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Medical Forum / General / Dentistry / September 2006Maxillary Sinus
From a cursory observation of the anatomy of the maxillary region, it would appear that the maxillary sinus is directly above the upper rear molars. The maxilla (jaw bone) is there too but the maxillary sinus is larger than the maxilla, so there is a way for infection in the root area to find its way to the sinus. It may not bore a hole into the sinus but the tissue inside the sinus can get inflamed just like the outside of the gums get inflamed on the side of the root cavity. Therefore it would appear that there is a way for an infection of the upper rear molar to manifest itself as a severe pain in the maxillary sinus. It would also appear that a saline nasal wash (1 teaspoon non-iodized salt per 12 oz distilled water) forced into the maxillary sinus could provide relief to the inflamation. I have had such a condition for the past 15 years. Up to now, I thought the affliction was solely related to a sinus infection. Two dentists in two separate offices detected nothing wrong with the tooth. In each instance I was able to relieve the toothache with a nasal wash treatment. In the first attacks, simple snuffing salt water worked. Then I had to force the wash into the sinus with a modified Water Pic. It worked the first application. But this last time, due to the crown being broken off, I discovered that it was really a severe toothache that was causing the pain in the sinus, and this time I had to employ several nasal wash treatments to get rid of the sinus pain. Orientation of the head while the wash is in the sinus is critical for the treatment to work. Also the strength of the wash is important. I can imagine from what little I know that the root and gum tissue become infected and that the resulting inflamation radiates not only to the exposed gums, but upward to the sinus cavity tissue. Treating that inflamation inside the sinus is what the nasal wash is all about. Why it always stops the toothache is something I do not understand but it has not failed me in 4 attacks over 15 years. If the past is any indication, I should not experience another attack for about 5 years or so, unless the crown being broken off will change the conditions under which the process of later re-infection occurs. Your expert comments would be greatly appreciated. I am trying everything I can come up with to avoid extracting the root. If this latest treatment is truly successful - I will know in about 1 week - then I will assume the infection has either been destroyed for now or is made sufficiently dormant to avoid extraction. I realize that prudent dentistry would indicate extraction to play it safe, but I am willing to give it another round. -- Govt is an insult to human dignity. With or without govt, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes govt. Govt is the root of all evil. > From a cursory observation of the anatomy of the maxillary region, it > would appear that the maxillary sinus is directly above the upper rear [quoted text clipped - 9 lines] > non-iodized salt per 12 oz distilled water) forced into the maxillary > sinus could provide relief to the inflamation. Correct. However, ther referred pain works the other way as well. Meaning if you have a sinus infection, it could feel like you're having a tooth ache. I don't know about nasal wash providing relief. Never heard it done before for tooth ache. It's hard for me to imagine having a tooth ache for 15 years. And I don't think a tooth infection can last that long. If ther is still a lot of tooth structure above the gum line, and the remaining tooth is not moving, then it's still possible to save it with root canal, post and new crown. Without an xray, I can't give you a definitive diagnosis. Your dentist can. AdvanceAgent #367924] Game I am currently playing: http://uc.gamestotal.com/?in=367924 > From a cursory observation of the anatomy of the maxillary region, it > would appear that the maxillary sinus is directly above the upper rear [quoted text clipped - 49 lines] > people doing evil things. But for good people to do evil > things, that takes govt. Govt is the root of all evil. >>From a cursory observation of the anatomy of the maxillary region, it >>would appear that the maxillary sinus is directly above the upper rear [quoted text clipped - 17 lines] > It's hard for me to imagine having a tooth ache for 15 years. And I > don't think a tooth infection can last that long. You'd be surprised. In fact, having the records of a patient from the previous dentist, had a patient blow an acute abscess 15 years after the previous dentist had placed a direct pulp cap. The tooth hadn't been treated in the intervening time, and there was no caries. Why did it blow up after 15 years? Who the heck knows--but it did! Steve > If ther is still a lot of tooth structure above the gum line, and the > remaining tooth is not moving, then it's still possible to save it with [quoted text clipped - 60 lines] >>people doing evil things. But for good people to do evil >>things, that takes govt. Govt is the root of all evil. Interesting. But Citizen Bob has been having symptom for 15 years... [AdvanceAgent #367924] Game I am currently playing: http://uc.gamestotal.com/?in=367924 > >>From a cursory observation of the anatomy of the maxillary region, it > >>would appear that the maxillary sinus is directly above the upper rear [quoted text clipped - 90 lines] > >>people doing evil things. But for good people to do evil > >>things, that takes govt. Govt is the root of all evil. > Interesting. But Citizen Bob has been having symptom for 15 years... Obviously if there is a communication with the sinus, there is likely chronic sinus disease regardless of whether the infection originated in the tooth or the sinus. Of course the bacterial flora of sinus infections tend to be different, but if there's a communication you could see all kinds of atypical bugs after that much time. If the tooth has to come out, it should come out of course, regardless if nasal irrigation brings transient relief. I am concerned of course that extraction could lead to a chronic communication, so anyone who touches this tooth should be aware and ready for the possible complications of the extraction. Steve > [AdvanceAgent #367924] > Game I am currently playing: [quoted text clipped - 96 lines] >>>>people doing evil things. But for good people to do evil >>>>things, that takes govt. Govt is the root of all evil. >Interesting. But Citizen Bob has been having symptom for 15 years... I have had symptoms 4 times over a 15 year period. In the interim perioids between attacks there has been no toothache whatsoever. In fact two dentists in two separate offices did not detect anything wrong with the tooth. That's why I never associated the sinus pain with a toothache - until this time, probably because the crown fell off. The longest episode lasted 2 months - when I did not treat with nasal wash. The shortest was 1 day when I did treat with nasal wash, Another was 2 days when I treated with nasal wash. This last episode is complicated by several factors, including the crown falling off completely - all that is left is the root which is flush with the gumline. Also, I screwed up and did not mix a sufficently strong saline solution and I did not orient my head properly. Or so it would seem, because the initial nasal wash treatment did not stop the toothache. But I eventually managed to get the nasal wash to work as before. It's been about 3 days now with absolutely no toothache. My gums are still sore, and I treat them with 50/50 peroxide which provides relief. But the excruciating sinus pain associated with this tooth is no longer present. I have been continuing the nasal wash twice daily as a followup. I am convinced that the inflamation worked its way upwards into the maxillary sinus and produced a sore spot inside the sinus cavity. Once the proper nasal wash treatment was applied, it stopped the pain, hopefully for good. I may still have to have the root extracted, but I am in a watch and wait mode now. The tooth inflamation on the gums seems to be residing. I should know in about a week. -- Govt is an insult to human dignity. With or without govt, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes govt. Govt is the root of all evil. Does the tooth with the crown broken off have root canal treatment(RCT) before? It sound like it has, otherwise you will be in excruciating pain. If it has RCT, then it will not be as urgent to treat as if it is still vital. Even if the tooth is broken to gingival(gum) margin, it can still be save with RCT, post and crown. Again, assuming it has good bone support. Too many unknowns without the xray. I feel naked without them xrays in terms of making diagnosis. [AdvanceAgent #367924] Game I am currently playing: http://uc.gamestotal.com/?in=367924 > >Interesting. But Citizen Bob has been having symptom for 15 years... > [quoted text clipped - 38 lines] > people doing evil things. But for good people to do evil > things, that takes govt. Govt is the root of all evil. >Did the tooth with the crown broken off have root canal treatment (RCT) >before? It sound like it has, otherwise you will be in excruciating >pain. I was in excruciating pain. It feilt like someone was forcing a redhot ice pick up my nose into my sinus and then into my brain. It was also unrelenting. >If it has RCT, then it will not be as urgent to treat as if it >is still vital. I do not recall it ever having a RCT. But that doesn't mean it hasn't. The tooth has been subjected to multiple infections, the pain of which, if any, was masked by the sinus pain. However, the instant the nasal wash relieved the sinus pain, I experienced no pain whatsoever. Is it possible that these infections have caused the nerves to be destroyed? It is also possible that what I call "sinus pain" is really a toothache that projects the pain into what feels like my sinus. For example, I was able to get significant relief from the "sinus pain" by treating the root with maximum strength Orajel (Benzocaine 20%). That treatment had nothing to do with any sinus cavity, and indicates that the pain was indeed a toothache. But that does not explain why the pain goes away with proper nasal wash treatment. Three times now the nasal wash has stopped the pain dead in its tracks. Is that just coincidence and the pain in the tooth stopped abruptly for some other reason? I have been treating the outside of the tooth/gum area with 50/50 peroxide and vigorous flossing/brushing. >Even if the tooth is broken to gingival(gum) margin, it can still be >saved with RCT, post and crown. Again, assuming it has good bone >support. The root feels quite secure - no wobble when I attempt to move it around with my finger. The reason the crown fell off was because the tooth was overdrilled. I could see how thin the crown was at the base where it connected to the root. It was paper-thin along most of the periphery. >Too many unknowns without the xray. I feel naked without xrays in >terms of making diagnosis. Xrays were unable to detect any pathology on two prior occasions in two separate dental offices. -- Govt is an insult to human dignity. With or without govt, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes govt. Govt is the root of all evil. |
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