Tooth Pain and Its Connection to Headaches and Sinus Issues

Q: Tooth Pain and Its Connection to Headaches and Sinus Issues

Hello： It is normal to experience mild pain during root canal treatment, but if the pain persists for 1-2 months, you may consider consulting an endodontist. <br>The apices of the maxillary premolars are often located close to the maxillary sinus, and infections in these teeth ca

Toothache causing temple pain?

Hello Dr.
Liu,
I am experiencing the following symptoms:
1.
My upper left second molar underwent root canal treatment three to four years ago, and in mid-August of this year, I started a retreatment (due to frequent floss snagging, an X-ray revealed that the previous root canal treatment was not adequately cleaned).
I am still experiencing pain (both spontaneous pain and pain after chewing).
Since mid-September, I have noticed that the pain in that tooth is accompanied by a feeling of pressure and pain in the left nasal cavity near the eye, as well as a migraine-like pain in the left temple.

2.
Additionally, I sometimes hear a strange sound when brushing my teeth or exhaling (similar to a whistling wind sound).

3.
I am currently still undergoing treatment (but I feel more pain on one side of the apex during each debridement, while the other side is less painful).
The dentist indicated that the temporary filling is clean, and the root canal length is fine (it was mentioned that my tooth has a long root canal, measuring 25 mm), and advised me to see an ENT specialist.
On September 10, I visited the ENT department, where a skull X-ray was taken.
The doctor noted that there is bone loss above the tooth and slight swelling of the inferior turbinate.

I would like to ask the following questions:
1.
Since mid-August, I have been experiencing persistent pain from the root canal retreatment, along with the newly developed deep nasal and temple pain.
Under what circumstances do these symptoms typically occur?
2.
Given my symptoms, is there a need for a joint consultation between dentistry and ENT? (My dentist advised me to register for an ENT appointment at the hospital; does this count as a consultation?)
3.
Since March of this year, I have been continuously undergoing dental treatment (after inadequate treatment at a clinic, I went to a major hospital and also had apex surgeries on two other teeth).
I have undergone numerous X-rays, in addition to several skull X-rays from the ENT department.
Could this have any adverse effects on my health?
4.
Since my symptoms frequently occur and my dentist cannot identify the cause, along with the recent onset of soreness in another tooth where I had apex surgery (which had been pain-free for a long time), should I consider seeking treatment at another hospital? If so, should I see an oral surgeon or an endodontist? (Could you recommend a dentist with extensive experience in this area?) (I previously consulted at Taichung Veterans General Hospital, but the wait time between appointments with that doctor was a month, which is quite frustrating.)
I apologize for the lengthy message, and I greatly appreciate your time and assistance, Dr.
Liu.
I feel quite disheartened about my dental situation.
Thank you very much!
Sincerely,
Leonard

Leonard, 30~39 year old female. Ask Date: 2004/10/04

Dr. Liu Tiancai reply Dentistry

Hello: It is normal to experience mild pain during root canal treatment, but if the pain persists for 1-2 months, you may consider consulting an endodontist.
The apices of the maxillary premolars are often located close to the maxillary sinus, and infections in these teeth can easily spread to the sinus.
Based on your described symptoms, there may be a possibility of sinusitis, so please visit the ENT department for further examination.
A consultation refers to a situation where a dentist seeks further evaluation from a specialist for other areas, rather than a discussion between two doctors about the case.
The radiation dose from dental X-rays is very low and does not pose any adverse effects on the body, so there is no need for concern unless you are pregnant.
Since you are currently undergoing root canal treatment, it is advisable to see an endodontist.
Please visit the outpatient clinic of Dr.
Chen Jin at Chung Rong General Hospital for treatment.
Sincerely, Dr.
Liu Tian-Cai, Dentistry.

Reply Date: 2004/10/04

More Info

Dear Leonard,
Thank you for sharing your detailed symptoms and concerns regarding your dental issues and the associated headaches. It’s understandable to feel overwhelmed given the complexity of your situation. Let’s break down your concerns and address them systematically.

1. Connection Between Tooth Pain and Headaches: The symptoms you describe, particularly the pain in your left upper second molar and the accompanying discomfort in your left nasal cavity and temple, suggest a potential connection between dental issues and sinus problems. The roots of upper molars are often located close to the maxillary sinuses. If there is an infection or inflammation in the tooth, it can lead to referred pain in the sinus area, causing sinusitis-like symptoms. Additionally, the trigeminal nerve, which innervates the teeth, also supplies sensation to the forehead and sinuses, which can explain the headache you are experiencing.

2. Need for Multidisciplinary Consultation: Given that your symptoms involve both dental pain and sinus discomfort, it is indeed advisable to have a multidisciplinary approach. Your dentist's recommendation to see an ENT (ear, nose, and throat) specialist is appropriate, especially since they noted bone loss above the affected tooth and swelling in the nasal cavity. This could indicate that the infection or inflammation is not limited to the tooth but may also involve the surrounding structures. A collaborative evaluation between your dentist and an ENT specialist can provide a comprehensive understanding of your condition.

3. Concerns About X-ray Exposure: You mentioned undergoing multiple X-rays during your dental treatments and ENT evaluations. While it is true that excessive radiation exposure can have adverse effects, the amount of radiation from dental X-rays is relatively low. Modern dental X-ray equipment is designed to minimize exposure, and the benefits of diagnosing and treating dental issues typically outweigh the risks. However, if you have concerns about the cumulative exposure, it is worth discussing this with your healthcare providers. They can assess whether further imaging is necessary or if alternative diagnostic methods can be employed.

4. Considering a Second Opinion: If you continue to experience pain and your current dentist is unable to identify the cause, seeking a second opinion can be beneficial. You might consider consulting an endodontist (a specialist in root canal treatment) or an oral surgeon, especially if you suspect that your previous treatments were not entirely effective. They can provide a fresh perspective on your case and may suggest different treatment options. It’s essential to find a practitioner who is experienced in managing complex dental cases, particularly those involving recurrent pain and potential sinus involvement.

In summary, your symptoms are indicative of a complex interplay between dental health and sinus issues. A thorough evaluation by both dental and ENT specialists is warranted to ensure that all potential causes of your pain are addressed. Don’t hesitate to advocate for your health and seek the care you need. I hope you find relief soon and regain confidence in your dental health.

Best wishes for your recovery,
Doctor Q&A Teams

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