Sinus Toothache

A sinus toothache is a type of referred tooth pain caused by an inflammation of the maxillary sinus (sinusitis) or a sinus infection. Sinus toothache feels much like common toothache and in some cases it is difficult, even for the dentist, to understand that the toothache is related to a sinus problem than a tooth problem. Pain relief is achieved by treating the infection and relieving the pressure in the sinus cavities.

Sinuses are air filled cavities inside the human skull, lined with a mucous membrane. When someone develops a sinus infection, one of the symptoms may be a throbbing tooth pain which is referred as a sinus toothache. Sinus related toothaches affect the upper back teeth (usually several or all teeth) which are closer to the maxillary sinuses. Maxillary sinuses, which are located inside each cheekbone above the upper jaws, are mostly related to sinus toothaches. Drainage of any fluids accumulated inside them in case of an infection is difficult because their lower part is below the nasal passage to the nostrils while the body is erect.

An infection or inflammation is causing the mucus lining to swell, blocking the nasal passages. The sinus gets clogged with mucus, trapping bacteria that continue to multiply inside the blocked sinus. Further swelling and the concentration of mucus fluids results in the build-up of pressure inside the sinus cavity and over the upper jaw bones.

The roots of the upper molar teeth in the back of the jaw may be too close to the floor of the maxillary sinus cavity. In some cases they may even extend into the sinus cavity. When the roots of the upper molar teeth are in close proximity with the sinus area, the teeth nerves are affected by this pressure and the patient experiences a pain much similar to toothache pain. This painful feeling is called a sinus toothache, although there may not actually be a problem with any tooth. Experiencing a toothache in the upper teeth is fairly common when having sinus problems.

The intensity of pain of a sinus toothache depends on the extend of sinus infection and swelling along with the proximity of the root endings to the infected sinus.

A healthy sinus is filled with air and a small amount of thin mucus that drains away continuously. The increased pressure build-up inside the sinus cavity that triggers a sinus toothache is usually caused when:

• the airflow into the sinus cavity is restricted or/and
• the drainage of the mucus out of the sinus cavity is restricted.

Both conditions occur when there is swelling of the mucous membranes that line the sinus and nasal passages. Inflammation of the mucous lining of the sinuses can be caused by several conditions but the most common causes of a sinus infection toothache are:

• the common cold
• allergies
• pollutants and tissue irritants
• anatomical obstruction in the nasal passage or sinus polyps
• respiratory or dental infections

In some cases the root cause of the sinus toothache may actually be a dental condition. The most common dental problem that may lead to a sinus infection is a tooth abscess in the upper molar teeth and especially the wisdom teeth that are usually closer to the sinus cavity. In this case, bacteria may spread from the periapical area (around the tooth roots) to the sinus causing infection and sinus toothache.

Some oral surgery procedures such as a root canal treatment, a sinus lift or the improper placement of a dental implant may cause an injury to the mucus lining allowing the bacteria of the mouth to invade the sinus and infect it.

A sinus toothache is not always easy to identify, especially when there are not much symptoms to reveal the sinus infection. The sinus pain may be sharp and spontaneous like if you had a cracked tooth, or it may be mild felt only when chewing such as a mild sensitivity.

The painful feeling is so similar to that of a common toothache, that the patient would normally relate it with a dental problem than with a sinus problem. In many cases other symptoms beside the toothache that may be present, such as facial swelling or facial tenderness in the cheek area can not help in the diagnosis because they are common in both sinus infection and dental problems.

If you get a tooth pain in the upper back teeth some days after you had a cold, you must consider the possibility of a sinus related toothache. However the differential diagnosis should also consider the following conditions: tooth problem, tmj disorder and bruxism.

A characteristic of a sinus toothache is that the pain will appear or intensify with any form of movement but will subside when you are sitting or lying down. A quick check to identify a sinus toothache is to jump on your feet. If there is a sinus infection, the sudden movement of fluid in the maxillary cavity will cause a throbbing pain in one or more upper teeth.

Another indication of a sinus toothache is that the pain is rarely isolated to only one tooth but affects several teeth. If when the dentist is gently tapping each tooth (percussion test), there are multiple teeth aching, it is possible to have a sinus toothache. However, teeth clenching may also create a similar clinical image, so diagnosis is not always certain. Headaches that usually accompany sinus infections, may also be caused by dental problems such as temporomandibular joint disorders (TMJD).

Even a dentist may be confused if there is some indication of tooth decay or an old restoration in the pain area. In some rare cases, it may also happen for both conditions to exist at the same time. The dentist must review the patient’s history and ask for any other symptoms of sinus irritation (runny nose, nasal congestion, post-nasal discharge, sore throat, fullness feeling under the eyes, reduced appetite).

If the patient has symptoms of sinus inflammation and there is no apparent dental problem (tooth decay, abscess, fracture), it is probably a sinus toothache. Taking a periapical x-ray that shows the sinus area above the tooth roots can help verify the diagnosis. An inflamed sinus with accumulated fluid will look white in an x-ray, while a healthy one looks black. The dentist will then advise you to visit your family doctor or an otolaryngologist (ear, nose and throat specialist) who specializes in the treatment of sinus problems.

Unfortunately, wrong diagnosing a sinus toothache as a tooth problem, will not only lead to an unnecessary dental treatment but will also delay the treatment of the sinus inflammation and allow it to become a serious and hard to cure case of sinusitis.

In case of a sinus toothache your dentist can not help. Only if the sinus infection is caused by a dental problem such as a tooth abscess, the dentist will have to provide treatment, but unfortunately this will not relieve the pain until the sinus inflammation is also treated.

The only way to treat a sinus toothache is to fight the sinus infection. When the infection is treated and the accumulated fluids are drained out of the sinus cavities, the pain should subside and disappear without requiring further treatment. Antihistamines, decongestants or/and antibiotics can be used to treat the inflammation and provide relief from the sinus toothache. Medications are usually prescribed for 10-14 days or longer depending on the severity of the problem.

Other remedies such as steam inhalation and nasal sprays that keep the nasal tissues moist and allow the sinus to easily drain through the nose can relieve the pressure in the nasal passages and help ease the pain in your teeth. You can also reduce the tooth pain by having a softer diet and chewing on the less painful side of the mouth. Over the counter pain relievers may also needed for severe sinus toothaches.

If the other symptoms of the sinus problem subside but the toothache continues, there was probably a dental problem simultaneously with the sinusitis, and you have to visit your dentist for dental treatment.

Sinusitis induced toothache is a relatively common complaint for patients who develop a sinus infection due to a cold or other reasons. Accurate diagnosis is important for the effective treatment of the sinus toothache and the underlying infection that is causing it. Eliminating the infection and relieving the pressure from the sinuses is normally enough to stop a sinus toothache.