When you have a toothache, a dental problem is the most logical and likely explanation. But that's not always the case. Inflammation of the maxillary sinuses, which are located in your cheeks, can cause pain in your upper rear teeth. The pain occurs because the roots of these teeth lie in very close proximity to the floor of the sinus on each side of the face. More than one tooth usually hurts and the pain is commonly described as a dull ache that might throb. Coughing, sneezing and bending forward often aggravates the pain. If the teeth are otherwise healthy, treating the sinusitis will relieve your tooth pain.
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Flushing your nasal passages with a saltwater (saline) rinse can help clear mucus and promote drainage of your sinuses. Rinsing your nose will also wash away allergens that might be contributing to your sinusitis. A number of saline wash products are available over the counter. If you're also using a nasal spray as part of your treatment, perform the saline wash before using the nasal spray.
Nasal steroid spray is recommended for treatment of sinusitis and is particularly helpful if you have underlying nasal allergies. The medicine in the spray reduces nasal and sinus inflammation and related swelling, thereby relieving congestion. Several over-the-counter nasal steroid sprays are available (Flonase, Nasacort, Rhinocort) or your doctor might recommend a prescription spray (Beconase, Dymista, Nasonex, Qnasl, Veramyst, Zetonna).
Over-the-counter pain relievers are useful for relieving facial and tooth pain associated with sinusitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered most effective because they both relieve pain and reduce inflammation. Over-the-counter NSAIDs include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve). Talk with your doctor if you are unsure whether these medications are safe for you.
Your doctor might recommend short-term treatment with a nasal or oral decongestant. These medications reduce swelling of the lining tissue of the nose and sinuses, relieving congestion and promoting drainage. Over-the-counter decongestant nasal sprays (Afrin, Mucinex Sinus-Max, Neo-Synephrine, SinuFrin) should only be used for 2 to 3 days as prolonged used can cause rebound congestion. Oral over-the-counter decongestants include pseudoephedrine (Sudafed) and phenylephrine (Suphedrine) and should be used as directed. If you have high blood pressure, check with your doctor before taking a decongestant.
Most sinusitis is not caused by a bacterial infection and, therefore, does not require antibiotic treatment. However, if your doctor determines that you likely have bacterial sinusitis, she might prescribe an antibiotic. Many doctors suggest a 7-day trail of treatment without antibiotics to give the condition a chance to resolve before prescribing antibiotics.
Warnings and Precautions
It can be challenging to distinguish a sinus-related toothache from a dental problem. And in some cases, a tooth infection can spread to the maxillary sinus. Therefore, it's best to see your dentist if you experience new upper tooth pain. If your teeth are healthy, talk with your primary healthcare provider about the best treatment for your sinusitis.
Reviewed and revised by: Tina M. St. John, M.D.