Tooth or Sinus

Can sinusitis cause toothache?

If several of your upper back teeth ache at once, the source may not be the tooth itself

When several of your upper back teeth suddenly start to ache, the first thing that comes to mind is decay or a root canal problem; but the culprit is often the sinus. The floor of the upper jaw sinus sits genuinely close to the roots of these teeth; when one becomes inflamed, it can make the other ache too. Below, in order, are the signs that tell sinus pain apart from tooth pain, the fact that the reverse is also possible (a tooth causing sinusitis), and why the sinus matters for upper jaw implants.

Short answer

Yes, sinusitis can cause pain that closely resembles toothache, because the roots of the upper back teeth sit right against the floor of the upper jaw sinus, and when the sinus becomes inflamed, pressure builds around these roots. The distinguishing sign is this: with sinus pain, it is not a single tooth but several upper back teeth on the same side that become tender at once, the pain gets worse when you lean forward, and it comes with a blocked or runny nose. The reverse is also possible: an inflamed upper back tooth can infect the sinus and cause sinusitis; in that case, the sinusitis will not clear up until the tooth is treated.

Distinguishing sign: Not one tooth, but several upper back teeth at once
What makes it worse: Leaning forward, bending your head down, lying down
How long it takes to clear on its own: Acute sinusitis usually clears within 4 weeks
Emergency sign: A high temperature, swelling around the eye or a change in vision

Why tooth pain and sinus pain get confused

In the back of the upper jaw, right above the roots of the upper back and premolar teeth, sits an air space called the maxillary sinus. In some people the bone between this space and the roots is quite thin. This closeness explains why sinus pain and toothache get confused so often.

When the lining of the sinus becomes inflamed, for example after a cold, flu or an allergy, the swollen tissue presses on the nerve endings around the root tips just below it. The brain reads this pressure as toothache, even though the source is not the tooth itself but the sinus above it.

The first distinguishing sign is how many teeth ache. Sinus pain usually affects several upper back teeth on the same side at once, as a dull, spread-out ache. With tooth pain, a cold test or tapping the tooth gives a sharp, repeatable response in a single tooth; the neighbouring teeth stay calm.

The second distinguishing sign is what changes the pain. Sinus pain noticeably increases when you lean forward, tip your head down or lie down; this comes from the pressure inside the sinus changing with gravity. Tooth pain changes with cold, sweet things or biting, not with position.

The third distinguishing sign is what comes with the pain. Sinusitis usually follows a cold or flu; a blocked nose, coloured discharge, mucus running down the back of the throat and sometimes bad breath come with it. None of these are present with tooth pain; if there is swelling or discharge from the gum, the source is already the tooth itself.

The reverse is also true: this is called sinusitis of dental origin. Deep decay reaching the pulp, a failed root canal treatment or advanced gum disease can break through the thin layer of bone at the root tip of an upper back tooth and infect the sinus. The sign that sets this picture apart from ordinary sinusitis is usually that it is one-sided and does not clear up with standard sinusitis treatment; as long as the source stays in the tooth, the sinusitis stays too.

This closeness has a separate importance for upper jaw implants. When an upper back tooth is missing for a long time, the floor of the sinus gradually expands downward and the bone in between gets even thinner. That is why one of the first things we look at when planning an upper jaw implant is the condition of the sinus floor; some patients need a sinus lift, while for others a different placement, resting on the hard outer layer of the jaw, avoids this step altogether.

Is your pain coming from the sinus, or from a tooth

These two lists do not give a firm diagnosis, only a first indication. The exact distinction is confirmed by an examination and, if needed, imaging.

The tooth can be saved

If several upper back teeth on the same side ache at onceA dull ache spreading across a group of teeth, rather than a single tooth, suggests a sinus-related picture.
If the pain gets worse leaning forward or lying downThis is a sign that the pressure inside the sinus is changing with position; tooth pain has no such trigger.
If you have a blocked nose, discharge, or a recent coldSinusitis mostly follows an upper respiratory infection; if these signs are present, the source is most likely the sinus.
If the pain is dull and spread out, not pointing to one spotPain with unclear borders, described as a feeling of pressure, fits a sinus-related picture covering a wide area rather than a single tooth.

Saving it is unlikely to hold

If only a single tooth has a sharp reaction to coldThis is a sign of irritation coming from the pulp; sinus pain does not give such a sharp, repeatable response in a single tooth.
If tapping or biting on that tooth reproduces the pain exactlyPain triggered only in one tooth, and that repeats, shows the source is the tooth itself.
If there is no blocked nose or discharge at allWithout the signs that come with sinusitis, a sinus-related picture is less likely.
If there is swelling or discharge from the gumThis directly shows there is an infection around the tooth; the source is the tooth itself, not the sinus.

How we tell the source apart

The aim is to get you to the right doctor at the right time; dental treatment does not help sinus-related pain, and sinusitis treatment does not help tooth-related pain.

1
We take the history
Whether the pain started after a cold, how many teeth it affects and whether it changes with position make the first distinction.
2
We test the teeth one by one
A cold test, light tapping and a bite test show whether the pain appears in one specific tooth or several teeth at once.
3
We assess the nose and the response to leaning forward
Whether the pain increases when you tip your head forward, and whether a blocked nose is present, strengthens or weakens the likelihood of a sinus cause.
4
We look at the sinus floor with an X-ray or a scan
Imaging shows the thickness of the sinus floor, any fluid or thickening inside the sinus, and its relationship to the tooth's root tip.
5
We refer you according to the source
If the source is the sinus, we refer you to an ear, nose and throat (ENT) specialist; if it is the tooth, we start treatment ourselves. With sinusitis of dental origin, the tooth is treated first.

Treatment given, depending on the source

There is no single treatment for this complaint; what is done depends on whether the source is the sinus or the tooth.

Watchful waiting for simple viral sinusitis

Simple sinusitis starting after a cold usually clears on its own within a few weeks; rest and managing symptoms is enough during this time.

ENT treatment if sinusitis lasts more than three weeks

For sinusitis that does not clear on its own or gets worse, an ENT specialist may recommend a nasal spray, antibiotics if needed, or another treatment.

Treating the tooth, if it is dental in origin

If the source of the sinusitis is an upper back tooth, it will not clear for good without root canal treatment, or extraction if needed.

A sinus assessment when planning an upper jaw implant

If you are missing upper back teeth and considering an implant, planning starts with imaging of the sinus floor; some patients need a sinus lift and others do not, and the image determines which.

What happens if the two get confused

We are not writing this to frighten you, but so you go to the right doctor.

A dental infection can be missed as sinusitis

In a patient managed with sinusitis treatment alone, an infection whose source is actually the tooth keeps progressing silently.

A tooth can have unnecessary root canal treatment

Root canal treatment carried out on the tooth the patient points to, without testing, cannot be undone and does not stop the pain if the source is the sinus.

Sinusitis of dental origin keeps coming back if the tooth is not treated

Standard sinusitis treatment (rest, a nasal spray, antibiotics if needed) will not give a lasting result as long as the source stays in the tooth.

Procedures done without noticing a thin sinus floor carry risk

Extracting an upper back tooth or placing an implant without imaging the thickness of the sinus floor beforehand can lead to unexpected complications; this is why imaging is done first in the upper jaw.

Sinusitis that becomes chronic can be missed

If symptoms last longer than twelve weeks, the picture is no longer acute and is considered chronic sinusitis, needing different management. A complaint lasting this long should be taken to a doctor rather than managed with painkillers for months.

When the pain goes away

How long it takes depends on the source. The timeline below is the realistic course for the pictures we see most often.

The first week
With simple viral sinusitis, symptoms start to ease with rest, keeping the nose clear and managing the symptoms.
Three weeks
If sinusitis has not cleared on its own by this point, seeing a doctor is recommended.
Four weeks
Most acute sinusitis clears completely within this time. Complaints lasting longer are considered chronic sinusitis.
If it is dental in origin
Sinusitis symptoms keep coming back until the source tooth is treated; once the tooth is treated, noticeable relief follows within days.

Message us right away if

You have a high temperature. This is a sign the infection could get out of control; it needs to be assessed the same day.
There is swelling around your eye or a sudden change in vision. An infection spreading to structures near the sinus is urgent; go to A&E without losing any time.
Your symptoms have lasted more than three weeks. Going past the time it is expected to clear on its own means a doctor's assessment is needed.
Your discharge is one-sided and foul-smelling. This is a sign the source may not be ordinary sinusitis but an infection coming from a tooth; you should also see your dentist.

What determines the cost

We do not give a single figure on this page, because if the source is the sinus, the work falls to an ENT specialist, and if it is the tooth, to a dentist, and the scope is completely different from the start. These are the items that determine the price:

Whether the source is the tooth or the sinus: Sinusitis treatment and root canal treatment or extraction are completely different procedures, each the domain of a different specialist.
How much imaging is needed: In some cases a panoramic X-ray is enough; a CBCT scan may be needed to clarify the thickness of the sinus floor.
The type of dental treatment needed: With sinusitis of dental origin, root canal treatment and extraction with an implant carry a completely different scope.
Whether an ENT referral is needed: If the source is the sinus, a referral to a separate specialty and a separate assessment there are needed.

Frequently asked questions

How can I tell at home whether it is sinusitis or toothache?

Look at three things. With sinusitis, several upper back teeth on the same side become tender at once; with tooth pain, a single tooth stands out. Sinus pain gets worse when you lean forward; toothache gets worse with cold and with biting. Sinusitis comes with a blocked nose. If all three point to the sinus, see an ENT specialist first.

My sinusitis has cleared but my tooth still hurts; is that normal?

No, this is not an expected course. If pain in the same tooth continues after the sinus has improved, the source was the tooth all along. See your dentist.

Can a dental infection cause sinusitis?

Yes. Deep decay, a failed root canal treatment or advanced gum disease can break through the thin bone at the root tip of an upper back tooth and infect the sinus. In this picture, the sinusitis will not clear until the source tooth is treated.

My upper back tooth is going to be extracted; will it harm my sinus?

This possibility is assessed in patients whose sinus floor is thin; that is why an X-ray or scan is taken before extraction to check the position of the sinus. A decision made without imaging is made with incomplete information.

How long does sinusitis take to clear, and when should I see a doctor?

Simple sinusitis usually clears on its own within four weeks. If it has not improved after three weeks, if you have a high temperature, or if you have swelling around your eye or a change in vision, you need to see a doctor.

I want an implant in my upper jaw; is my sinus a problem for that?

Not on its own, but it is part of the planning. When upper back teeth are missing for a long time, the sinus floor expands downward and the bone becomes thinner. That is why imaging is done first in the upper jaw; some patients need a sinus lift, while for others a placement resting on the hard outer layer of the jaw avoids this step entirely.

Can I take a painkiller for toothache caused by sinusitis?

You can take ibuprofen or paracetamol following the patient information leaflet and your pharmacist's advice; this does not treat the sinusitis itself, it only eases the discomfort. If the sinusitis lasts more than three weeks or gets worse, you need to see a doctor.

Should I see an ENT specialist or a dentist first?

If several upper back teeth ache at once, you have a blocked nose and you have recently had a cold, an ENT specialist is a sensible first step. If a single tooth has a sharp reaction to cold, or there is swelling or discharge from the gum, go straight to a dentist. If you are not sure, a dentist can make the fastest distinction between the two by testing the teeth one by one.

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