Sinus Tooth Pain: Understanding the Two-Way Relationship

Tooth infection causing sinusitis
Have you ever experienced a throbbing toothache accompanied by sinus pain and pressure? These seemingly unrelated symptoms could actually be connected.

The sinuses and teeth share a unique and complex relationship, where problems in one can cause pain in the other.

A tooth infection can travel up to the overlying sinuses and cause sinus pain, a condition known as sinusitis of dental origin. Conversely, pain can also spread from the sinuses to the teeth.

In this article, we will learn more about this complex two-way relationship between the sinuses and teeth

What are the maxillary sinuses?

The sinuses are air-filled bony cavities. There are several in your face named after the bone they're in. The ones that lie close to the teeth are called the "maxillary sinuses." maxillary sinus The term "maxilla" refers to the maxillary bone, a fancy way of saying the upper jaw. Maxillary sinuses are located next to your nose, above your upper back teeth, and on each side of your cheeks.

Their main role is to produce a thick liquid called mucus, which lubricates the nose and prevents it from drying out. In addition, they act as filters, helping to remove bacteria, dirt, and dust from the air we breathe.

What is sinusitis?

Sinusitis refers to inflammation of the sinus cavities, leading to an overproduction of mucus. This buildup can clog the sinuses, causing pressure and pain.

This condition arises when something is preventing the proper drainage of the sinuses. As a result, mucus, bacteria, and dust build up and cause inflammation.

We distinguish three types of sinusitis, depending on duration and intensity:

  • Acute form: It's temporary and lasts less than four weeks. Allergies and upper respiratory infections are among the most common causes.

  • Chronic form: This one is long-lasting, lingering for more than 12 weeks.

  • Recurrent form: This is when sinusitis keeps coming back, with more than four episodes per year.

Poor relationship between the sinuses and the teeth

Common symptoms of sinusitis:

  • Nasal congestion and stuffiness
  • Facial pain and pressure, particularly around the eyes and forehead
  • Headache, particularly around the temples or back of the head
  • Postnasal drip, which can cause a sore throat, coughing, or hoarseness
  • Reduced sense of smell and taste
  • Fatigue
  • fever

Pain from sinusitis can spread to the upper back teeth

Sinuses and teeth, particularly the upper and back ones, are like neighbors who don't get along very well. And this goes both ways!

This means that issues in the sinuses can impact the teeth and vice versa. In other words, a problem in your sinuses can cause toothache, and if you have dental problems, it can trigger sinus pain.

It's mainly because they are too close to each other. In addition, the nerves that provide sensitivity to the upper back teeth pass through the sinuses and innervate a large part of them.

the innervation of the maxillary sinus and the upper back teeth

As the picture above shows, the nerve branch responsible for the sensation of the upper back teeth also innervates some part of the maxillary sinuses along its pathway. As a result, when the brain tries to determine the source of the pain, it can become a bit confused.

That's why when the sinuses become inflamed, the increased pressure can press on the surrounding nerves and cause discomfort in the entire region, including teeth, upper jaw, eyes, and forehead.

Sinusitis pain can spread to other areas of the face, including the upper jaw, eyes and forehead

Sinus pain can be caused by dental issues

If sinusitis can cause toothache, the opposite way is also possible.

The upper back teeth and the maxillary sinuses are separated only by a thin layer of bone. Sometimes, this barrier is missing, creating direct communication between teeth and sinuses.

So, an infection from an upper back tooth can make its way up to the sinuses and cause problems there. We call this sinusitis of dental origin.

According to studies, 10% of maxillary sinusitis cases are caused by dental issues.

molar teeth communicating with the sinus

Here are some of the most common scenarios where teeth may contribute to sinusitis and result in sinus pain.

1. Tooth Infection

A tooth infection or dental abscess is one of the most common causes of sinusitis of dental origin. It occurs when the infection goes beyond the tooth and reaches the overlying sinus.

2. Failed Root Canal Treatment

A failed root canal treatment can also lead to sinusitis of dental origin. This occurs when bacteria enter the root-canal-treated tooth and cause a new infection that spreads to the maxillary sinuses.

This can also happen if the dentist has accidentally damaged or perforated the sinus wall during the procedure. Root canal filling leakage into the sinus

3. After Tooth Extraction

While extracting a tooth, there is a risk of accidentally damaging the bone and soft tissues lining the sinus. This may create an abnormal connection between the mouth and the sinus, known as oro-antral communication.

If left untreated, this can develop into an oro-antral fistula, a permanent passageway between the mouth and the sinus. As a result, saliva and oral bacteria can leak upwards, leading to sinusitis. Sinus communication after tooth extraction

How do you know if sinus pain is coming from teeth?

Usually, the signs of sinusitis of dental origin are limited to one side of the face. These include:

  • Unilateral pain (pain on one side of the face)
  • Runny or stuffy nose on one side
  • Pain in the upper back teeth, especially under pressure
  • Worsening pain when bending over or lying down
  • Previous history of dental infection or treatment (extraction or root canal)
  • Bad taste in the mouth or bad breath
  • Pus leakage around the tooth or gums

Dealing with sinus toothache

When it comes to treating sinus pain, finding the source of the problem is key.

If you're experiencing a toothache and suspect an infection, especially in your upper back teeth, don't delay seeing your dentist. It's crucial to tackle the root cause first, which in this case is the tooth infection.

After clearing up the infection, the next step is to treat the sinus problem, which is the role of an Ear, Nose, and Throat (ENT) specialist.

If your sinus pain isn't caused by a dental issue, other potential reasons need to be investigated, like allergies, respiratory infections, abnormalities, or even tumors. The ENT specialist will likely recommend further tests to find out exactly what's going on.

So, don't wait any longer! Make an appointment as soon as you can to get an accurate diagnosis and the right treatment for you. In the meantime, here are a few tips to ease the pain:

  1. Stay hydrated: Drink plenty of water to help thin out the mucus in your sinuses and relieve the pressure.

  2. Elevate your head while you sleep: Elevating your head while you sleep can help reduce mucus build-up in the sinuses and improve breathing. You can try using an extra pillow to prop up your head or a wedge pillow designed for this purpose.

  3. Use a decongestant: Over-the-counter decongestants like sprays can help open up the airways, relieving the pressure and pain.

  4. Spice up your food: Spicy foods can help clear out your sinuses and reduce congestion. Just be sure not to overdo it if you're not used to spicy foods.

  1. Chronic sinusitis https://www.ncbi.nlm.nih.gov/books/NBK441934/
  2. Acute Sinusitis https://www.ncbi.nlm.nih.gov/books/NBK547701/
  3. Odontogenic maxillary sinusitis: A comprehensive review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770314/
  4. Maxillary Sinusitis of Odontogenic Origin: Prevalence among 3D Imaging—A Retrospective Study https://www.mdpi.com/2076-3417/12/6/
  5. Les sinusites d’origine dentaire : diagnostic et prise en charge https://www.revmed.ch/revue-medicale-suisse/2008/revue-medicale-suisse-173
  6. Bobby Pate - book: Endodontic Diagnosis, Pathology, and Treatment Planning
  7. Structures of the Head and Neck - Book by Frank J. Weaker