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Claudia Hoffman, D.D.S.
Endodontic Pain or Acute Maxillary Sinusitis?
Claudia Hoffman

Claudia Hoffman
 
 

PATIENTS often present to our office with pain, under the assumption—correctly or incorrectly—that their discomfort is associated with a sinus infection.  As endodontists, we are supposed to be experts in diagnosing and relieving oral pain.  Because of the complex anatomy in the head and neck region, conditions in this part of the body often cause referred pain that turns up in and around a tooth. 
     One anatomical structure that can be challenging to the dentist is the maxillary sinus.  The average dimension of the maxillary sinus is 40 x 26 x 28 mm (15 ml; Bailey 1998). The maxillary sinus is usually in the premolar to molar region and in rare cases may extend to the canine. The innervation is the maxillary division of the trigeminal nerve, the infraorbital nerve, and the anterior palatine nerve. The maxillary sinus is in close proximity to the maxillary teeth. 
    A sinus condition is a very common cause of non-dental tooth pain; therefore, it can result in unnecessary dental treatment. Acute maxillary sinusitis (AMS) is a bacterial infection that needs to be correctly diagnosed.  Patients with a sinus infection usually present with a chief complaint that involves dull aching pain that they are not able to pinpoint. The pain is usually lessened when the patient is standing up and worsens when the patient is lying down, so it may present as worse at night.  Proper diagnosis starts with a complete medical and dental history.  Non-invasive tests—such as radiographs, percussion, palpation, and thermal testing—should be performed.  Does the patient have chronic allergies, a cold, or a history of sinus infections?  Always ask patients if they have flown on an airplane recently.  A true sinus infection usually increases in pain if the patient bends over and places the head below the knees.  In addition, extra-oral palpation over the sinus area will usually cause discomfort. 
    If the diagnosis is AMS, the dentist should prescribe analgesics, antihistamines, antibiotics, and nasal sprays.  If it is truly a sinus infection, the patient should feel significantly better in twenty-four hours.  If the pain recurs, the patient should be referred to an ear, nose, and throat physician.
 
January - March 2005
A sinus condition is a very common cause of non-dental tooth pain; therefore, it can result in unnecessary dental treatment.



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