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Upper Airway Disease: Allergic Rhinitis, Sinusitis, and Streptococcal Pharyngitis: Assessment, Analysis, and Associated Dental Management Guidelines

ALLERGIC RHINITIS

Allergic rhinitis can be seasonal or constant. Most patients have associated allergies of some sort.

Allergic Rhinitis Symptoms

Nasal discharge, sneezing, and itchy eyes are the most common symptoms experienced.

Allergic Rhinitis Treatment

The patient should avoid exposure to known allergens. Additionally, the patient should be evaluated for underlying allergies and receive appropriate allergy shots when possible. Nasal or oral antihistamines are often prescribed along with nasal or systemic steroids to gain relief.

SINUSITIS

Sinusitis could be bacterial or viral in origin. S. aureus is a common pathogen in sphenoid sinusitis. The most common pathogens isolated from maxillary sinus cultures in patients with acute bacterial rhinosinusitis include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Streptococcus pyogenes, Staphylococcus aureus, and anaerobes are less commonly associated with acute bacterial rhinosinusitis. The vast majority of sinusitis episodes are caused by viral infection. Most viral upper respiratory tract infections are caused by rhinovirus, but coronavirus, influenza A and B, parainfluenza, respiratory syncytial virus, adenovirus, and enterovirus are also causative agents. Patients can sometimes present with unilateral sinusitis, and, in such cases, it is always important to rule out a dental-related cause or an underlying neoplasm cause.

Sinusitis Symptoms

The patient experiences mild, moderate, or severe pain over the sinuses affecting the cheeks, forehead, and eyes, in addition to the top and back of the head. Additionally, the patient experiences malaise, nasal obstruction, headaches, purulent rhinorrhea, and, at times, thick nasal discharge.

Sinusitis Treatment

Medical Management

Acute sinusitis typically presents with nasal congestion, purulent nasal discharge, and facial pain. In the immunocompetent host, antibiotics are initially unnecessary. Initial treatment should consist of topical decongestants used every four hours, steam inhalations, saline flushes, and sleeping in a semi-upright position to facilitate drainage – especially when the maxillary sinuses are involved. Antibiot/>