‫بسم هللا الرحمن الرحيم‬

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1.Know the relation between ENT and DENTAL
department.
2.Know how both are intimately related to each
other.
3.Understand how dental disease can present as
ENT complaint and vice versa.
4.Understand the concept of disease process.
5.Know the different treatment options and guide
patient to suitable doctor.
6.Select the best suitable option for management.
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 Skills and knowledge
1.How to examine patient with head and neck
complaint.
2.Know the possible etiology of the condition.
3.Assess the areas related to oro-gingival and jaw
diseases.
4.Evaluate the importance of the condition and
when to ask for consultation of other specialty.
5.Know how to assess and prepare the patient and if
he needs cooperation with other specialty.
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ENT

TEETH
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 ENT AND TEETH
•ENT manifestations of teeth
diseases
•Teeth manifestations of ENT
diseases
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 ENT manifestations of teeth diseases
• EARACHE
• FACIAL PAIN
• HEADACHE
• FACIAL SWELLING
• PALATAL AND ALVEOLAR SWELLING
• NECK SWELLING --- SUBMANDIBULAR CELLULITIS
(LUDWIGS ANGINA)
• OROANTRAL FISTULA
• NASAL OBST., DISCHARGE, HALITOSIS, EPISTAXIS---
(MAXILLARY SINUSITIS)
• TONGUE ULCER
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 Teeth manifestations of ENT diseases
• TEETH CARES
• TEETH LOSENING
• TEETH LOSS
• TOOTHACHE
• ALVEOLAR SWELLING
• OROANTRAL FISTULA
• JAW DEFORMITY
• TEETH MANIFESTATIONS OF SYSTEMIC DISEASES
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• Benign conditions
– Acute sinusitis
– Fungal sinusitis
– Oral ulceration
– Oral infections
– Dental cysts
– Oroantral fistula
– Benign tumours
– Gingival diseases
• Malignant conditions
– Maxillary cancer
– Dental cancer
– Lymphoma of maxilllary sinus 10
 Investigations
– RADIOLOGICAL
• X ray
– Sinus
– Dental
– Panorama
• Ulrasound
• CT scan
• MRI
– BIOPSY: FNAB, Incisional
– LABORATORY
• CBC, LFT,RFT,FBS --- SWAB C&S
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ALVEOLAR CANAL

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• EARACHE
History
• FACIAL PAIN
• HEADACHE
• FACIAL SWELLING
• PALATAL AND ALVEOLAR SWELLING
• NECK SWELLING --- SUBMANDIBULAR CELLULITIS (LUDWIGS ANGINA)
• OROANTRAL FISTULA
• NASAL OBST., DISCHARGE, HALITOSIS, EPISTAXIS--- (MAXILLARY SINUSITIS)
• TONGUE ULCER
• TEETH CARES
• TEETH LOSENING
• TEETH LOSS
• TOOTHACHE
• ALVEOLAR SWELLING
• OROANTRAL FISTULA
• JAW DEFORMITY
• TEETH MANIFESTATIONS OF SYSTEMIC DISEASES 15
 EXAMINATION
• ORAL, PALATAL
• DENTAL
• NASAL, ENDOSCOPIC
• FACIAL
• NECK
• EAR
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 Acute sinusitis
• Rhinosinusitis is defined as inflammation
of the nose and the paranasal sinuses
mainly rhinovirus, influenza and
parainfluenza viruses.
• Acute rhinosinusitis
Strept. Pneumoniae 31%, Haemophilus
influenza 21% , Anearobes 6%, Staph.
aureus 4%, Strept.pyogenes 2% and
Moreaxalla catarrhalis 2%.
• Chronic rhinosinusitis
Coagulase- negative Staph. 51% , Staph.
aureus 20% , Anearobes 3% and
Strept.pneumoniae 4%.
• Recurrent acute rhinosinusitis
• Acute exacerbations of chronic
rhinosinusitis
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 Fungal sinusitis
• Fungal Ball Aspergillus
• Allergic fungal RS
• Chronic or indolent invasive FTS
• Acute fulminant FRS Mucur and aspergillus

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 Oral ulceration
• Aphthous
• Traumatic
• Viral
• Tuberculous
• Syphilitic
• Malignant
• Necrotizing sialometaplasia
• Others
– Site
– Size
– Number
– Edge
– floor 19
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Oral infections

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 Dental cysts
• Dental
• is a cyst formed in
relation to the apex of
the root of a septic
tooth.

• Dentigerous
• cyst formed in relation to
an unerupted tooth.

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 Oroantral fistula
• Oroantral Communication is an
abnormal communication
between the maxillary sinus and
the oral cavity. It may be the
result of different pathological
processes and often occurs
following an extraction. Other
causes include: infection,
inflammatory conditions,
neoplasm, Paget’s disease,
iatrogenic injury, and trauma. 24
 LUDWIGS ANGINA
• Submandibular space infection is
acute cellulitis of the soft tissues
below the mouth.
• Symptoms include pain,
dysphagia, and potentially fatal
airway obstruction.
• Diagnosis usually is clinical.
Treatment includes airway
management, surgical drainage,
and IV antibiotics.
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• Submandibular space infection is a
rapidly spreading, bilateral, indurated
cellulitis occurring in the suprahyoid
soft tissues, the floor of the mouth,
and both sublingual and submaxillary
spaces without abscess formation.
Although not a true abscess, it
resembles one clinically and is treated
similarly.

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• The condition usually develops from an odontogenic
infection, especially of the 2nd and 3rd mandibular molars, or
as an extension of peritonsillar cellulitis. Contributing factors
may include poor dental hygiene, tooth extractions, and
trauma (eg, fractures of the mandible, lacerations of the floor
of the mouth).
• Antibiotics should be chosen to cover both oral anaerobes
and aerobes (eg, clindamycin ampicillin sulbactam, high-dose
penicillin).

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•
Benign tumours
Hyperplasias
• Fibroma
• pyogenic granuloma
• Papillomas
• Pleomorphic adenoma
• Lymphangioma
• Hemangioma
• Lipoma
• Neurofibroma
• Granular cell tumour
• Osteoma
• Ossifying fibroma
• Fibro-oseous dysplasia
• Aneurysmal bone cyst
• Torus
• Others 28
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Gingival diseases

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Maxillary cancer
The majority of tumors of the
paranasal sinuses present with
advanced disease, and cure rates
are generally poor (≤50%).
Squamous cell carcinoma (SCC) is
the most frequent type of
malignant tumor in the nose and
paranasal sinuses (70%–80%).

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 Looseness of tooth may
be the presenting c/o
• The cancers grow within the bony
confines of the sinuses and are often
asymptomatic until they erode and
invade adjacent structures
• Nodal involvement is infrequent.
Although metastases from both the
nasal cavity and paranasal sinuses
may occur, and distant metastases
are found in 20% to 40% of patients
who do not respond to treatment,
locoregional recurrence accounts for
the majority of cancer deaths since
most patients die of direct extension
into vital areas of the skull or of
rapidly recurring local disease. 32
• c/o: Nasal mass or obstruction,
rhinorrhea, epistaxis, cranial
neuropathies, or pain. Long-
standing lesions may alter the
patient's facial features causing
asymmetry or proptosis.
• Visual disturbances and
paresthesias are not
uncommon.
• On occasion, malocclusive
phenomenon occurs with a
notable mass effect arising from
the floor of the maxilla and hard
palate.
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 Dental cancer
• Odontogenic carcinomas
– malignant ameloblastoma
– primary intraosseous carcinoma
– malignant variants of other odontogenic
epithelial tumours
– malignant changes in odontogenic cysts
• Odontogenic sarcomas
• Odontogenic carcinosarcomas

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Lymphoma of maxilllary sinus
• Lymphomas are malignant
neoplasm of lymphoreticular
cells. Malignant lymphomas of
the oral cavity represent 5% of
all lymphomas and are most
common among male patients
between 50-70 years of age.
Hematologic malignancies are
very often seen in
immunocompromised patients.
Large B-cell lymphoma (LBCL) is
the most common non-
Hodgkin's lymphoma.

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 DENTAL CARE FOR ENT PROCEDURES
• PRE-OPERATIVE: TOTAL LARYNGECTOMY, NECK
DISSECTION OR MAJOR ORAL SURGERY
• PRE-OPERATIVE FOR MAXILLARY AND PALATAL
SURGERY (DENTAL OBTURATOR)
• PRE- RADIOTHERAPY
• PRE- ENDOSCOPY UNDER GA
• POST-OP. FOR DENTAL CARE
• PRE-OP. IN RHEUMATIC HEART PT
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Types of dental and oral side effects
Side effects of the mouth caused by cancer treatment
may include:
• Dry mouth (xerostomia)
• Mouth sores (mucositis)
• Tooth decay
• Difficulty swallowing (dysphagia)
• Difficulty chewing or opening the mouth
• Infection
• Bone disease
• Inflammation or pain in the lining of the mouth and
tongue 37
 EARACHE

TMJ DENTAL

CERVICAL PHARYNX

PNS LARYNX

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 Otalgia
• Primary (Aural)
Otitis externa
Perichondritis
Acute otitis media
Complicated CSOM
Otitic barotrauma
Rupture TM
• Secondary (Referred)
Auriculotemporal nerve (V)
Lesser occipital ( C2.)
Greater auricular (C2, C3).
Vagus
Jacobson’s nerve (IX)
Caroticotympanic sympathetic plexus
Referred Otalgia (Auriculotemporal nerve of V)
• Oral Cavity

Dental Caries Tongue Ulcer Gingivitis

• Acute sinusitis
• TMJ Disorders

• Trigeminal Neuralgia
Referred Otalgia (Lesser occipital C2 & greater auricular C2,3)
 Referred Otalgia (Arnold’s nerve X)

Glottic carcinoma Postcricoid carcinoma

Supraglottic carcinoma
 Referred Otalgia (Jacobson’s nerve IX)

Acute Tonsillitis AFT

Tumour Post Tonsillecomy

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FACIAL PAIN& HEADACHE

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 Diagnosis Features

History
Severe pain; feels deep
of URI within Child pulling on ear
inside the ear.
10 days
Acute otitis media

Fever Hearing loss Pain may disrupt sleep

Perforated tympanic
Discharge followed by pain improvement
membrane

History of URI >10 Recent history of URI or

Children
days ear infection

Pain is located behind the

Mastoiditis May see signs of ear with postauricular (i.e.
Fevers/chills
otitis media on exam near mastoid process)
swelling

Diagnose with CT

May see perforation of

Chronic suppurative otitis Conductive Relapsing/remitting
tympanic membrane
media hearing loss or chronic discharge
or cholesteatoma on exam

Serous otitis media No signs of Prominent hearing May have history of URI or
infection loss acute otitis media
(Otitis media with effusion)

Swimming Psoriasis Seborrheic dermatitis

Q-tips in the
Bilateral pain Scaling
Otitis externa ear
Pain exacerbated May see granulation tissue
Itching
when ear is pulled in canal on exam
Immuno- Constant pain with
Necrotizing/malignant Diabetes
compromised increasing severity at night
otitis externa Purulent Pain out of proportion Biopsy granulation tissue
discharge to exam findings for culture
Recent ear Chondritis more likely46 than
External ear appears
Chondritis vs perichondritis trauma (i.e. ear perichondritis if ear shape
inflamed
piercing) is distorted
 FACIAL SWELLING
• History
• Examination
• Signs of inflammation
• Radiology
• Laboratory

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 PALATAL AND ALVEOLAR SWELLING
• Radiology
– CT scan PNS, upper jaw, MRI
• Biopsy (incisional)

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• Aetiology
– Minor salivary gland tumours
• Adenoid cystic carcinoma
• adenocarcinoma
– Torus
– Bone tumours
– Maxillary tumours
– Midline grauloma
– Necrotizing sialometaplasia

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NECK SWELLING
• History of dental disease
• Signs of infection
• Air way assessment is very important
• Early antibiotic treatment
• Anaerobic antibiotic is added
• Incision and drainage is considered
• Dental treatment of affected tooth
• Parapharyngeal spaces infection can
happen due to dental infection
• Lymph node enlargement can be due
to acute lymphadenitis due to tooth
infection or metastasis of
odontogenic carcinoma. 50
OROANTRAL FISTULA
• Mostly after extraction of the
upper 2nd molar followed by
the upper first molar teeth.
• May be malignant fistula due
to maxillary carcinoma
• The likelihood of the
development of a
communication is increased if
there is pre-existing sinus
disease, periapical infections,
or if the floor of the sinus is in
close proximity to the tooth
roots 51
Unilateral maxillary sinusitis, dental
causes is considered
• Following the creation of an oro-
antral communication, the patient
may experience various symptoms
including air and fluids passing into
the nose and mouth.
• The diameter of the communication
usually decreases over time but often
the ‘tract’ from the antrum to the
mouth fails to heal and becomes lined
by epithelium. Once this occurs the
communication is referred to as a
fistula. This fistula acts as a pathway
for infection and can result in the
development of acute sinusitis which
further impedes healing. 52
NASAL OBST., DISCHARGE, HALITOSIS,
EPISTAXIS
• Unilateral maxillary sinusitis
• Unilateral nasal obst., offensive
nasal discharge.
• Halitosis.
• Offensive bad smell.
• Due to peri-apical tooth root
infection, tooth piece, tooth pix.
• Anaerobic infection is common
• FESS and treatment of tooth
infection are the treatment of
choice. 53
TONGUE ULCER

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JAW DEFORMITY
• Adenoid facies
– Protrusion of upper jaw due to
prolonged nasal obstruction in
adenoid enlargement.
– Recurrent mouth infection, teeth
decay due to mouth breathing.

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ORAL MANIFESTATIONS OF SYSTEMIC DISEASES
• GIT diseases • Pulmonary diseases
– Crohn disease – Cystic fibrosis
– Ulcerative colitis – Sarcoidosis
– Gastroesophageal reflux • Cutaneous diseases
– Chronic liver diseases – Psoriasis
• Hematologic diseases – Acantosis nigricans
– Anemias • Endocrine diseases
– Leukemia – Diabetes mellitus
• Connective-tissue diseases – Hypoparathyroidism
– Sjögren syndrome – Hyperparathyroidism
– Kawasaki disease – Cushing´s syndrome
– Scleroderma – Addison´s disease
– Lupus erythematosus • Renal diseases
– Behcet's syndrome – Uremic stomatitis
(disease)
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 Summary of oral manifestations of
gastrointestinal and hematologic diseases
Angular cheilitis Intraoral burning
• Iron-deficiency anemia • Iron-deficiency anemia
• Pernicious anemia
Hemorrhage
Candidiasis
• Pyostomatitis vegetans
• Crohn's disease (steriod therapy)
• Scurvy
• Iron-deficiency anemia
• Ulcerative colitis • Pyostomatitis vegetans (steriod
therapy)
Aphthous ulcers • Ulcerative colitis (steroid therapy
• Crohn's disease
• Pernicious anemia
• Ulcerative colitis
 Summary of oral manifestations of
gastrointestinal and hematologic diseases
Labial swelling Glossitis
• Crohn's disease • Crohn's disease
• Iron-deficiency anemia
Erosion of enamel and dentin • Pernicious anemia
• Ulcerative colitis
• Anorexia nervosa/bulimia
• Gastroesophageal reflux
Ulcerations and erosions
• Crohn's disease
Gingivitis • Iron-deficiency anemia
• Anorexia nervosa/bullimia • Pernicious anemia
• Crohn's disease • Pyostomatitis vegetans
• Scurvy • Ulcerative colitis
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