Salty Taste Sinus Tract — ORE Part 1 MCQ

Correct answer: A — Purulent drainage from a chronic apical abscess

**A is correct.** A chronic buccal sinus tract adjacent to a previously root-treated tooth indicates a draining chronic apical abscess. Intermittent purulent/inflammatory exudate reaching the oral cavity can produce the reported unpleasant or salty taste. The localised relationship between the taste and the sinus tract is the discriminating feature. Reduced salivary secretion and Sjögren syndrome more typically cause xerostomia and widespread oral symptoms, rather than drainage from one site. Some medicines can cause dysgeusia, but would not account for a visible sinus tract. Gastro-oesophageal reflux can cause an acidic or bitter taste, but likewise does not explain the focal odontogenic sinus. The appropriate clinical next step would be assessment of the endodontic status and source of the persistent apical infection.

Reference: AlSulaimani RS et al. Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial (2016). The abstract states that chronic apical abscesses are characterised by intermittent pus discharge through an associated sinus tract. https://pubmed.ncbi.nlm.nih.gov/27553664/