A toothache is not always from a tooth
How Do I Know If I Need a Root Canal?
We had 50 patients for dental pain in the last 4 weeks. Half of the patients were convinced they needed a root canal treatment.
A complete diagnosis was undertaken. This included a full history, X- ray, review of prior x rays, palpation of the area, occlusion (or biting) slight percussion (tapping), a gentle air stream, vitality testing, photography for fractures, and comparison to 30 years of similar clinical histories.
Dental X- rays usually showed cloudiness or calcification of the maxillary sinus on one or both sides. This together with marked tenderness in the maxillary tuberosity distal to the root of the last molar indicates a history of sinus inflammation.
When the lining of the sinus is thickened from chronic allergies or infection, the ostium (or opening) which drains fluid from the sinus becomes clogged like a stopped up sink. The fluid does not drain, it produces pressure in the small sinus, and the pressure produces pain in the nerve endings within the sinus.
This fluid can then become secondarily infected. The roots of the upper teeth are commonly in or near the sinus, so pain in the area is referred, or seems to come from these teeth. The pain actually comes from the sinus itself. The thin bony wall of the sinus expands under pressure, the teeth change position slightly, and then the lower teeth start to ache as well.
The correct treatment should be directed to the sinus area. Clenching and grinding your teeth when they are aching makes the problem feel worse and harder to diagnose.
Pathognomic for sinus infection diagnosis is a history of increased pain when using stairs or when bending the head down and up.
Root canal pain usually doesn’t change with head position, whereas sinus pain changes with fluid level changes (like a carpenter’s level).
Since it feels like a toothache, the dentist is the first call. Without time spent diagnosing, everyone will agree a root canal should be done. Teeth that are intact, cavity free and not fractured might be root treated or even extracted.
Unnecessary root canal treatment can be avoided by thorough diagnosis and if appropriate, referral to an Ear Nose and Throat physician. Clenching pain can be treated with a properly fitted professionally made night guard or bruxing appliance.
With proper management the problem will resolve, and the patient soon feels better. New Jersey is a prime area for sinus involvement, and these changes are clearly visible on a large percentage of patients x-rays.
If you need an oral exam, make an appointment with Dr. Korwin with our online form.