showed that after adjusting for other factors, CPI was an independent factor related to CRS. It can be speculated that poor periodontal status may be related to living in rural areas, lower family income, or lower education level. .
A limitation of this study is that due to the cross-sectional design, a causal relationship between CRS and periodontitis cannot be determined. In addition, the KNHANES data only include endoscopic examination results from 2008 to 2012. After 2013, without endoscopy results, the current trend of the relationship between CRS and CPI cannot be analyzed. Additionally, although specialist endoscopy findings are used to diagnose CRS, some patients may have polyps or secretions in the back of the nasal cavity (such as the posterior ethmoid or sphenoid sinuses), which are difficult to detect and may lead to sinusitis. . It remains undiagnosed. Paranasal sinus computed tomography can help more accurately identify participants with CRS. Finally, CPI measurements are affected by the pressure applied during probing and inter-examiner variability (sensitivity ~66%, specificity ~85%)31, considering KNHANES is a large-scale study, this may lead to errors. Another limitation of dental examinations is that the CPI does not grade each tooth but rather four areas of the mouth; upper right, upper left, lower right and lower left.