Tooth pain is a common symptom of Maxillary Sinus infection because of the close proximity of the Palatal root of Maxillary first molar to the floor of Maxillary Sinus. The close proximity is the reason why dentists are very careful before going for extraction or doing Root canal treatment in Maxillary first molars.
Most of us who have suffered from sinusitis or seen a family member suffering from Sinusitis know that during sinus infection Tooth pain is a symptom but we might never have thought that a Tooth infection can be the cause of a Sinus infection.
Sinus Infection is nothing but Bacteria growing in the Sinus Spaces which are empty spaces in the Face lined by Epithelium to circulate warm and cold air through their chambers to regulate temperature.
Which Sinus infection can be affected by an Infected tooth:
The Maxillary sinus is the one which is in close proximity to the Maxillary 2st molar on either side of the face. Because of the close proximity of the roots of the Maxillary 1st molar the chance of transferring the infection are greater. It is said that in most cases only 2 mm of bone is present between the Maxillary Sinus and Root tip.
“Approximately 20% of the Maxillary Sinus infections are caused due to maxillary posterior teeth infections such as Periapical or Periodontal infections” – Textbook of Oral and Maxillofacial Surgery
Red Lines – Floor of the Maxillary Sinus
Red – Floor of Sinus, Blue – Root tips outline
In the above given OPG you can see on the right side that the Floor of the maxillary Sinus is very low in relation the the Maxillary 1st and 2nd molar teeth roots which clearly gives an idea of hoe an infected tooth can lead to Maxillary Sinus infection.
This is true in some cases because the periapical or periodontal infections of posterior maxillary teeth erode the bone separating the maxillary sinus from the root tip of Maxillary molar and the infection can go through and lead to Sinusitis.
As we can see in the Xray below that the Roots of Maxillary 2nd Pre molar, 1st Molar and 2nd molar are in very close proximity to the Maxillary Sinus and these are the teeth which when infected can lead to maxillary sinusitis infection. This is the reason why many dentists are very careful in placing implants in posterior region and also suggest you to perform Sinus lift Surgery.
Conclusion: “Teeth infection can be a cause for Sinus Infection”
Many people are confused with Sinus infection and Teeth pain as we know that Tooth pain is a symptom of Chronic Sinusitis but here we can see that Tooth infection can also cause Sinusitis infection.
The treatment of this type of relative infection is determined by using Antibiotics and controlling the Sinus and tooth infection and later meticulous Root Canal Treatment done for the infected tooth. Later if required Sinus Lift Surgery is performed in case Implants are to be placed where the floor of the sinus is lifted away from the root tips.
So make sure you keep your teeth healthy and have regular Dental visits to keep your Dental health in check.
Good article and helpful information. Thank you for sharing this to us. Thank you so much.
I have constant pain in my 1st + 2nd molars and sinus infections that come and go on the opposite side of my nose that burn and itch in the upper area of my nose, mostly on the opposite side. I do have a molar on the other side that needs a crown. I just had a crown put on the side opposite to sinus itch/burn and it is as bad if not worse than before the crown. Sinus got bad again after the crown so I have started antibiotics. Sinuses are clearing up and the gums are getting better, which got kind of trashed, but the tooth is still bad 12 days after crown and 3 days of antibiotics. Does this sound more like the tooth infecting the sius?
Upper Molar infection and Sinus infection are connected in many instances, that is the reason after Antibiotics both the gum infection and Sinus infection have decreased. I you had a Root Canal treatment done sometimes in case of a failed RCT sinus infection can flare up. So getting your tooth checked once again can be useful in knowing whether the Sinus infection is due to Tooth infection or the Tooth pain is caused due to Sinus infection.
Hi Varun
i had a RCT done on my upper 1st molar and since then i have constant pain (pain when tooth felt by tongue or finger) its almost 70 days that i had done the RCT and again went through a 2nd RCT procedure almost a month with a 2nd doctor as they suspected pain could be due to some infection on the RCT tooth. Post the RCT the endodontist says he does not see any infection or issues with my tooth but says it could be the truma or a distrubed sinus thats the cause of pain. i’m facing severe headache for last two months which is is on and off .
last month i also visited a ENT specialist who put me on a course of antibiotics (Augmentin) and other medication but since i was in the middle of the course of antibiotics (Amoxillin) and had finished 4 days of the course prescribed by endodontist i skipped the augmentin. The ENT did say that he did not see any issue with the Sinus but would treat it as a precaution. (after seeing x-ray)
the headache i have is in the temple area. can you please advice which medical specialist should i see to find if this indeed is a sinus issue or a tooth.
Hi Anil,
There can be three causes for your problem –
1. Missed Pulp chamber, each Molar has a minimum of 3-4 pulp chambers and in some teeth the number can be more, if pulp tissue is left it can be the cause.
2. Dental Infection leading to Sinus infection – Although the Dental infection might have subsided due to RCT, the Sinus infection might still persist if the bacteria from the infected tooth enter the sinus chamber due to its close proximity.
3. High Contact point – When the tooth filling or restoration done is higher than the normal tooth level and the treated tooth first contacts the opposite tooth leading to excessive force on it on chewing or biting. As it is an infected tooth it is tender and leads to – TFO or Trauma from Occlusion.
The pain in the temple region is seen in all the three situations mentioned above.
Hi Varun.
I have periodontal disease on my upper first molars. After the perio treatment, I feel pain when I bite down on that molars.
I recently have an x-ray taken, showing that my sinuses are very close to the floor of the 1st molars maxillary.
My question is, could it be that I have sinuses infection and causing my tooth to feel pain, or is it of the perio treatment.
Sinus infection can lead to tooth pain in general. The main question is whether the Periodontal surgery was successful or not, if bone grafting was performed, you will be having slight discomfort and pain on biting down for a couple of weeks. But if it was Deep cleaning performed, then you it can be due to Sinus infection.
Hi Varun, I have very bad decayed teeth I’m having them removed for full dentures . My 1st upper molar was inflamed and pretty positive infected before extraction I have since has all teeth on my right side extracted. It’s not 1 week since the extraction and the infection still persists in the extraction site and my sinus area, any information on this? I have just started antibiotic a couple days ago it’s very slow healing if at all, I just recently thought to cover the extraction site with thing gauze due to the unpleasant inflammation and Taste, should I be concerned ?
hi
how is a sinus infection then treated once and abscessed molar tooth has been extracted. have already been on antibiotics for 5 days prior to extraction
Usually the Antibiotics which are used for treating Tooth infection should act on the Sinus infection as well, the Sinusitis comes down once the affected tooth is Extracted or treated. In very rare cases where there is excessive pus accumulation in the sinus cavity, a Sinus drainage procedure is followed to remove the Pus and treated with Antibiotics accordingly.
This is excellent information Varun, thanks for sharing. Do you advise having a conversation with the endodontist prior to RCT on a 1st molar? I had some filling work done on the same tooth 1 year ago. I recently had an infection in the tooth (1st molar left side), and just finished a round of Amoxicillin which cleared the infection immediately. I realized that I still still have some tenderness to touch on the left paranasal sinus. I learned this when I casually rubbed my face and felt the pain. Does this sound like a situation where the tooth infection caused the.sinus pain? I am.confused because the tooth seems to be better, but the only pain and discomfort seems to be originating just at the root tip (as shown in one of your diagrams above). I have an upcoming RCT on the tooth, but I am concerned about disturbing the sinus further.
Getting Root Canal treatment will help clearing the source of infection. So in a way it helps in clearing the Sinus infection as well.
Hi Dr. Varun,
I had a RCT done on my upper right 2nd premolar, it’s been 4 months now but I still have uncomfortable ache from that tooth and not just that tooth but I can also feel pressure from my first premolar to my front teeth. Some of the tooth especially the 2nd and 1st premolar and my canine feels loose, 2nd premolar is looser though. When I checked with my dentist she saw that my sinus is touching the root of my 2nd and 1st back molars and the 2nd premolar also however I’m not experiencing any discomfort on my 1st and 2nd molars only the 2nd premolar and pressure from 1st premolar through the front teeth. My another problem is I’m getting this awful taste coming from that 2nd premolar, it taste bitter like medicine it’s taste very gross even my dentist doesn’t know where it’s coming from since she saw on the xray that the RCT is looking fine. It’s very disturbing because it makes me want to spit and gargle with water everytime. I don’t know how many times I have to do that in a day because of how awful the taste is. I don’t know if that’s because of too much irrigation or anesthesia. I’m very anxious because of this, what do you think doctor?
Do you have any history o Sinusitis ? In some cases you can see bad smell and taste due to Sinusitis which can seep into the oral cavity. As you have mentioned that your Dentist has checked the teeth with an X-ray any chances of it being periodontitis is ruled out.
Hi Dr. Varun, I had RCT on my upper right molar tooth. Before the 2nd step of RCT, there was serious green discharge from my right nostrils. It was later diagnosed as sinusitis by ENT specialist (MRI image shows complete blockage). Had endoscopic sinus surgery to clear the blockage and cut off a small part of tissue to expand the airways. After surgery, dentist completed the RCT procedure.
But till today (after 6 months), I still feel slight numb whenever I touch that tooth with finger or tongue. I touched my gums that is just right above the tooth and I can feel a small soft node there. This pain is with me and I’m getting concerned. Would really appreciate your advice.
If the Sinus has healed completely and you can feel a slight bump on the gums above the tooth, it is better you get an IOPA or local X-ray for the tooth done to check any abscess of the RCT treated tooth. There can be chances of Recurrence in cases such as yours.
In most cases if that is the case, an Apicectomy can be performed to cut off the portion of the Root which is causing the bump which can save your tooth. An IOPA X-ray can give a clear picture of what exactly is it.
I had a root canal on my bottom molar and my ear and face is feeling like pins and needles. I had sinus surgery thinkin it will help and no. I’m on agmentun and steriods almost done still feel the pain. My ear feels like a burning sensation. Any advise.
This is something we don’t see regularly but do you have any other symptoms like swelling or skin change to black on the site affected ?
Hi Varum, for 13 years (!) I complain from swollen cheek. The problem is that is not very swollen, but still I feel great asymmetry that make me feel kind of bad. Back then i had tooth abcess that made my cheek really big, but my dentist open the tooth and all have gone well. However I now have big iron thing (I don’t know the term) between the root and the crown to keep it together, and he don’t recomment opening it again. I had magnetic ressonaince and it showed nothing abnormal. Is it possible to have infection to the sinus from the tooth abcess, and what would be the options?
How many days has it been since the swelling is present ? has it started after the tooth infection and persisted ?
Hello dear Dr.
You have been so helpful,hope you can help me.
I have an infection in my front tooth the nostril directly above it gets blocked. Then clears. The side of my nose feels pressure too my dentist explained a number of front root tips are bothering my sinus cavity. He is reluctant to do RCT because he fears it might fail. He tells me 3 teeth at front need RCT. Problem I have 30 days before I fly on holiday 10 hours flight for 3 weeks. Two questions, i
1. Is it advisable to get this done before my holiday? (Some days it’s very quiet, never huge pain,never taste or swelling) the main annoyance is the pressure and nostril blocking.
2. Is it ok to just take ABX then go on holiday, and have surgery when I return home? Or best to cancel holiday?
Did you get an Xray done ? It all depends on whether there is a communication between the Sinus and the Tooth, are the tooth infected having an Abscess etc ?
Hello Dr. Pandula,
I had a bone grafting and sinus lift on an empty space (tooth was extracted long time ago) from third tooth from back (right upper). The graft infected after 6 months and did not work out. I have sinus infection and my surgeon clean the graft 4 months ago but when i bite with second mollar , i have pain, it is not terrible but hurts. My ENT doctor said i have sinus infection and gave amoxicillin but it is not effective. Do you think that sinus infection causes tooth pain when i bite? I had the tooth checked, it is totally health. Thank you.
It can be the reason for the Pain you are experiencing as the tooth in question (2nd Molar) is in close proximity to the Sinus Floor. Sinusitis pain can mimic Tooth pain as well as the inflammation of the tissue close to the Root tips of the Tooth triggers pain in the Teeth (mild discomfort of mild pain on chewing).