Sinus Tooth Pain: Understanding the Two-Way Relationship

Tooth infection causing sinusitis
Do you ever experience a throbbing toothache accompanied by sinus pain and pressure?

You might be surprised to know that 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.

The condition where the teeth are involved is called sinusitis of dental origin. It can be a frustrating and uncomfortable experience.

In this article, we will learn more about this two-way relationship between the sinuses and teeth and discover some tips for finding relief.

What are the maxillary sinuses?

There are different sinuses in our heads whose names refer to the bone where they lie. The one we are interested in in this article is the maxillary sinus. maxillary sinus The term "maxilla" refers to the maxillary bone, which is a fancy way of saying the upper jaw. Maxillary sinuses are air-filled cavities next to your nose, above your upper back teeth, and on each side of your cheeks.

Their main job is to produce mucus, which lubricates your nose and prevents it from drying out. In addition to this, the maxillary sinuses also act as filters, helping to remove bacteria, dirt, and dust from the air we breathe in.

So, if you're experiencing tooth pain in your upper jaw, it's possible that your maxillary sinuses could be the cause. We're talking about a condition called sinusitis.

What is sinusitis?

Sinusitis is a condition where the sinuses become inflamed, leading to an overproduction of mucus. This buildup can clog the sinuses, causing pressure and pain.

Normally, the sinuses work to filter the air we breathe in and drain out dirt and bacteria through the nose. However, in sinusitis, something prevents this proper drainage, leading to inflammation. (1)

Viral upper respiratory infections and allergies are among the most common causes of acute sinusitis, which is usually temporary and resolves within four weeks. (2)

There are also other types of sinusitis depending on the duration of symptoms.

Chronic sinusitis lasts more than 12 weeks, while recurrent sinusitis is defined as having more than four episodes of sinusitis in a one-year period. (1)

It's important to note that dental infections can also cause sinusitis. If an upper molar becomes infected, it can spread and result in sinusitis of dental origin.

We will discuss later how teeth and sinuses are connected and how dental infections can lead to sinusitis.

How can sinus pain spread to our teeth?

Now that we have a good idea of the sinus functions and how sinusitis develops, let's delve deeper into the problem at hand.

Sinuses and teeth, especially the upper and back ones, are like neighbors who don't get along very well. And this goes both ways.
Poor relationship between the sinuses and the teeth
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.

To better understand the underlying cause of this conflict, it is important to take a look at their anatomy.

The sensitivity of the upper jaw, which includes the sinuses, teeth, cheeks, and lips, is primarily controlled by the "maxillary nerve."
the innervation of the maxillary sinus and the upper back teeth
As the picture shows, the nerve branch responsible for the sensation and function of the upper back teeth also innervates a considerable part of the maxillary sinuses along its pathway (7). As a result, when the brain tries to determine the source of the pain, it can become a bit confused.

This is why pain from sinusitis can spread to the teeth and cause discomfort in the entire region.

This happens because the pressure from the buildup of mucus in the sinuses can press on the surrounding nerves, leading to pain and tenderness in other areas, especially in the upper molars and premolars.

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

When the roles turn around: Sinusitis of dental origin

Previously, we discussed how pain in the sinuses can cause toothaches. In this section, we will explore the opposite situation, where the teeth are the culprit.

The upper back teeth and the maxillary sinuses are located close to each other, separated only by a thin layer of bone. In some cases, this bone layer is even missing, further emphasizing the intimate connection between the two structures.
molar teeth communicating with the sinus
When tooth decay is left untreated, it can spread to the tooth's nerves, resulting in an infection. If it takes over, it can lead to the pulp's death and travel down to the root tip, causing an abscess.

periapical periodontitis

This infection can then spread to the nearby maxillary sinuses, which can cause what we call sinusitis of dental origin. In fact, according to studies, 10% of maxillary sinusitis cases are caused by dental issues.

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 spreads to the root tip and beyond, eventually reaching the maxillary sinuses and causing sinusitis.

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.

Also, if your dentist didn't follow the right steps, they may have accidentally caused inflammation in your sinuses by using their tools or filling material. Root canal filling leakage into the sinus

3. After Tooth Extraction

After tooth extraction, a hole can be created between the mouth and the maxillary sinuses, known as sinus communication.
If left untreated, this hole can develop into an oroantral fistula, which is an abnormal passageway between the mouth and the maxillary sinus. This can cause saliva and bacteria to leak into the sinuses and lead to infection. According to one study, this is the most common cause of odontogenic maxillary 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

Some tips for relieving maxillary sinusitis:

These are tips that can help you relieve symptoms of maxillary sinusitis. But remember, identifying the root cause is key. If you find that your symptoms are not improving or are getting worse, do not hesitate to consult your healthcare provider.

  1. Stay hydrated: It's important to drink plenty of water and other fluids to help thin out the mucus in your sinuses. This can help relieve pressure and make it easier to breathe. Aim to drink at least 8 glasses of water a day, and avoid caffeine and alcohol as they can dehydrate you.

  2. Sleep in a reclining position: Elevating your head while sleeping can help reduce the mucus accumulated in your sinuses and improve your 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 can help reduce swelling in the nasal passages and sinuses, thus relieving pressure. They are available as nasal sprays, pills, or liquids. However, it's important to follow the instructions carefully and not overuse them.

  4. Spice up your food: Spicy foods like chili peppers, horseradish, and wasabi can help clear out your sinuses and reduce congestion. They contain compounds that can thin out mucus and increase blood flow, helping to relieve sinus pressure. 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