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                                                        DR. DAN PETERSON

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Sinusitis as a source of denatl pain
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.


bulletallergic responses
bulletchemical irritation
bulletinfections mechanical obstruction
bulletinfected 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:

  1. History of previous episodes of sinusitis
  2. Clinical exam, palpation of maxillary bone over the sinuses 
  3. Evaluation of teeth to identify a possible dental origin
  4. X-rays, including P.A. and possibly panorex
  5. Vitality testing of the tooth by electric pulp testing, ice, heart percussion
  6. Rule out sinusitis by treating the pain with medication

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Signs and symptoms of sinusitis

bullettenderness over sinuses
bulletnasal congestion
bulletfoul odor
bulletdischarge down the back of the throat
bulletnasal discharge 
bulletdental pain
bulletIf 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

bulletendodontic, periodontal
bullettooth fracture

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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.

bulletDecongestants used to treat sinusitis

       Topical decongestants

bulletPhenylephrine HCL (Neo Synephrine) 2 drops or 2 sprays into each nostril q 4 hours
bulletOxymetazoline HCL (Afrin) 2 sprays into each nostril bid

       Systemic decongestants:

bulletPseudoephedrine (Sudafed) 30 mg q 6 hours
bulletChlorpheniramine (Chlor-Trimeton) 4 mg q4-6 hours

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Antihistamines used to treat sinusitis


bulletBenadryl 25 mg q 6 hours
bulletTravis 1.34 mg bid


bulletAllegra 180 mg q 
bulletClaritin 10 mg q d 

Xylitol Nasal Wash

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Antibiotics to treat acute sinusitis:

bulletAmoxicillin 500 mg tid
bulletAugmentin 875 bid (amoxicillin 875mg clavulonic acid 125 mg)

Antibiotic of choice for penicillin allergic:

bulletTrimethoprim 160 mg/Sulfamethoxazole 800 mg (Bactrim DS or Septra DS) 1 tab bid

Antibiotic of choice for penicillin and sulfa allergic:

bulletAzithromycin, (Zithromax, Z-Pak) 500 mg on day 1 and 250 mg on day 2 to 5*
bulletLevaquin is a 10 -14 day course
bulletSimple 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.


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.

Sinus infections can cause pain in the upper teeth. *

     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.


Maxillary back teeth roots can be located in the sinus cavity to cause sinus pain
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

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