Sinusitis or Toothache?
There is often confusion between sinusitis and a toothache.
In order to distinguish between sinusitis and a toothache, one needs to understand just a little about the anatomy of the skull and face and the sinuses. There are seven sinuses in the skull but we are really only talking about the maxillary sinuses. The two maxillary sinuses are on each side of the nose in the upper jaw and are above the maxillary (upper) teeth. They are air chambers lined with mucous covered skin which “traps” pollutants in the mucous. The sweeping motion of the cilia (hair-like appendages in the lining) moves the mucous to the ostia (drainage hole) and into the nose chamber where it is swallowed and eventually excreted. The sinuses also warm and moisten the air breathed in and cause a resonance of the voice. Sometimes, due to inflammation or infection of this lining, these chambers fill with more than normal mucous which will not drain out the ostia efficiently due to the swelling of the lining. This often causes pain and discomfort to the upper back teeth. The physical weight of the mucous in the sinus, plus the built-up pressure within the sinus, causes discomfort to the nerves, arteries, and veins which enter the root tips of the teeth. Sometimes these root tips actually protrude into the sinus chamber. The lining of the sinus when infected or inflamed is similar to a “wet blanket” over the roots of the teeth which puts pressure on the nerves. This may be interpreted as a toothache. The “itis” portion of sinusitis simply means inflamed, so sinusitis means inflammation of the lining of the sinus. One can look at this lining as a bladder in a football. This lining technically is called the Schniderian membrane.
If more than one tooth is tender to light percussion (tapping on it), approximately 90% of the times it will be sinusitis. If the teeth are tender on both sides, that percentage is even higher. This pressure is caused by the physical weight of the mucous and the increase of internal pressure in the sinus since it cannot properly drain. The ostia do not allow proper draining as the swollen membrane reduces the size of the “drain hole.”
It is important to eliminate all possible sources of dental problems and then refer the patient to an Ear, Nose, and Throat specialist or an Otolaryngologist. Yes, of course treat any dental problem. Considerations for diagnosis of sinusitis are congestion, tenderness, halitosis, nasal drainage, history of a cold or flu, sore throat, and discomfort of several teeth to percussion. Other considerations are hay fever, asthma, smoking, or nasal polyps. X-rays may show a cloudy appearance in the sinus. The patient often gets confused as sinusitis may emulate the symptoms of a previous toothache. Sinusitis will not make your teeth hypersensitive to hot or cold, but a dental problem will. Sinusitis usually causes more discomfort when the patient lays down rather when sitting or standing. The patient normally will be unable to pin point a particular tooth and says that all of them in the upper back hurt, and it could be only one side but likely both. If it is a dental problem, it is usually only one tooth.
Sinusitis is either chronic or acute, and may be viral or bacterial. Chronic means that it has lasted approximately 3 months and acute means less than one month. Chronic sinusitis may develop from acute sinusitis if not property eliminated. This is the most common complication. Most cases of sinusitis are viral in nature and the normal body defense mechanism will eliminate it. Antibiotics do not kill viruses! A small number of sinusitis cases are bacterial. The immune system of the body will usually take care of this too. But antibiotics, such as amoxicillin or azithromycin (Z-Pac) may help out since they will kill bacteria. Steam in a hot shower, warm face packs, plenty of fluids, and saline nose drops will usually aid in easing the discomfort. Over-the-counter decongestants may also be helpful. Drugs like Sudafed or Actifed may be helpful as they constrict the blood vessels which reduces inflammation and swelling in the sinus. The discomfort associated with this condition may be reduced by such other OTC drugs as Tylenol, Motrin, Ibuproen, Aleve, or Advil.
It may be difficult to differentiate between viral and bacterial sinusitis. If it is short-lasting it is considered viral. If it lasts longer than two weeks, it is considered bacterial.
One can actually have both a dental problem or toothache and a sinusitis problem at the same time, but this is not the norm. Both the dental problem and the sinusitis must be resolved. Sinusitis does not affect the mandibular (lower) teeth as there are no sinuses in the mandible (lower jaw). The patient should be aware that all teeth give or move ever so slightly, so when they bite down hard, the teeth may be slightly intruded and this can increase the internal pressure in the sinus which will result in discomfort.
An upper respiratory tract infection or cold is the most common culprit causing an acute sinus infection. This is a viral infection which results in inflammation and swelling of the sinus membrane. It is usually self-limiting. The defense mechanism of the sinus leads to an excessive production of mucous which may be a bed for bacterial infection resulting in acute sinusitis. This situation requires antibiotics such as amoxicillin or azythromycin. Cephalexin, erythromycin, and penicillin are not recommended for acute sinusitis. The use of antibiotics for chronic sinusitis is controversial and should only be used for acute sinusitis.
Approximately 20% of the population have acute sinusitis yearly with fewer than that having chronic sinusitis. It seems to have more of a proclivity for women.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists.