Thursday February 3, 2005
Dear Dr. Mady: I have been experiencing sinus congestion off and on for the past month and now my upper back teeth are very sensitive and I have some pain on both sides when biting. I believe it all started with a cold but now I am wondering if my teeth are the root the problem. What do you think could be wrong and what is your advice?-Donna in Chatham
Dear Donna: From what you are describing, I have to say that it appears that you may be suffering from a sinus infection or sinusitis. Sinusitis simply means that your sinuses are infected and/or inflamed. Although sounding simple, this condition can cause much agony and pain.
Sinusitis actually refers to inflammation of the lining of one or more of your sinuses. Dentists and physicians typically classify these sinus infections according to the sinuses involved. If the maxillary sinus in the mid-face is involved, we call the condition maxillary sinusitis. We also indicate which side is involved because these infections are often unilateral (one sided) in nature, but can be bilateral.
We have four of these hollow air spaces in our heads. If the sinusitis is affecting all four at one time, then we refer to it as pansinusitis. The four sinuses are the the maxillary, frontal, ethmoid, and sphenoid sinuses.
The maxillary sinuses are inside each cheekbone. The frontal are over the eyes in the brow area. The ethmoid are located immediately posterior to or behind the bridge of the nose, between the eyes and lastly the sphenoid sinuses are behind the ethmoids in the upper area of the nose and behind the eyes.
Sinusitis is also classified by its duration and frequency. “Acute” sinusitis is the term used when the infection lasts less than six to eight weeks and occurs less than four times per year. “Chronic” sinusitis however is when the problem is persistent for more than eight weeks or occurs more than four times per year. Each is different and as a result is usually treated differently.
Each sinus has an opening into the nasal cavity for exchanging of air and for the release of mucus. If there is a swelling in the nose or anything similar to that, as in the case of the common cold, this can cause air and mucus to become trapped inside the sinuses. Pressure on the sinus wall is the end result and it is this pressure that elicits the pain, pain that may refer to other areas. The common cold is often a precursor to acute sinusitis, especially when the cold lasts more than ten to fourteen days. The presence of headache or facial pain can suggest that the sinusitis is beginning. Facial pressure, especially under the eyes is very common.
With chronic sinusitis, the most usual symptom is postnasal drip. With this there is usually a constant flow of mucus into the back of the nose or throat. It can trigger a cough at times if it drips down into the vocal cord, windpipe or bronchial tube area. In this case the cough will be worse in the morning.
Toothaches and tooth sensitivity in the upper back teeth is an often apparent sinus infection symptom. The main reason for this is that in most human’s anatomy, the roots of the upper molars and sometimes the premolars or bicuspids in front of them, sit right in the maxillary sinuses. Pressure in the maxillary sinus can irritate the nerves and surroundings of these teeth and cause many symptoms. Sensitivity is most often the first symptom, but as pressure builds up in the sinuses the teeth are actually being pushed outward and then biting pain occurs. This is because even if these teeth are a micron more into occlusion (bite) from sinus pressure, they will take more biting forces than any of the other teeth in the mouth during chewing. In addition to irritating the teeth more, the chewing may also irritate the maxillary sinus where they originate from.
In my practice I often see individuals present with these symptoms and sometimes you can even see the white fluid filled sinus on the dental x-ray. Tapping the teeth may cause pain and is another diagnostic test that can be performed. Molars on one side or both may be affected.
Patients often refuse to agree with a diagnosis that their dental pain may be from a sinus infection, even if the pain extends over the roof of the mouth. I have accepted patients that have previously had extensive dental treatment on their upper teeth to help alleviate sinusitis symptoms, with no change in their condition. Some people have even gone to the extreme of having teeth extracted unnecessarily from sinusitis.
My best advice to you at this point is to start with the simplest form of treatment. Seek assistance from your physician or dentist and if they feel that sinusitis is the problem, it may be as simple as a regimen of a good upper respiratory antibiotic for ten days. If that does not work, they can “dig a little deeper” and if the problem really becomes chronic to the point where it is affecting your quality of life, your physician may choose to refer you to an ear, nose and throat specialist for evaluation. In the meantime see your pharmacist immediately for a good antihistamine/decongestant that will work for you and not interfere with any other medications that you may be taking. This will help carry you until you see your health care professional and it may even be a good idea to take it in conjunction with an antibiotic, if one is prescribed. After being assessed you will be treated accordingly. I hope this helped.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5