Can sinusitis cause toothache in the upper teeth?

Short answer: Yes. The roots of the upper back teeth sit very close to the maxillary (cheek) sinuses, so sinus inflammation can feel like toothache in several upper teeth at once, often worse when walking or bending. The link works both ways, so persistent pain may need both a dentist and an ENT.

Key takeaways

• Upper back teeth roots lie just below the maxillary sinuses.
• Sinus-related tooth pain usually affects several upper teeth, not one.
• An infected upper tooth can also cause sinusitis.
• Seeing both a dentist and an ENT helps identify the main source and avoid unnecessary treatment.

Dr. Prashanth's perspective

Toothache can occur with a sinus infection even when there is no dental cause. So whenever the dentist gives clearance that there is no dental reason for the tooth pain, the sinuses should be suspected and evaluated.

— Dr. Prashanth R. Reddy, ENT Surgeon, ENTHealth360

Why can sinusitis cause upper toothache?

The maxillary sinuses sit directly above the roots of the upper back teeth, so inflammation in one can be felt in the other.

The maxillary sinuses are the largest sinuses, located behind the cheeks. Their floor lies just above the roots of the upper premolars and molars. In many people, only a thin layer of bone separates them, and in some the roots even project slightly into the sinus.

The nerves supplying these teeth run close to the sinus lining. When the sinus is inflamed and filled with mucus, pressure on these nerves can be felt as toothache, even when the teeth themselves are healthy.

The reverse is also true. An infected upper tooth, a deep cavity, gum infection or a complication after extraction can spread infection into the sinus. This is called odontogenic sinusitis, meaning sinusitis that starts from a tooth.

How can you tell if tooth pain is from the sinuses or a tooth?

The pattern of pain and the other symptoms give useful clues.

More likely sinus-related:

• Ache in several upper back teeth on one or both sides.
• Pain that worsens when walking, jumping, bending forward or lying down.
• A blocked nose, thick discharge or heavy face at the same time.
• Started during or after a cold.

More likely dental:

• Sharp pain in one specific tooth.
• Sensitivity to hot, cold or sweet food.
• Pain on biting on one tooth.
• Gum swelling or a visible cavity.

Possible tooth-to-sinus infection:

• One-sided sinus symptoms with a foul smell or taste.
• Recent dental extraction, implant or root canal on that side.

What can you do at home?

If the pain seems sinus-related, supporting sinus drainage may ease it.

• Saline rinse once or twice a day with boiled-and-cooled, distilled or sterile water.
• Steam inhalation for five to ten minutes with plain hot water.
• Warm compress over the cheek.
• Stay hydrated to keep mucus thin.
• Paracetamol may help short-term, as directed.
• Maintain good oral hygiene: brush twice daily and floss.
• Do not start leftover antibiotics.

If the pain is in one tooth or comes with sensitivity to hot or cold, see a dentist first.

How are breathing, sleep and energy connected here?

Sinus-related tooth pain usually comes with a congested nose, which can disrupt sleep.

A blocked nose often leads to mouth breathing at night. Combined with facial ache, this can cause broken sleep, a dry mouth and grogginess in the morning. Mouth breathing also dries the mouth, which may not help gum and dental health.

Treating the sinus cause may ease the pain and restore nasal breathing, which for many people supports more restful sleep and better daytime energy.

How does nose breathing support energy and BMR?

Your basal metabolic rate (BMR) is the energy your body burns at rest to keep the heart beating, the brain working and cells repairing. Your cells make that energy using oxygen, so how well you breathe matters.

Nose breathing helps in two ways:

• Warm, moist, filtered air. The nose warms, humidifies and filters each breath before it reaches the lungs. Conditioned air is gentler on the airway lining, which matters in Bangalore's air-conditioned offices and traffic dust. Mouth breathing skips this step and can leave the throat and airways dry.
• Nitric oxide from the sinuses. The paranasal sinuses continuously make nitric oxide (NO), a natural gas. When you breathe in through your nose, small amounts of this NO travel to the lungs, where studies suggest it may help widen tiny blood vessels and improve oxygen uptake. Mouth breathing largely bypasses it.

Nose breathing does not "boost" your BMR. That is set mainly by muscle mass, age, body size and hormones such as thyroid. But comfortable nasal breathing by day, and undisturbed breathing at night, support efficient oxygen supply and deeper sleep, which your body needs to use energy well and recover.

A simple check: sit quietly and breathe through your nose with your mouth closed for two minutes. If that feels difficult, or one side is always blocked, it is worth having your nose examined.

When should you see an ENT?

See an ENT if upper tooth pain persists with sinus symptoms or dental treatment has not helped.

• Upper tooth pain with nasal symptoms lasting more than 10 days.
• Pain continuing after the dentist finds the teeth healthy.
• One-sided sinus symptoms with a foul smell after dental work.
• Seek urgent medical care for swelling of the face or around the eye, vision changes, high fever, difficulty opening the mouth, or difficulty swallowing or breathing.

How an ENT evaluates and treats it

An ENT, often working with a dentist, finds which is the main source of the pain.

The ENT may perform a nasal endoscopy to look for pus, swelling or polyps near the sinus openings. A CT scan may be advised to show the sinuses and the relationship of the tooth roots to the sinus floor. A dental examination and dental X-ray help assess the teeth.

If the sinus is the source, treatment may include saline irrigation, steroid nasal sprays and, when indicated, antibiotics. If an infected tooth is causing sinusitis, the dental problem usually needs treatment too. In persistent cases, endoscopic sinus surgery may be considered. The right option depends on the cause.

Frequently asked questions

Does nose breathing give me more energy? It does not add energy by itself, but it delivers warm, humidified air and sinus nitric oxide to the lungs, which may help oxygen uptake. Together with better sleep, that supports the energy your body uses at rest (BMR) and during activity.

Will the tooth pain go away when the sinusitis clears? If the teeth are healthy and the pain is sinus-related, it usually eases as the sinus inflammation settles.

Can a tooth extraction cause sinus problems? Occasionally. Removing an upper back tooth can create a small opening into the sinus, which may lead to infection. Your dentist can advise on care after extraction.

Should I see a dentist or an ENT first? For pain in one tooth or with sensitivity, see a dentist first. If the teeth are healthy and you have nasal symptoms, an ENT review is the next step.

References

• Lundberg JO, Farkas-Szallasi T, Weitzberg E, et al. High nitric oxide production in human paranasal sinuses. Nature Medicine. 1995;1(4):370-373.
• Lundberg JO, Settergren G, Gelinder S, et al. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica. 1996;158(4):343-347.
• Keck T, Leiacker R, Heinrich A, Kühnemann S, Rettinger G. Humidity and temperature profile in the nasal cavity. Rhinology. 2000;38(4):167-171.

About the author

Dr. Prashanth R Reddy is an ENT surgeon at ENTHealth360, Bangalore (MS ENT; MBA, IIM Bangalore; Seoul Rhinoplasty Fellowship), seeing patients at Sakra World Hospital, Marathahalli and in Koramangala. His practice focuses on how breathing affects sleep, energy and everyday performance.

Related reading: Sinusitis: Causes, Symptoms, Home Care & When You Need an ENT (Bangalore Guide)

For educational purposes only. Not a substitute for medical advice. Please consult a qualified ENT specialist.