FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SINUS PAIN IS SOMETIMES THE RESULT OF A DENTAL PROBLEM

Question: I had trouble with sinus pain, or it seemed like sinus pain. My doctor gave me antibiotics for it, but I didn't get any better. Eventually, my dentist figured out that my pain was from a bad tooth. I had a root canal that has cleared everything up. Why did my tooth problem seem like a sinus infection, and how is a root canal different from a filling?

Answer: I've just taken down our Christmas tree. One of our decorations is a string of bubble lights that is quite old. The bulbs are in a series so that when one goes out the entire string goes out. You can't tell which specific bulb died or if the string became unplugged.

In a way, the nerves that bring pain sensations from the sinus area and teeth to the brain -- since they are all branches of the same nerve -- are like my old bubble light string. Often you can't immediately tell if the pain originated from a specific tooth or even from a sinus infection. We doctors make an educated guess based upon where the pain is most intense, what makes it worse, what makes it better, and any additional symptoms such as nasal congestion. In clear-cut cases the educated guess is accurate, and appropriate treatment is instituted. A person suffering from a dental infection is referred to a dentist. Pain from a sinus infection is cleared with an antibiotic and other medicines. In your case, however, the symptoms you reported and your doctor's observations didn't lead to a correct first guess.

You didn't explain what finally led you to your dentist and the correct diagnosis. When sinus infection symptoms fail to clear up within a reasonable period of time, we physicians need to think through the diagnosis-making process again. Often a CT scan of the sinus area is called for in this situation. Perhaps yours was normal, thereby indicating that your symptoms were the consequence of some other disorder. Your dentist, by virtue of his or her expertise and knowing that sinus infection was not involved, could then look at your teeth as the potential cause of your discomfort. Thus, your dental examination revealed that you had infection in the root of your tooth where it connects to the jawbone. This type of infection is located where the blood supply is not as brisk as in some other tissues, and as a consequence, it is not improved with antibiotics. As a consequence, the treatment for the painful infection you experienced, called a dental abscess, is to open and drain the infected area. This is root canal surgery.

The central portion of the tooth, the pulp, and the narrow canal into the root(s) of the tooth are involved in dental abscess. The dentist or endodontist, a dental specialist who performs root canal surgery, removes the infected tissue and the dead or dying nerve of the problem tooth. Often a medicine is then placed within the hollowed-out tooth canal to kill any remaining bacteria. A filling is then placed over this to seal the canal. Within a few days or weeks pain subsides as healing occurs. I can tell you from recent personal experience that though root canal surgery sounds terrible, and everyone has heard supporting stories to this effect, it is not a traumatic experience when done by an accomplished endodontist.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.