One aspect of my job that I enjoy greatly is the ability to help people who are in pain. There are many causes of mouth pain, and although diagnosis is usually straightforward, sometimes it can be complicated. In the majority of cases, patients present to our office with pain originating from the teeth or gums (e.g. cavities, damaged tooth nerves, gum disease, trauma to teeth, etc.) but not infrequently we see pain stemming from non-tooth sources as well. It is the purpose of this brief post to outline and provide some information about one of the more frequently seen non-tooth sources of pain: sinus infections (sinusitis).
What are the Sinuses?
The bones of the face are not solid bones; they contain hollow spaces called sinuses which serve at least four purposes: 1) They make the skull lighter and lessen strain on neck muscles, 2) They act as air-conditioners and humidifiers which filter the air we breathe, 3) they act as resonance chambers that aid in speech, and 4) they act as crumple zones (similar to how our cars are designed) that, in cases of trauma, absorb energy which could otherwise cause brain damage. These functions are great, but the real benefit of having sinuses is not so much in the spaces themselves, but in the special tissue which lines them on the inside: a mucous membrane which is covered in tiny hair-like projections called cilia which protect us from dust, pollen, germs, and other foreign material in the air we breathe. These cilia wave back and forth to trap and transport these unwanted things down our throats and into the stomach so that they cannot enter our bodies through breathing.
Sinusitis is the inflammation of the sinuses, or more specifically of the mucous membrane lining the sinuses. Due to the function and location of this special lining tissue (it is literally on the front lines of the immune system’s war with germs) it is susceptible to becoming infected or irritated. Viruses and bacteria can cause sinusitis directly, and irritants such as allergens can irritate the membrane and cause the body to initiate an inflammatory response leading to sinusitis as well. Although inflammation is a natural process of the immune system intended to fight germs, it is usually accompanied by discomfort and even pain. Additionally, symptoms such as stuffiness, facial pressure, runny nose, loss of smell, headache, fever, bad breath, fatigue, and dental pain may be present. Depending on what causes sinusitis, it can be classified as acute or chronic, and intensity can range from mild to severe.
Let’s look at that last symptom in a little more detail. There are several sinuses in the bones of our skull, but one particular set of sinuses is located just above or to the side of the root tips of our upper molars/premolars. Sometimes, these sinuses are so close to the teeth roots that only a paper-thin section of bone separates them. Due to the proximity of these structures and the body’s inability to exactly pinpoint the location of pain, inflammation in the sinuses can be interpreted as tooth pain. Often this pain manifests as a constant ache, pain upon biting or touching the teeth, or pain when lying down to sleep (due to the body’s position). These symptoms all mimic the pain a patient feels when a root canal is needed. In the case of an abscessed tooth needing a root canal, the source of the pain is within in the ligament which holds a tooth in its bony socket, but again, the tooth root can be so close to the sinus that it is hard to determine the exact source of the pain. Anytime symptoms like this are felt on upper teeth, sinusitis always enters into a good dentist’s differential diagnosis as well as problems arising from the teeth themselves. If a dentist were ignorant of sinusitis, many needless root canals would be performed and time and money would be wasted.
Diagnosis and Treatment:
Luckily, there are several tests that dentists can perform to determine the source of a toothache, and dental x-rays can be taken to determine if a tooth has a cavity, abscess, etc. In the case of tooth pain that persists for more than a couple of days it is always smart to schedule a quick dental visit to catch and fix a potential problem early. If it is diagnosed that something is wrong with the tooth, appropriate dental treatment will be recommended. If sinusitis is suspected, decongestants or antibiotics may be prescribed initially, followed by a period of healing and observation. In serious cases referral to a medical doctor or an ear, nose, and throat specialist may be made.
Nicolas K. Young, DMD