The roots of the upper back teeth sit right under the sinus floor, so a blocked sinus can feel exactly like toothache, and an infected tooth can inflame the sinus. A few clues, and an X-ray, usually tell them apart.
Mention any recent cold, blocked nose or previous treatment on the upper teeth when you book.
Yes. Sinus toothache happens because the roots of the upper back teeth sit just below the maxillary sinus, so inflamed, congested sinuses press on the same nerves. It typically affects several upper teeth, worsens when you bend down and comes with a blocked nose. One tooth that is sensitive to hot or cold, painful to bite or swollen points to a dental cause. At Creative Arts in Dubai, an examination and X-rays tell them apart.
Who treats you here Dr. Duaa Ameen General Dentist · Dr. Julia General Dentist · Dr. Marina Antoniuk Dentist
Every dentist’s licence can be checked on the DHA Sheryan medical directory.
The maxillary sinuses are air spaces in the cheekbones, one on each side. Their floor sits directly above the roots of the upper premolars and molars, and in many people the root tips almost touch it, separated only by a thin layer of bone and lining. The same nerves supply the sinus lining and those teeth.
When a cold, allergy or sinus infection makes the lining swell and the sinus fill with fluid, pressure builds on that floor. The brain cannot tell exactly where the signal comes from, so it is felt as an ache in the upper back teeth. The NHS lists toothache among the symptoms of sinusitis, alongside pain and tenderness around the cheeks, eyes or forehead, a blocked or runny nose and a reduced sense of smell. Sinusitis usually clears up on its own within four weeks.
The relationship also works the other way. An infection at the root tip of an upper tooth can spread through that thin bone into the sinus, which is covered further down.
These clues point one way or the other, but they overlap. An examination and X-rays are what confirm the cause.
| Clue | More likely sinus toothache | More likely a tooth problem |
|---|---|---|
| Which teeth | Several upper back teeth, sometimes on both sides | One tooth you can point to, upper or lower |
| Other symptoms | Blocked or runny nose, pressure in the cheeks or forehead, reduced smell, recent cold | None from the nose; perhaps a bad taste or a gum boil |
| Movement | Worse when bending forward, lying down or walking down stairs | Little change with head position |
| Hot, cold and sweet | Usually no sharp reaction | Sharp or lingering pain with hot, cold or sweet |
| Biting | Teeth may feel tender together | Pain when biting on one particular tooth, or on release |
| Swelling | Puffiness around the eyes or cheeks | Swelling of the gum or face over one tooth |
| Lower teeth | Not affected | Can be affected |
Pain that also spreads to the ear, jaw or temple has other causes too; see toothache spreading to the ear or head.
Bending forward, lying flat or jogging down stairs shifts the fluid and raises pressure in a congested sinus, so the ache in the upper teeth surges for a moment. That pattern, across several teeth, is one of the more reliable signs of a sinus toothache.
Changes in air pressure do something similar, which is why sinus-related tooth pain can flare during flights or diving; see tooth pain when flying. A single tooth that throbs harder when you lie down is different: that is more typical of an inflamed nerve or an abscess, and it should be examined.
Yes. Dentists and ear, nose and throat doctors increasingly look for a dental source when sinusitis affects one side or keeps coming back.
The American Association of Endodontists describes sinusitis of endodontic origin, where infection from the root of an upper back tooth spreads into the sinus. The tooth may cause dental symptoms, sinus symptoms, or none at all.
Symptoms on one side only, a bad smell or taste, sinusitis that returns after treatment, or an upper tooth with a large filling, crown, previous root canal or past injury.
Standard dental X-rays often miss these changes. The AAE notes that limited-field CBCT significantly improves detection of a dental source of sinusitis.
According to the AAE, treatment that focuses only on the sinus will not resolve it; the source tooth needs root canal treatment, root-end surgery or extraction.
Either is a reasonable first step. This is how the decision usually works.
| Your situation | Usually start with | Why |
|---|---|---|
| Ache in several upper teeth during a cold, nose blocked | Pharmacist or GP; dentist if it does not settle | Most sinus toothache eases as the sinusitis clears |
| One tooth hurts with hot, cold or biting | Dentist | A dental cause is likely and needs examining |
| Gum swelling, bad taste or a tooth with a root canal or large filling | Dentist | Rules out an abscess or a tooth draining into the sinus |
| Sinusitis on one side that keeps returning | Dentist and ENT doctor together | A dental source is worth excluding with 3D imaging |
| Recent upper tooth extraction, with liquid or air passing to the nose | The dentist or surgeon who did the extraction | May be an opening into the sinus; see sinus opening after an extraction |
Go to a hospital emergency department straight away for swelling or redness around the eye, changes in vision, a severe headache, a stiff neck, confusion, or facial swelling with fever, difficulty breathing or swallowing. For tooth pain or swelling without these signs, contact the clinic during opening hours, daily 10:00–20:00; it is not a 24-hour service.
The goal is to confirm or rule out a tooth before you are sent elsewhere.
When the pain started, which teeth, what makes it worse, any cold or allergy, and past treatment on the upper teeth.
QuestionsGentle tapping, biting and cold tests on the upper and lower teeth, and checking the gums for swelling or a draining point.
ExaminationDental X-rays show decay and root-tip changes; a 3D CBCT scan is used when the relationship between a root and the sinus needs a closer look. See dental X-rays.
ImagingDental treatment if a tooth is the cause, or advice to see a GP or ENT doctor if the teeth are healthy.
PlanDr. Duaa Ameen (general dentistry), Dr. Julia (general and microscopic dentistry) and Dr. Marina Antoniuk (restorative and root canal treatment) examine upper tooth pain and treat the tooth when it is the source.
Clinical statements on this page are consistent with these independent sources. They describe averages from studies, not a promise for any one patient.
Sinus toothache usually affects several upper back teeth at once, comes with a blocked nose or pressure in the cheeks, and gets worse when you bend down or lie flat. A tooth problem is more often one tooth that reacts sharply to hot, cold or sweet, hurts when you bite, or has gum swelling. If unsure, have the teeth examined.
It usually lasts as long as the sinus congestion. The NHS notes that sinusitis usually clears up on its own within four weeks, and the tooth ache fades as the pressure settles. If the ache stays after the cold has gone, or focuses on one tooth, a dental cause is more likely and the tooth should be checked.
Not usually. The maxillary sinuses sit above the upper teeth only, so sinus toothache affects the upper premolars and molars. Pain in the lower teeth, or in the lower jaw, points to another cause such as a dental problem, grinding or the jaw joint, and is worth having examined.
An abscess usually affects one tooth, throbs, hurts to bite on and may cause gum or face swelling, a bad taste or a gum boil. Sinus toothache is more diffuse across several upper teeth with nasal symptoms. Because a tooth abscess can also spread into the sinus, an X-ray is the reliable way to tell.
Yes. Infection at the root of an upper back tooth can spread into the sinus above it. Clues are symptoms on one side only, a bad smell or taste, sinusitis that keeps returning, or an upper tooth with a large filling, crown or past root canal. A 3D CBCT scan helps find it, and the tooth itself must be treated.
Many cases of sinusitis clear without antibiotics, and they do not treat a tooth problem that is causing the pain. Whether you need them is decided by a doctor or dentist after an examination. Avoid leftover or borrowed antibiotics; our guide to antibiotics for a tooth infection explains why.
If several upper teeth ache during a cold, a pharmacist or GP is a reasonable first step. See a dentist first if one tooth hurts with hot, cold or biting, if there is gum swelling, or if the ache continues after the cold. For one-sided sinusitis that keeps returning, a dentist and ENT doctor together is ideal.
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