Non-Odontogenic Toothache Caused by the Fungal Ball of Maxillary Sinus: Case Reports

  • Ha, Ji-Woo (Department of Oral Medicine, School of Dentistry, Jeonbuk National University) ;
  • Jung, Won (Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Lee, Kyung-Eun (Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Suh, Bong-Jik (Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University)
  • Received : 2019.11.23
  • Accepted : 2019.12.10
  • Published : 2019.12.30


A fungal ball (FB) of the paranasal sinuses is a chronic, non-invasive fungal sinusitis defined as the accumulation of dense aggregation of fungal hyphae in a sinus cavity. A patient with FB infection in a sinus cavity has usually non-specific symptoms such as post-nasal drip, nasal congestion, headache. However, facial pain and toothache can be developed if FB infection is in maxillary sinus. The aim of this case report is to present two cases of FB of the maxillary sinus which caused toothache in the upper molar region. It is also to make dental practitioners consider the non-odontogenic origins of toothache and to pay special attention to avoid unnecessary dental treatment.


  1. Soni A. Toothache of non-dental origin: a review of its mechanism and clinical characteristics. Int J Sci Study 2018;6:26-35.
  2. Chung JW, Kim JH, Kim HD, Kho HS, Kim YK, Chung SC. Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale. Pain 2004;112:164-170.
  3. Balasubramaniam R, Turner LN, Fischer D, Klasser GD, Okeson JP. Non-odontogenic toothache revisited. Open J Stomatol 2011;1:92-102.
  4. Kim KM, Byun JS, Jung JK, Choi JK. Non-odontogenic toothache caused by acute maxillary sinusitis: a case report. J Oral Med Pain 2016;41:80-84.
  5. Kang JK, Ryu JW. Nonodontogenic toothache. Oral Biol Res 2018;42:241-247.
  6. Mascia P, Brown BR, Friedman S. Toothache of nonodontogenic origin: a case report. J Endod 2003;29:608-610.
  7. Linn J, Trantor I, Teo N, Thanigaivel R, Goss AN. The differential diagnosis of toothache from other orofacial pains in clinical practice. Aust Dent J 2007;52(1 Suppl):S100-S104.
  8. Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 2007;264:461-470.
  9. Yoon YH, Xu J, Park SK, Heo JH, Kim YM, Rha KS. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015). Int Forum Allergy Rhinol 2017;7:1070-1075.
  10. Pinar E, Imre A, Ece AA, et al. Paranasal sinus fungus ball: analysis of clinical characteristics and surgical outcomes. ENT Updates 2015;5:124-127.
  11. Klossek JM, Serrano E, Peloquin L, Percodani J, Fontanel JP, Pessey JJ. Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses. Laryngoscope 1997;107:112-117.
  12. Ahn SH, Lee EJ, Hong MP, Shin GC, Kim KS. Comparison of the clinical characteristics of bilateral and unilateral fungal balls in Korea. Eur Arch Otorhinolaryngol 2019;276:1975-1980.
  13. Patrascu E, Manea C, Sarafoleanu C. Difficulties in the diagnosis of fungal rhinosinusitis - literature review. Rom J Rhinol 2016;6:11-17.
  14. Yoon JH, Na DG, Byun HS, Koh YH, Chung SK, Dong HJ. Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results. AJNR Am J Neuroradiol 1999;20:571-574.
  15. Aribandi M, McCoy VA, Bazan C 3rd. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 2007;27:1283-1296.
  16. Yatani H, Komiyama O, Matsuka Y, et al. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil 2014;41:843-852.
  17. Hansen JG, Hojbjerg T, Rosborg J. Symptoms and signs in culture-proven acute maxillary sinusitis in a general practice population. APMIS 2009;117:724-729.
  18. Okeson JP. Bell's oral and facial pain. 7th ed. Chicago: Quintessence Publishing Co, Inc; 2014. pp. 384, 458-459