Sinusitis, dental infection or both

Sinusitis affects 28.9 million Americans each year, causing headaches, runny or stuffy nose, facial pressure and even tooth pain. When the mucous lining of the nasal passages and sinus cavities becomes inflamed, sinus drainage is blocked, causing a buildup of mucus and bacteria, viruses, or fungi that can cause infection.

Traditional toothaches are often localized to individual teeth, which may be sensitive to temperature changes or accompanied by swollen gums and pain when chewing. Tooth pain from sinusitis occurs when the sinuses of the palate, located behind the cheekbones and over the teeth, are affected. In some cases, when the anatomical structures are in close proximity, tenderness across multiple maxillary teeth may result, worsened by changes in head position (such as bending over).

More than 40% of maxillary sinus infections originate from dental infection, a condition called maxillary odontogenic sinusitis (MSDO). Gum disease, fillings, sealants, dental implants, and tooth extractions are some common causes of MSDO.A related condition called maxillary sinusitis of endodontic origin (MSEO) is unique in that it originates solely from the infected root of the tooth

Dr. Diogenes is wearing a UT Health San Antonio branded white coat and smiling.
Anibal R. Diogenes, DDS, MS, PhD

“Everyone’s tooth anatomy is different,” says Anibal R. Diogenes, DDS, MS, PhD, professor of endodontics at the Health Sciences Center at the University of Texas School of Dentistry at San Antonio. “Some patients have tooth roots that extend directly into the sinus cavity. This makes it easier for bacteria to enter the sinus from the diseased tooth, or from the infected sinus to the area around the tooth, creating inflammation.

Diogenes says it's difficult for general dentists and primary care providers to diagnose MSDO or MSEO as the cause of sinusitis because the inflammation doesn't show up on traditional X-rays. In fact, as many as 86% of cases go undiagnosed.

“It is important to get to the root of the problem and know exactly where the infection is coming from,” Diogenes said. If a patient has a dental infection and is receiving other treatments, they can tolerate several rounds of antibiotics or even expensive surgery and still not get relief, and vice versa.

Diogenes encouraged anyone experiencing unusual tenderness around a tooth to see a general dentist and ask for a referral to an endodontist, known as a root canal specialist.

“Not seeking timely treatment can lead to dangerous complications such as chronic sinusitis, abscesses or orbital swelling,” he said. “In severe cases, the infection may even reach the brain – this is rare, but possible.”

Endodontists like Diogenes can quickly diagnose tooth and sinus infections by using advanced imaging equipment and testing tooth health. They can treat tooth infections or refer patients with suspected sinusitis to an otolaryngologist.

The most common cause of sinusitis originating from the teeth is dental infection,” Diogenes said. “Solving this problem is our main mission. That's what we do: identify, treat, or rule out any endodontic problem. Anyone who's not sure where their toothache comes from is welcome to sit in our chairs.

For more information about endodontic services and how to schedule an appointment with a specialist, visit the UT Dentistry website.

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