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Pinpointing source of tooth pain trickyDear Dr. Reitz: My wife went to our dentist seeking relief from a toothache. The dentist has been treating her for gum disease, but did not think that was the cause of her pain, and referred her to an ear, nose and throat specialist. He treated her for a sinus infection which has eliminated her pain. Can the gums infect the sinus or are they two distinct problems? - Rick Dear Rick: Finding the origin of tooth pain is often challenging and made more difficult with the upper teeth because of the sinuses. Above the upper back teeth are air spaces called sinuses that are lined with membranes that can get infected and/or inflamed. What feels like a toothache can actually be a sinus infection. Some patients can distinguish a sinus infection from a toothache; however there are times they feel very similar. The roots of the upper molars and premolars come very close to the base of the sinus, and although separated by a bony wall, a network of blood vessels provides a pathway for the spread of bacteria between the sinus and teeth. For a dentist to determine the source of pain in and around the mouth, it's important for the patient to keep a record of things that affect the pain. The dentist will try to identify the problem by reproducing the source of pain. When a tooth hurts during chewing, the reason can be either a dental problem or a sinus problem. If the pain is initiated or intensified by hot or cold it's likely a dental problem. Some common causes of facial pain around the mouth include tooth abscess, sinus infection and muscle pain from a condition termed myofacial pain dysfunction syndrome (previously called TMJ). If your wife's pain was a sinusitis, and the gum disease is not resolved, there is a possibility that the sinusitis will return. In cases of chronic sinusitis, successful periodontal treatment often results in the sinus membrane returning to normal. Clinical studies have shown that patients with periodontal disease are twice as likely to develop sinus disease. In cases of severe periodontal disease the sinusitis may not resolve unless either the bad bacteria in the gums are completely eliminated or the teeth are extracted. Your wife did the correct thing by first seeking the advice of a dentist. Since there are multiple causes of tooth pain it's important to first determine if it's a true dental problem. It would then be for her dentist to make a referral to a physician for an evaluation. A coordinated effort between your wife's dentist and physician is important to treat both the sinus infection and periodontitis. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610. John
V. Reitz, D.D.S., F.A.G.D. Copyright
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