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:
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.
Dental Pain:
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
