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Introduction Odontogenic infections are a common cause of maxillary sinusitis. This study aimed to evaluate the relationship between teeth with periapical lesions or periodontal disease and sinus mucosal thickening using cone-beam computed tomography (CBCT) imaging. Methods CBCT scans of 243 patients (485 sinuses) were evaluated retrospectively for the presence of periapical lesions and/or periodontal disease in posterior maxillary teeth and associated sinus mucosal thickening. Thickening >2 mm was considered pathological and was categorized by degree (2–5 mm, 5–10 mm, and >10 mm) and type (flat or polypoid). Descriptive, bivariate, and multivariate statistical analyses were performed. Results Mucosal thickening >2 mm was observed in 147 (60.5%) patients and 211 (44.6%) sinuses and was mostly of a "flat" type. Bivariate analysis revealed significant associations between mucosal thickening >2 mm and sex (males), age (>60 years), and teeth with periapical lesions and periodontal disease ( P ≤ .027). Multivariate regression analysis identified only sex (males, odds ratio=1.98, P = .004) and teeth with periapical lesions (odds ratio=9.75, P 2 mm. Conclusions Sinus mucosal thickening is a common radiographic finding, which is more likely to be observed in males (2×) and in relation to teeth with periapical lesions (9.75×).