Microbiology of periapical abscesses and associated maxillary sinusitis
Secondary maxillary sinusitis is a known complication of periapical abscesses of the upper jaw. The infection may spread from the involved sinus to the central nervous system, where it can cause serious complications such as subdural empyema, brain abscess, or meningitis.
In the following study, aspirate of pus from five periapical abscesses of the upper jaw and their corresponding maxillary sinusitis were studied for aerobic and anerobic bacteria. Polymicrobial flora were found in all instances, with the number of isolates varying between two and five. Anaerobic bacteria were isolated from all periapical abscesses and maxillary sinuses. The predominant isolates were Prevotella sp., Porphyromonas sp., Fusobacterium nucleatum, and Peptostreptococcus sp. Concordance in the microbiological findings between the periapical abscess and the maxillary sinus flora was found in all instances. Certain organisms were only present at one site, however, and not the other sites in all instances. P. gingivalis, Streptococcus sanguis, and Streptococcus milleri were found only in periapical abscesses. Five betalactamase-producing organisms were present in two abscesses and three sinuses. These were P. intermedia (three isolates) and F. nucleatum (two isolates).
The data presented in this study support the importance of anaerobic bacteria in periapical abscesses and demonstrate their predominance in maxillary sinusitis that is associated with them. [I.S.]
Brook, I., E.H. Frazier, and M.E. Gher Jr., J Periodont, 67:608,1996