u/PreferenceVirtual515

Hello everyone,

I'm writing to seek your advice regarding a persistent chronic sinusitis on my right side that has been ongoing since last March. After a CT scan of my sinuses, it was revealed that I have granulomas on teeth 11, 12, 13, 21, and 22 (all of which were root-canal treated in 2018). My ENT specialist suspects that these granulomas are the primary cause of my sinusitis, as I experience:

• Persistent purulent (green/yellow) or sometimes reddish nasal discharge from the right nostril,
• A constantly blocked right nostril,
• Intermittent hearing loss

I also suffer from Hidradenitis suppurativa (Verneuil's disease) and chronic periodontitis, which complicate my situation. Since 2023, my dental condition has worsened: periodontitis has set in, I have had several teeth root-canal treated, others extracted, and a bridge placed on the lower left side last January.

I have already undergone four different courses of antibiotics (including moxifloxacin, clindamycin, and amoxicillin-clavulanate), but the symptoms keep recurring. As I said, my ENT suspects the link between the dental granulomas and my sinusitis, but I need a dentist’s perspective on the following questions:

• Are dental granulomas on teeth 11, 12, 13, 21, and 22 the most likely cause of my chronic sinusitis? Especially tooth 13, which is close to the maxillary sinus ?
• How urgent is this situation ? I have a scheduled surgery on July 21st, and I need to resolve this infection beforehand to avoid complications or postponement.
• What are the best treatment options for my case? (Extraction, apicoectomy, endodontic retreatment, etc.)
• Could you recommend the most cost-effective and timely solution? The estimated cost for treating the mentioned teeth and my gums is around 10,000 euros, which is currently waaaaay beyond my budget.
• Will I be able to proceed with surgery on July 21st if the infection is not fully resolved but controlled with antibiotics? Would it be safe ?

Additionally, all the crowns on my upper teeth are bonded together. I don't drive. I quit smoking in December 2024. I have attached photos of today’s dental X-rays and a dental X-ray from 2023 for your reference. Apologies if they're upside-down. I'd greatly appreciate your opinion on how to proceed.