How do you tell a sinus infection from a damaged tooth root?

May 19, 2007 11:26 AM

Tooth question: How do you tell a damaged root from a sinus infection? Also, I just had my wisdom teeth out.

On Tuesday I had all my wisdom teeth out. At first, things seemed to be ok: less pain and swelling than I expected. I was vigilant about all the thngs you're supposed to do: cold packs, then hot packs, mushy food, salt rinses after 36 hours, and so on. I had a slight fever the second day, but that went away with sleep and Advil. I didn't even need the percocet after the first day.

Then, Thursday night, the pain started getting worse. It took a while to figure this out, but the pain actually seemed to be mostly in my upper right teeth. At about the same time, I started experiencing sinus problems. I'd been having a slight amount of pain/pressure at the top of my cheeks before the surgery, but this was now intensified. I feel a lot of pressure in my sinuses, and my ears are constantly popping.

The worst of the pain seems to be above teeth that are two and three teeth away from where the extracted wisdom tooth was. When I inhale deeply, or the pressure changes in my head, it feels like the nerves *above* my teeth are being jangled. This is unpleasant but not actually super-painful. Except that ever now and then, I get a very sharp pain in this area. Eating, or walking for more than a few minutes, results in a dull ache in all my back upper right teeth.

I went back to the surgeon who did my extractions and she's pretty convinced it's just the sinus infection. She prescribed some heavy-duty antibiotics and recommended I take a decongestant. These seem to be helping a bit, along with more advil.

However, I'm nervous because this reminds me a little bit of the pain I had before a root canal last year. I've read, though, that the pain of a sinus infection can be similar to the pain caused by damaged roots. And I suppose that an immune system weakened by surgery and general anesthesia (sp?) could result in a seriously painful sinus infection.

So, I was wondering if anyone out there regonizes these symptoms from a sinus infection? If the pain persists by Monday, I'll go to my regular dentist and get a diagnosis, but I thought maybe some first-hand experiences could hold me till then.

posted by lunasol to Health & Fitness (19 answers total)

The way to confirm or rule out sinus infection would be to visit a physician, not a dentist or dental surgeon.
posted by winston at 11:35 AM on May 19, 2007

You might have dry sockets. Don't wait, call your surgeon's office now and have the on-call doctor paged. They'll want to see you. Even if you have a sinus infection, you need to call them, because that would mean your surgical sites could get infected.

(Seriously, I didn't think it was a big issue either, but my timeline was the same as yours -- had them out Tuesday, was back at school by Thursday and Friday, by Sunday morning, at 20 years old, I was in so much pain that all I could do was rock and cry.)
posted by SpecialK at 11:41 AM on May 19, 2007

Well, don't get too worried yet. Your upper teeth and sinuses have a close relation to one another. In my experience I have had cavities which resulted in pain in the sinuses, or pain on the opposite side of the mouth. I have also had sinus headaches that make my teeth hurt. It's really tricky.

As your extraction sites heal, you can certainly have pain start up again, and go away again. You may also have some slivers of bone or tooth in the gum that got left behind; it's very common. If that's the case, they should work themselves out.

In short, I don't think anyone here can give you a definitive answer, but I can just try and encourage you to not worry too much ahead of time. Take the meds, take the pain meds if you need to, but do follow up with your dentist and doctor.

Good luck!
posted by The Deej at 11:42 AM on May 19, 2007

I you have an infected root, then tapping on the tooth normallyl causes pain.
posted by MonkeySaltedNuts at 11:48 AM on May 19, 2007 [1 favorite]

If it hurts more when you bend over (as if to tie a shoe), it's likely a sinus infection.
posted by mattholomew at 11:54 AM on May 19, 2007

MonkeySaltedNuts you are dead on. Last time I had a root canal I had to go to an oral surgeon I had never been to before. She was all business, no talk. She asked me which tooth it was, and before I could answer she was in there tapping each tooth with the metal end of one of her instruments.

I wept in pain when she hit the one.
posted by zymurgy at 12:11 PM on May 19, 2007

Abcessed upper teeth and sinus infections feel very, very similar: Teeth sensitive to pressure, sucking cold air past them, cold/hot liquids... Abcessed teeth can refer pain to their neighboring teeth, sinus infections feel like two or three teeth in a row are abcessed. Both feel like throbbiness and may involve swelling feeling. Both conditions respond to ibuprofen and antibiotics.
A sinus infection(usually) is treated definitively with the medications. An abcessed tooth will settle down after treatment with antibiotics but eventually flairs back up again when the infected tooth remains (root canal or extraction is needed)
Since you have already seen the original surgeon, and she felt the extraction wounds were healing well, I'm assuming there was either a pre-surgery x-ray taken, and possibly one taken when you went back? If not, when you do see your dentist, he will take one or two x-rays, which may show either cloudy looking sinus cavity or if it's a tooth causing the symptoms, then he may be able to see indications. Or nothing may be suspicious on x-ray, and you'll just finish the antibiotics and be well thereafter.
If I were in your situation, I'd see my dentist, finish the meds, and go from there, if he felt a medical opinion was necessary then see your MD.
And, because it can't be said enough, if you start antibiotics, finish the whole bottle as prescribed, don't add to the superbug problem.
posted by Jazz Hands at 12:15 PM on May 19, 2007

Sounds like sinus infection is the most likely candidate, especially if you're feeling a teensy bit better with the antibiotics and advil. If the getting-better trend reverses, however, I'd get it checked out again.

Ugh. Sounds horrible. Hope you feel better soon.
posted by treepour at 12:52 PM on May 19, 2007

Response by poster: Thanks for all the tips, etc. I just tried tapping the tooth in question, and it wasn't really painful. Also, lowering my head increases the pain.

Hopefully the antibiotics will sort things out...
posted by lunasol at 1:09 PM on May 19, 2007

re: tapping on the tooth. That doesn't always work. I had my first and only root canal last year. But I was convinced that it was some sort of jaw problem, because there was no pain when I chewed, nor when my dentist tapped on my teeth. He was only able to figure out which tooth it was by having me hold some hot water in my mouth. Holy crap, I nearly flew out of the chair. Sensitivity to heat and cold are another symptom of root issues.
posted by kimdog at 1:13 PM on May 19, 2007

When I got my wisdom teeth out I was told that sinus problems were a relatively common side effect of the surgury. I guess the roots of the teeth can nick your sinuses or something as they come out. I then, of course, proceeded to get the nastiest sinus infection the world has ever seen, roughly 3-4 days after the surgery. Holy crap that sucked. So it's very likely that the surgury either exacerbated an existing infection or created a new one.
Note: this is purely anecdotal and I may have no idea what I'm talking about re: the sinus/wisdom teeth connection.
posted by ohio at 3:40 PM on May 19, 2007

If the tooth hurts when you tap it then it's the tooth with the problem.
posted by koshka at 4:28 PM on May 19, 2007

I've read, though, that the pain of a sinus infection can be similar to the pain caused by damaged roots

The pain of a sinus infection can be identical to the pain of an infected tooth. It's the same nerves being stimulated, our brain can't tell the difference. The hot/cold/tapping stuff? Also could be a sinus infection. If your tooth is sticking into the inflamed sinus then tapping it will feel just like an abscessed root.

The only way to tell is to go back to your dentist and get xrays and let them poke around. Then if they think it's the sinuses you take antibiotics and see if it improves (the whole course, and often two courses in a row). Which you've done already. There is no surefire way to diagnose this yourself and no reason to second guess the dentist who is treating you so far. If the antibiotics don't work and/or the pain recurs and they aren't worried, then start questioning. But so far everything is happening just how it should.
posted by shelleycat at 5:05 PM on May 19, 2007

As long as I can remember I've had chronic sinus discomfort, have been through the revolving door of infections and antibiotics, though for years now I just deal with the low level discomfort; which nearly always feels like tooth pain.

I am one of the few to have kept their wisdom teeth(though unfortunately not for much longer), and a few years back I went to an eyes, ears and nose specialist to find out if I should get the surgery where they drill an tiny extra hole in your sinuses to help them drain. The doctor told me to wait until I had my wisdom teeth pulled since the spot where they drill is right by the nerve that feeds the wisdom teeth.
I was told if something accidentally effected the nerve I could lose my wisdom teeth; which I wanted to keep.

That always freaked me out that the wisdom teeth were so connected to the sinuses, and so if you have problems with one it seems like there will of necessity be problems with the other.

My two cents, for what it's worth...
posted by archae at 12:41 AM on May 20, 2007

I've been told that sensitivity to cold/hot = teeth, but pressure and "tapping" = sinuses. After a few days of blinding pain and some serious drugs, it turns out to have been true. I almost had a root canal for nothing!
posted by answergrape at 6:52 AM on May 22, 2007

Response by poster: For anyone that's still keeping track: turns out it was a sinus infection plus a perforated sinus, which led to an infection in my mouth! Eek!

After the pain spread to my lower molars on both sides (inluding a tooth that was root canalled and crowned just a year ago) and another unsatisfying visit to the surgeon (who tought I had a bunch of cavities and that it was "just a coincidence" - yeah right), this morning I fled to my regular dentist. He poked around, took a bunch of xrays. When he swabbed my upper right extraction site with gauze (ow!) and it came back yellow, we had our answer.

The perforation is probably small and should heal on its own, and the penicillin already seems to be doing its work. Yay!
posted by lunasol at 7:18 PM on May 23, 2007

Oh wow, that sounds so, so horrible. I'm so sorry to hear that (but glad your regular dentist discovered the problem), and hope you feel much better very, very soon. Thanks for the update.

Just out of (morbid) curiosity, I googled "perforated sinus" and found this on wikipedia:

Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure--depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.

posted by treepour at 11:40 PM on May 23, 2007

Response by poster: Thanks for posting that. I think the main problem was that they didn't take the Xrays until the day of the surgery (the machine was broken the day I went in for the consult). So the surgeon may have been a bit rushed in looking at it.

On the other hand, the more I read, the more I think that the surgeon's office was a bit sloppy with the aftercare. When I called the day after the surgery to say I had a fever and salty discharge, the receptionist just said that was normal! Lesson learned: be more aggressive in getting the care I need!
posted by lunasol at 7:04 AM on May 26, 2007

I don't know if anyone is still interested in this discussion( postings from May), seeing how we are in the middle of august now, but just in case...maybe it will help.

Last summer I developed an infection in an upper right back tooth. It had to be extracted. The infection nuetralized the local that was used to numb the nerve so that the nerve could not be deadened at the time of the extraction. It is not a process I ever want to live through again. Also because of the closeness to the sinus cavities to the surface, the dentist did not think it advisable to replace the tooth while at the same time any bridgework would have meant the loss of strength in the surrounding back teeth.

Some weeks ago I had adominal surgery. The surgery weakened my immune system, and i have been fighting sinus problems ever since. 24 hrs ago I began to feel the soreness again of a growing infection in the gum area above where the tooth had been extracted last summer.
This soreness was relieved when I took an Allegra Plus prescribed by my MD for allergies, tipping me off it is most likely sinus related. There remains however a slight swelling in the gums, and tingling sensation, just enough to remind me it is there. And it is dangerously close to another tooth. I guess what I am trying to say is just because the pain goes away doesn't mean the source of the problem has cleared up, you should get in to see your dentist as soon as possible. Maybe you can avoid having a worsening/spreading infection and save any need for possible tooth extractions.
posted by Lyra G at 3:41 AM on August 14, 2007