Why do my gums hurt when I blow my nose?

Have you ever had a toothache after a dentist appointment? At your checkup, your dentist gave you a clean bill of health. So, what on earth could be causing your tooth pain?

Can a sinus infection cause a toothache? If it’s one of your upper teeth that’s hurting, it might not be your tooth at all. It might actually be sinus pressure causing “referred pain” in your tooth. It feels just like a toothache and you might not even have sinus drainage. 

Understanding the signs and symptoms of a sinus toothache can help you avoid an emergency trip to the dentist and get timely pain relief.

Sinusitis Tooth Pain Symptoms

Self-diagnosing a toothache can be tricky, because you don’t want to accidentally overlook something major like a cavity, leaky filling, or abscess. But since sinusitis tooth pain is unique, it’s typically easier to narrow down without seeing a dentist. Especially if you recently had a dental exam, no existing work on the tooth, and there’s no hot or sweet sensitivity.[1]

The most prevalent sinus toothache symptoms include signs of:

• sinus pain or pressure
• headache
• noticeable pressure when you bob or tilt your head
• relief with allergy, antihistamine, or decongestant medication
• no visible infection or fractures to the tooth
• feels worse when you change your position

At times, the pain will come and go depending on the inflammation of your sinuses. If medications like a decongestant are wearing off and you apply pressure to the tooth while eating, you may notice discomfort. Since your teeth slightly depress when you’re chewing with them, the root may be pushing into the sinus lining and causing a false sense of dental pain. However, cracked teeth tend to experience more moderate to severe pain while chewing on them, even in the absence of sinus pressure.[2]

Sinus toothaches typically catch most people off guard. If you’re someone that takes great care of your teeth but are experiencing occasional sinus pressure, the last thing on your mind is probably that your allergies are causing your tooth pain. Finding out that your symptoms are sinus-related is typically a big relief! It’s usually easier to manage sinus pressure and congestion than it is to start treating a toothache.

What Causes Sinus Tooth Pain?

Sinusitis tooth pain is fairly straightforward. Your nasal sinuses become swollen or congested, leading to inflammation above your teeth. And since your upper teeth often rest directly next to your nasal sinus cavity lining, the pressure can cause your sinuses to press directly into the tooth roots themselves.

Usually, a sinus toothache will be most evident in your upper canines (eye teeth), premolars (bicuspids), or first molars. Since these teeth are closest to your nasal cavities, they’re more prone to what we call pseudo-toothaches. Canine teeth have the longest roots of all, so they may be especially prone to sinusitis tooth pain.

These types of sinus toothaches can pop up unexpectedly or last an extended period of time. They’re typically triggered by sinus infections or hay fever/seasonal allergies. As your sinus becomes infected, irritated, and swollen, it begins to press into those tooth roots nearest it. And when there’s physical pressure against the nerves of those teeth, it typically feels like a standard toothache.[3] Your dental nerve isn’t able to tell if the pressure is from an abscess or the sinus inflammation, so your brain interprets them as the same type of sensation.

The Sinus And Tooth Connection

Your upper tooth roots lay directly next to or underneath your sinus lining. In some cases, you can even take an X-ray and see the sinus lining draped up and down over the roots as it lays on top of them. Since your nasal sinuses fill the entire area above the roof of your mouth, and since your upper back teeth have 2-4 roots each (except for canines, which have one) there are — you could say — well over two dozen different root tips that could potentially be pressing into your nasal sinus lining.

Difference Between A Regular Toothache And A Sinus Toothache?

Sinus toothaches can be alarming, because they often feel like a regular type of toothache caused by dental infections. But if you know that your mouth is generally healthy, it’s not normal for a traditional toothache to appear out of nowhere.

Usually, sinusitis tooth pain will accompany other types of nasal sinus congestion. If you have a sinus headache, pressure, or drainage, it’s highly likely that you’re experiencing some type of referred pain.[4]

Keep in mind, sinus toothaches do not affect lower teeth. So, if it’s a bottom tooth that hurts, you can rule out the chance of it being sinus-related. Additionally, normal toothaches tend to be most evident when you’re eating certain foods, drinking something hot/cold/sweet, applying pressure to the tooth, or if there is a visible abscess on the gums near the root area.

How To Treat Sinusitis Tooth Pain

Even though your tooth probably hurts similar to a dental abscess, you’re going to want to treat your sinuses instead. Remember, referred pain is when another area is hurting but it causes symptoms that feel like your tooth is in pain (when it really isn’t.)

The first thing you want to do is figure out if you have allergy issues or it’s more of a sinus infection. If it’s the latter, your doctor may need to call in an antibiotic. But usually you can take an over-the-counter allergy medication and decongestant to relieve the initial pressure. The decongestant will help to relief some of the pressure from inside of your sinuses.

If you tend to get hay fever, take allergy medication proactively before it turns into a full-on sinus infection. Keep in mind that xerostomia (dry mouth) is a common side effect of most allergy meds and decongestants, as they slow down your saliva production. If you need to take one for a long period of time, work with your dentist to find a fluoride supplement that keeps your teeth strong.

Soothing Sinusitis Tooth Pain

Since typical toothache treatment normally doesn’t help with sinusitis tooth pain, getting relief can take a bit of creativity. Even though it’s your tooth that hurts, make it a point to treat the sinus inflammation.[5] Over-the-counter medications like a decongestant can take a couple of hours before any relief is noticeable, and maybe mild at first, so the best thing for quicker relief is to usually take an anti-inflammatory medication along with it. Typical examples of non-steroidal-anti-inflammatory drugs (NSAIDs) include ibuprofen or Motrin.

Always take medication as directed. Most pain relievers will last up to 8 hours or more, but a decongestant may need to be taken as frequently as every 4 hours. Try to set a timer to remind you when to take the next dose, as you may keep seeing flare-ups until the overall sinus pressure is eliminated. Be careful about taking decongestants before bedtime, as they can sometimes cause difficulty falling asleep.

Some people also get relief by using nasal flush systems such as a Neti Pot. Keep in mind that those types of nasal irrigation systems require specific steps and hygiene measures (such as using distilled, bottled water) so that you don’t actually make the sinus infection worse.

If you have a chronic sinus infection, no amount of over-the-counter treatment is going to help to clear up the pain. At that point the best thing to do is to schedule an appointment with your primary care physician — or even a Telehealth appointment over your phone — to discuss getting some prescription-strength sinus medication.

When To See A Doctor

As with any type of a health condition, you need to see your doctor or dentist if symptoms don’t resolve with home care. Assuming you’ve ruled out that your sinus toothache is caused by a dental infection, over-the-counter treatment can usually help you to “get in the clear.” But if things don’t improve and you’re several days into sinusitis symptoms, you have to take steps to ensure it doesn’t evolve into a sinus infection.

Fortunately, you may not actually have to step foot inside of a doctor’s office. These days, health apps and other types of telemedicine platforms make it easy to virtually “see” a medical provider and get a prescription, if appropriate. Sinus infections are a common example. If it’s severe and your symptoms have progressed over several days, it’s likely that they’ll prescribe both an antibiotic and a strong decongestant.

Assuming your sinus infection clears up but your tooth still hurts, it’s best to go ahead and see your dentist for a limited exam. They’ll take a small X-ray (“PA”) of that specific tooth to get a look at the root anatomy and see what’s going on.

Overcoming Tooth Pain Form a Sinus Infection 

Sometimes it’s possible to get a toothache without anything being wrong with your tooth. How? Because sinus pressure is pushing against the root and nerve coming out of your tooth. Sinusitis tooth pain feels like an everyday toothache, but without any cavities, hot/sweet sensitivity, or cracked teeth. Fortunately, it’s possible to treat it by treating the sinus issues themselves. Usually, that involves an allergy medication or decongestant. If your sinus pain is severe or evolves into an infection, it’s time to see your doctor.