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

Interesting.  But Citizen Bob has been having symptom for 15 years...

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    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

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.

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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.