Recently I had three patients who were all experiencing issues with their sinuses. They had been to doctors, ENT’s, Neurologists and dentists trying to find out what was happening and how they could resolve their troubling sinus issues. While they all presented with a similar concern, their cases were very different.
Case 1
Case 1 involved a young man who had drainage and stuffed sinuses on the right side that had gotten progressively worse. He had seen an ENT who had scheduled him for sinus surgery to remove the infected mucus that had plugged up the sinus. The source of the infection was unknown, and the ENT recommended a dental examination prior to surgery.
We checked the health of the upper right back tooth using a routine endodontic test. The results showed that the tooth wasn’t healthy anymore, and potentially “dead” because the color appeared darker than the surrounding teeth. To get a clearer picture, we took a special 3D x-ray of the area. The x-ray revealed a large infection around the tooth that reached the sinus cavity in the cheekbone, suggesting the infection had been around for a while.
The infection around the tooth was quite large, so we decided to treat it in stages with a root canal procedure. Since the infection reached the sinus cavity, we also worked with an ENT specialist for additional cleaning. After a month of healing with antibiotics, we were able to complete the root canal and strengthen the tooth with a crown.
At one point the patient was asking if it would be better to just pull the tooth. Because of the bone damage from the infection, saving the tooth was the better option to allow the bone to heal naturally around the tooth. Even if we need to remove the tooth in the future, there’ll be enough healthy bone for an implant without needing a major bone grafting procedure.
Many times, sinus issues can be related to tooth issues and you need a Gilbert dentist with proper training to help determine if there is a dental source to the sinus issue.
Case 2
Case 2 was a young woman who was experiencing pain in her back teeth in the upper right and left as well as in her ears. We examined the upper teeth and found them all to be healthy and strong, however they were hypersensitive. An x-ray showed that the sinus cavity, located behind the cheekbones, was quite close to the roots of the upper back teeth. I also saw signs of inflammation in her sinuses (sinusitis). The patient confirmed that she had been ill recently and it had turned into a “head cold” with a very stuffy nose.
After a course of antibiotics and sinus meds, the sinusitis resolved and the tooth pain went away. No dental treatment was needed at all! The nerves to your upper back teeth can sometimes feel irritated if your sinuses are inflamed. This happens because the sinus cavity, located behind your cheekbones, can get close to the roots of these teeth. It’s more common to feel this with your back teeth than your front teeth. The good news is, even though your teeth might be sensitive, tests will generally show they’re still healthy.
Case 3
Case 3 involved an older gentleman who was having sinus issues, TMJ pain and ringing in his ear. This patient had also been to a number of doctors who could not find a reason for these issues. We did a comprehensive examination and a 3DCT. We found one old root canal that seemed infected again but it wasn’t entirely clear if this infection was connected to his sinus problems. Separately, we noticed he had a tongue-tie, slightly narrow jaw arches, and a gummy smile.
In this case we decided to start by eliminating one possible source of the sinus issues; the reinfected root canal. An endodontist completed the procedure; however it did not solve his sinus and ear problem. The next step was to examine the possible skeletal problems related to his tongue tie and mouth breathing. When the maxillary arch is narrow, so is the nasal cavity. This is caused by the tongue not being able to be in its natural place in the maxillary arch to guide proper growth patterns of the face. Rather than the facing growing out and forward with proper width, it grows down and back and is narrow.
All of this altered growth affects the size of the nasal cavity and the sinuses as well as the TMJ joint. This can lead to TMJ issues, sinus issues, ear issues, and grinding related to mouth breathing and airway dysfunction.
Treatment for this altered growth pattern is choosing either to use a repositioning device or to undergo maxillofacial surgery to move the jaws into the proper position and to develop a more open airway. The first option uses a mandibular advancement device to reposition the lower jaw to open the airway and encourage nasal breathing. This is usually worn at night and while it can help, it does not address the underlying skeletal cause. During the day the airway is still compromised so it may have a limited effect on the patient.
Maxillofacial surgery has a lot of evidence in helping patients who have restricted airways caused by altered skeletal growth patterns. The surgery is best done in the mid 20’s to late 40’s. There are many ways to address the issue from palatal expansion using mini screws to split the maxillary palate, the DOME procedure that widens the maxillary arch surgically, to mandibular and maxillary advancement.
Ideally the issues that affect the growth and development of the face such as tongue tie, mouth breathing, tonsils and adenoids that obstruct the airway can be caught earlier in life and corrected, leading to proper facial growth and avoiding the problems that can arise later in life. Ideally this should start at birth by identifying tongue ties and correcting them, ensuring proper breastfeeding that stimulates facial growth in the right direction. Then again at age 4 watching out for tonsillar hypertrophy that blocks the airway and having them removed. Early orthodontic treatment and myofunctional therapy can all help correct altered growth patterns.
Sinus issues are complex and there is no one-size-fits-all answer, however eliminating possible oral sources of infection should be the first step. When dental sources are eliminated, it takes a team of experts to determine the best course of action for your individual case. If you’re struggling with chronic sinus pain and related issues, I’d love to help you find relief! Please give our office a call and set an appointment for your evaluation.
