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Got An Unbearable Sinus Toothache?

Are you having a headache, sinus pain, and tooth pain all together? Could they all be possibly related or is it just one condition causing all of it? This syndrome is usually referred to as sinus tooth pain! Keep reading to find out all about it and what you can do.



Table of Contents:



Overview

From time to time, patients will experience pain and tenderness around their cheekbone or sinus area. They can't really pinpoint where exactly it is coming from aside from the fact that it is just around the sinus. On some days they may think it is coming from their tooth while other days they think maybe its just the sinus.


Due to this ambiguity, most patients are typically unsure about which doctor they should be making an appointment with. Should they see their dentist or should they see their ears nose throat (ENT) doctor?



Signs and Symptoms

Since people can't tell what exactly is causing the pain, they simply refer to this condition as a sinus tooth pain. The pain could be mild or it could be as severe as feeling unbearable. Nonetheless, here are some common symptoms that most patients come into the office with.

  • Generalized pain around the sinus area

  • Tenderness around the cheek bones

  • Headache

  • Sinus-like pain

  • Tooth pain or aching in the teeth

  • Congestion and stuffiness in the nose

  • Cough

  • Fatigue

  • Ear pressure

  • Pressure that feels worse when bending over




Is it sinus pain or is it tooth pain?

Our goal is to help you try to differentiate whether that unbearable sinus tooth pain is coming from the sinus or from your tooth. The reason why it is so difficult to figure out where the pain is coming from because your maxillary sinuses (sinus in the cheek bones) are actually right next to the roots of your upper back teeth.


Picture of an x-ray demonstrating the proximity of the maxillary sinus to the roots of the maxillary posterior teeth.

X-ray of sinus and upper teeth
  • Do you see two big black circles, one on the left and one on the right, right above the roots of the upper molars? Those black circles are the sinus cavities of the maxillary sinus.

Due to the fact that in some cases, the tips of the roots of the upper back teeth can almost touch the sinus it may be difficult to discern where the pain is coming from.

  • If your sinus was inflamed. That inflamed sinus can be touching the tip of the teeth roots and that may send you mixed signals about pain in the sinus and pain in your tooth.

  • If your tooth was inflamed. The tip of the inflamed roots could be touching the sinus and that may give you the impression that you could be having pain in the sinus and your tooth.

As you can imagine, it can be pretty confusing to figure out where the pain is coming from. Is it coming from your sinus or is it coming from your tooth? When it is ambiguous like this, we also refer to the phenomenon as referred pain. Referred pain is when you perceive pain at a location other than where it is actually causing it.


Just to drive the point home, here is a picture of a cross section lateral view of where the sinus and upper teeth roots are.

Cross section of sinus and roots of teeth
  • As you can see, the location of where the sinus is, is incredibly close to the roots of your teeth. Inflammation from one could cause you to perceive pain in both locations.


Since patients are unsure of where the pain is coming from, sometimes they end up seeing their dentist while other times they end up with their ENT.


How your dentist would diagnose it

If the patient decides to make an appointment with their dentist, there are ways that their dentist can diagnose whether it is sinus pain or tooth pain.


Your dentist can accurately diagnose tooth pain because that is their specialty. They are the tooth doctor after all! These are the techniques they use to do it.

  • Clinical examination of the teeth.

  • Dental x-rays to see if there is tooth decay or infection.

  • Vitality testing the pulp to see if the tooth is inflamed or not.

  • Probing the gums to make sure it is not coming from gum disease.

If your dentist comes to the conclusion that it is not your teeth causing you pain... by process of elimination it has to be sinus pain. Isn't that interesting? Your dentist can diagnose sinus pain and infection by process of elimination. They would also give you a referral to go see your ENT.


How your ENT would diagnose it

The same is also true for when you go see your ENT. Since they are the ears nose throat specialists, they can accurately diagnose sinus problems. They can do this via a couple of methods.

  • Use an otoscope to look inside your ear and nose.

  • They can also use a nasal endoscope to see inside your sinuses.

  • Alternatively they can get a CT scan to visualize the sinus on the computer screen.

If your ENT comes to the conclusion that it is not your sinus causing you pain... by process of elimination they can say it might be coming from your tooth. They would then recommend that you go see your dentist in order to figure out which tooth is the one that is causing you pain.




Treatment

The treatment for unbearable sinus tooth pain would depend on what is causing the pain. Is it the tooth or is it sinus related? The treatment would be different if it was sinus pain vs tooth pain. This is why it is important to get the correct diagnosis and be able to pinpoint where is the source of the pain. Once you have the proper diagnosis then you will be able to prescribe the right treatment. Otherwise you're just blindly guessing.


Therefore, step one for treating this type of pain is to get a diagnosis. After that, we can move on to discussing the various treatment options for each condition.


Tooth related

There can be a lot of things that can cause tooth pain and depending on what is causing it, the type of treatment may differ.

  • Gum related pain. If the symptoms are coming from the gums, you may need a dental cleaning or maybe even a deep cleaning. Afterwards, it also wouldn't hurt to get an antibiotic mouthwash to help the gums speed up the healing.

  • Nerve related pain. If the tooth nerve is unhealthy, you may need a root canal which is when your dentist removes the nerve from your tooth. This type of pain is usually very severe and excruciating. If you're experiencing unbearable sinus tooth pain, this could very well be the cause.

  • Cavity pain. If you're having pain or sensitivity from a cavity, it may just need a tooth filling. This is when your dentist removes the tooth decay and then fill it back in with a white colored tooth filling.

  • Tooth abscess. If you've an abscess, it may need to be drained first. After the infection is completely cleaned out, then there is a possibility you may also need a root canal. Usually the dental abscess stems from an unhealthy nerve.

Depending on how severe the inflammation and infection was, you may or may not be prescribed antibiotics. That will be at the discretion of your treating doctor.



Sinus related

A sinus infection would be most appropriately treated by your ENT doctor. Even if it was your dentist who diagnosed it, you should still go see your ENT for treatment.


Here are the common treatments that are usually prescribed for a sinus infection.

  • Antibiotics. depending on whether the infection is viral or of bacterial origin, you may be given antibiotics.

  • Saline nasal spray. This is to help rinse out the nasal passages.

  • Nasal corticosteroids. The steroids will help reduce inflammation.

  • Decongestants. If the sinus pain is making it hard for you to breathe, it could help to use a decongestant for your nose.

  • Allergy medications. If the sinus inflammation is due to allergies, these can help.

  • Pain medication. Of course if you're having pain, nothing works better than taking over the counter pain medication such as ibuprofen or acetaminophen.




The Verdict

Unbearable sinus tooth pain can come from either the sinus or the teeth. Depending on the source of the pain, the treatment for it would be different as well as the type of doctor that will be treating it. You may require the assistance of your dentist or maybe your ENT depending on what is causing you pain. The most important step in getting care is to properly diagnose the source of the pain.



Author: Written by Dr David Chen, a long island city dentist.


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