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Sinus Toothache?
Sinusitis is important
to dental patients because one of the symptoms of maxillary sinusitis is
pain that can mimic pain of dental origin.
There are 7 sinuses (air filled cavities) in the head.
Sinusitis, an inflammation of the sinuses, is a common dilemma.... the
fifth most common diagnosed problem requiring antibiotics to be
prescribed.
Causes:
 | allergic responses |
| chemical irritation |
| infections mechanical obstruction |
| infected maxillary tooth |
The sinus that most commonly becomes infected is the
maxillary sinus due to it prominent exposure to the environment and the
anatomy that allows drainage of the cavity. In the maxillary sinus
the mucus must move upward to drain from the sinus and to the nasal
cavity. When a person is standing the maxillary sinus does not
drain easily. This drainage pattern makes the maxillary sinus
prone to infection. These
infections can cause pain in the upper teeth. Tooth pain is often the symptom that brings patients
to the office after the cold has gone away.
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Step to evaluate sinus
pain versus tooth pain:
- History of previous episodes of sinusitis
- Clinical exam, palpation of maxillary bone over the
sinuses
- Evaluation of teeth to identify a possible dental
origin
- X-rays, including P.A. and possibly panorex
- Vitality testing of the tooth by electric pulp
testing, ice, heart percussion
- Rule out sinusitis by treating the pain with
medication
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Signs and symptoms
of sinusitis
| tenderness over sinuses |
| nasal congestion |
| headache |
| foul odor |
| discharge down the back of the throat |
| nasal discharge |
| fever |
| dental pain |
| If you have sinus pain, especially pain on
both sides of the face, as well as tooth pain, than it can be likely
that the sinus is the source of the pain |
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Possible sources of pain
in the maxillary area
| TMJ |
| endodontic, periodontal |
| tooth fracture |
| sinusitis |
| bruxism |
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Acute sinusitis -duration of less than 4 weeks, you
will be referred to your physician because dentist can not treat
sinusitis when there are no dental symptoms. Chronic
sinusitis which lasts greater than 12 weeks is best managed by a
doctor. If your dentist decides to treat the sinusitis to rule
this infection out as the source of the dental pain, the treatment needs
to focus on facilitating drainage and treating the
infection.
Most sinus infections are due to viral infections and
can be treated with decongestants because they will reduce tissue
swelling and allow drainage. Antihistamines are of benefits if
there is an allergic component.
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Treatment of sinus infections generally consist
of antibiotic prescription if over-the-counter decongestants do not
eliminate the swelling of the nasal passages.
Topical
decongestants
| Phenylephrine HCL (Neo Synephrine) 2 drops or 2
sprays into each nostril q 4 hours |
| Oxymetazoline HCL (Afrin) 2 sprays into each
nostril bid |
Systemic
decongestants:
| Pseudoephedrine (Sudafed) 30 mg q 6 hours |
| Chlorpheniramine (Chlor-Trimeton) 4 mg q4-6 hours |
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Antihistamines
used to treat sinusitis
Sedating:
| Benadryl 25 mg q 6 hours |
| Travis 1.34 mg bid |
Nonsedating:
| Allegra 180 mg q |
| Claritin 10 mg q d |
Xylitol Nasal Wash
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Antibiotics to treat
acute sinusitis:
| Amoxicillin 500 mg tid |
| Augmentin 875 bid (amoxicillin 875mg clavulonic
acid 125 mg) |
Antibiotic of choice for penicillin allergic:
| Trimethoprim 160 mg/Sulfamethoxazole 800 mg
(Bactrim DS or Septra DS) 1 tab bid |
Antibiotic of choice for penicillin and sulfa
allergic:
| Azithromycin, (Zithromax, Z-Pak) 500 mg on day 1
and 250 mg on day 2 to 5* |
| Levaquin is a 10 -14 day
course |
| Simple Saline daily |
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Sinus toothache?
When
the top sinuses are filled with fluid from inflammation (called
“sinusitis”) or infection, the fluid pressure can cause your upper
back teeth to ache. The
pain can be spontaneous---it may occur suddenly and may feel like air is
pressurizing above your upper back teeth....and/
or these teeth may feel sensitive when you chew.
If
you feel pain like this, please call for an appointment.
We will do a thorough diagnosis, including any necessary
X-rays, to see if the source of your pain is in the teeth.
If the pain is coming from your sinuses, we will provide you
a copy of the X-ray to bring to your medical doctor.
New:
A Sinus problem can also cause you
to become a mouth breather. Mouth breathers can develop plaque and
tarter buildup more quickly than a non-mouth breather because mouth
breathing causes your mouth to become dry
which is an excellent place for bacteria to grow. There are many
treatments to help you with this condition, please see
dry mouth treatment.
A recent advance in sinus
treatment involves reduction the fungus that research has discovered
causes 95% of all cases of sinusitis and the body's reaction to
it. An antifungal nasal wash is reducing the polyps in 39% of the patients
studies and show promise for the pain associated with sinus infection.
*
Recurrent sinus attacks (
more than three a year) can be a reason for surgery, which can correct
bony defects or remove polyps that obstruct proper drainage.
Periapical x-ray of maxillary teeth and sinus floor
10% of sinusitis is due to a dental source.
First maxillary molar
is usually the tooth involved because of its location.
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**Dentistry Today, Sinusitis As a Source
of Dental Pain, dr. Jacobsen, Casagrande; pg 112-113 September 2003
Source: New England Financial Journal, Fall 2001, Dentistry
Today, pg 32 January 2002
* Hippocrates.
com.
*Considered best IDF
February 06, 2008 |
