Can My Teeth Cause Sinus Problems?

Did you know that your teeth and sinuses are more connected than you might think? In this episode of We Nose Noses, Dr. Reddy and Dr. Smith break down how sinus problems can masquerade as dental issues—and vice versa. Find out why tooth pain might actually be a sinus problem, how age plays a role in this connection, and what the experts do to diagnose and treat these confusing cases. Whether you’re dealing with unexplained tooth sensitivity or curious about how dental implants can affect your sinuses, this episode is packed with insights you won’t want to miss.

Audio Transcript:

Dr. Reddy
Hey guys, welcome to another episode of We Nose Noses. I’m Dr. Reddy, joined by Dr. Smith. And today we are going to discuss a topic. The question we’re trying to answer is, can my teeth cause sinus issues? And so I’ll let Dr. Smith start off.

Dr. Smith

Sure. So there’s a lot of times that we get the impetus of this discussion is basically we get a lot of patients that either have teeth sensitivity or teeth pain, sinus pain, cheek pain, and don’t really know, should I go to an ENT, should I go to a dentist? And so we’ll kind of give you some pearls. We’ll go over a little bit of the background of kind of where the teeth are and why there might be some overlap between sinus problems and dental problems. So the teeth, you know, essentially you have 32 teeth in the adult mouth and they all sit kind of in four quadrants, so you have your uppers and then your lower quadrants here. The uppers all sit up on the maxilla, which is the upper part of the lip and mid face here, and that abuts against the sinuses. The sinuses are just air -filled trauma cushions that go around the eye, and so they sit like a C shape around the eye and underneath of the brain. The ones on the bottom here, the maxillary sinuses, excuse me, sit on either side of the nose, right underneath the eye, within the cheek. And those maxillary sinuses, as we start to age into our teenage years, start to get larger and larger and larger, and really about in close proximity, a lot of the upper teeth and dentition. So as we’re kids and we lose our first set and our second set of teeth start to drop in, sometimes those teeth are up against the sinus, sometimes those teeth are in the sinus.

And so there’s a lot of patients that may come in complaining of a sinus infection and they feel like they have a sinus infection because they have teeth sensitivity. So it’s our job to try to figure out is it really a sinus infection or is it something or a problem with the tooth? Do you want to talk about how you kind of first approach somebody they come in and they say, you know, I have teeth sensitivity. It’s always on my right hand side and try to figure out the problem.

Dr. Reddy

Sure. So one of the main things that we do is we take a look with a little camera on the nose called a nasal endoscopy. And we’re looking in the nose at the entranceway to the cheek sinus, which is the maxillary sinus. And we’re seeing if we see any evidence of obstruction or pus in that area. If there is any evidence of obstruction or pus in that cheek sinus area and the patient is complaining of pressure or tenderness by the cheek and the upper teeth, then it’s a sign that there’s probably some type of an infection causing irritation to the tooth. One of the next steps oftentimes is getting a CAT scan or an imaging study and actually taking a look at that tooth sinus interface and seeing if there’s maybe a tooth that’s extending into the sinus that might be seeding bacteria from your mouth into the sinus.

Or maybe there’s a small little fistula that’s there or a hole that shouldn’t be there between your sinus and your mouth. Or maybe there’s a chronic tooth infection that’s causing it. Things like a really bad cavity or what we call a periapical abscess or something else that’s similar to that that might be causing bacteria to go up from your tooth area or your mouth area to your sinus area.

Dr. Smith

So of course, like we always look at the teeth too and the gums to see if there’s any signs of inflammation along the tooth or, or if it’s, you know, we may sometimes palpate along the upper dentition and along the gum line up there up towards the cheek to see if there’s any fluctuance or any, and what we call induration or swelling or inflammation up there that might be indicative of it starting as a tooth proble and sometimes it is both.

Sometimes a patient may have a dental abscess that then becomes a bad sinus infection. And we often see these, a lot of times these come from dentists to us, but sometimes they come to us first as well. And they have this ongoing drainage. Some patients just have a cough and maybe a toothache from the pus draining down the back of the throat. But you want to go over a little bit of like what we do. if we have a sinus infection, we’ve diagnosed a sinus infection, we know it’s a sinus infection but we also suspect that there’s a tooth problem. And maybe we got a CAT scan that shows that it is a tooth problem. What are you next to? If you think that there’s like a root problem within the tooth that might also need to be addressed.

Dr. Reddy

Yeah, so it’s a little controversial. There’s not always a hundred percent right answer with this. I mean, do you start with a tooth that’s infected and you maybe ask the dentist to take out the tooth or maybe fill the tooth or drain the tooth abscess, and then, or do you start off with addressing the sinuses first, more maybe with conservative management like nasal sprays and rinses and antibiotics? Or do you do a sinus procedure, right? And I think generally speaking, you first try conservative measures first, which is nasal sprays, sinus rinses, antibiotics, things like that to try to get the infection under control. And if everything gets better, then you may be able to get away with not doing much more.

If the dentist feels like you absolutely need a tooth intervention, you can certainly start off with that. But if there’s anything more where you have like a fistula or you have recurrent sinus issues despite addressing the tooth, then it’s reasonable at that point to probably clean out that sinus via a minimally invasive sinus procedure.

Dr. Smith

Yeah, agreed.

Dr. Reddy

Because otherwise that pus that’s hanging out in the cheek sinuses is always right above your tooth line. And if you don’t clear it out completely, oftentimes the tooth may not get completely better.

Dr. Smith

Yeah, agreed. Yeah. One of that minimally invasive procedure that Dr. Reddy was talking about something that we all do here at NJENT. And it is nice to be able to go in there and maybe a combination with the dental treating the tooth source and us kind of dilating or opening up that sinus and cleansing out that pus it often gives patients an option to heal much faster than having to go through a full surgery and trying to schedule everything that way. So it does offer a nice additional option that’s kind of minimally invasive, less healing time for the patient.

Dr. Reddy

Correct. Did you want to comment on another common thing that we see, which is patients that are getting implants? Yeah, sure. Teeth implants. Oftentimes patients are getting implants for missing teeth for cosmetic reasons or functional reasons and the oral surgeon is putting these implants into the upper part of the teeth.

Dr. Smith

Right.

Dr. Reddy

Do you see any problems with those?

Dr. Smith

Yeah, sometimes. So yeah, those are very tricky, especially if there’s a very thin maxilla between the sinus. So if someone has a very large maxillary sinus, there may not be a lot of bone to put an implant in oral surgeons or implant surgeons for dental implants may offer what’s called a sinus lift where essentially they may lift the lining of the sinus and tuck some bone grafting in there to try to get more space to put an implant in because those implant posts are pretty long. And so in a lot of patients, those typical posts would sit right up into their sinus. And some patients, those posts will then trigger, because it’s a foreign body, sinus inflammation and sinus infection. So, good point. Yeah, the implants can certainly be a culprit for sinus pathology then. And do you ever see any, as far as like, I know we mentioned this maybe in an old podcast, but have you ever seen any other things with teeth in the nose or in the sinuses that might be of interest to people listening?

Dr Reddy

Yeah. I mean, sometimes you can find a tooth within the nose, which is rare, but more commonly within the actual sinus itself. And usually they don’t cause much issues within the sinus, but certainly you don’t want a tooth in your nose.

Dr. Smith

Yeah. Agreed. I’ve even found dental bits within the maxillary sinus. so a dental drill bit that had fractured off and gone into a maxillary sinus. Now that the dentist knew that that had gone in there, but had to fish that out a separate procedure. they are really close in proximity that is why a lot of people can’t quite figure out is it tooth or is it sinus.

Dr. Reddy

I think is do we have anything else to add?

Dr. Smith

No, I think that’s it. We’ll talk more in later and future dates about other dental overlaps with ENT because there are other areas that things from within the dental field tend to overlap a lot with other areas in the head and neck and we’ll talk about them at a later date. But no that’s it. That’s all that we have for today. So thank you for joining us on another We Know Knows podcast. Make sure you like and subscribe. Thank you.

In rare cases where a dental issue causes a chronic sinus infection that won’t resolve with standard treatments, sinus surgery may be required to clear the infection and repair the sinus area.