Sinus Infection or Toothache? How to Tell the Difference

Why a Sinus Infection Feels Like Tooth Pain

The maxillary sinuses are two air pockets in your cheekbones, one on each side, sitting directly above your upper back teeth. In many people the roots of those teeth poke up into the sinus floor with only a thin layer of bone between them, and sometimes no bone at all.

When a sinus infection (sinusitis) fills that space with pressure, the nerves supplying your upper teeth get squeezed along with everything else. Your brain cannot always tell the difference between pressure in the sinus and pressure in a tooth, so it reports a toothache. This is why a cold or a bout of sinusitis can leave your upper molars aching even though nothing is wrong with the teeth themselves.

Sinus Pain vs Tooth Pain: How to Tell the Difference

No single sign is proof, but the pattern usually points one way. Sinus-related tooth pain tends to look like this:

• Several teeth ache, not one. A true dental problem usually centres on a single tooth. Sinus pain spreads across two or three upper back teeth on the same side.
• It is dull and constant pressure, rather than a sharp, stabbing, or throbbing pain in one spot.
• It changes with your head position. Bending forward, lying down, or jumping down a step often makes it worse.
• You have other cold or sinus symptoms: a blocked or runny nose, pressure across the cheeks and forehead, a reduced sense of smell, or thick nasal discharge.
• Both sides can be involved, whereas a dental problem is almost always one side.

Tooth pain from an actual dental cause behaves differently. It usually reacts sharply to hot or cold, or to biting down, and it stays fixed on one tooth. Our guides on pain when biting down and pain that comes and goes walk through what those patterns mean.

When It's Actually Your Tooth

Lean toward a dental cause when the pain is locked onto one tooth, reacts strongly to cold or heat, or wakes you at night with a deep throb. A tooth that is sensitive to a single tap, or one with a known cavity, cracked filling, or old crown, is telling you something the sinus is not.

Swelling in the gum, a bad taste, or a pimple-like bump on the gum points at infection in the tooth rather than the sinus, and that does not clear up with a decongestant. If you are unsure whether you are dealing with an ache or an infection, our post on the difference between a toothache and an abscess lays out the warning signs.

What to Do Right Now

If the picture looks like a sinus problem, treating the sinus usually settles the teeth:

• Try a steam inhalation, saline nasal spray, or a short course of a decongestant to reduce the pressure.
• Stay upright during the day and prop your head up at night, which helps the sinus drain.
• Take a painkiller you tolerate at the packet dose. An anti-inflammatory like ibuprofen works on both sinus and dental pain.
• Give it a few days. Sinus toothache eases as the congestion clears.

If it looks dental instead, none of the above will fix it, and our note on which painkillers actually help a toothache covers what to reach for while you arrange a visit.

When to See a Doctor, and When to See Us

Be honest about which problem you have, because it saves you a wasted trip. If your only tooth symptom is dull pressure across several upper teeth alongside a cold or blocked nose, start with your GP or family doctor, not a dentist. That is a sinus problem, and a dentist cannot treat your sinus. Do not book a dental appointment for what is clearly a head cold.

Come to us if the pain settles on one tooth, reacts sharply to hot or cold, throbs at night, or comes with gum swelling or a bad taste, especially once any cold has passed and the tooth is still sore. A short exam and an X-ray sort out sinus from tooth quickly, because the root and the bone around it are where a dental problem hides, and neither shows from the outside. Our page on what a dental X-ray actually shows explains how.

If a sinus infection turns severe, with a high fever, swelling around the eye, or vision changes, that is a medical emergency and belongs at a hospital, not a dental clinic.

Not sure whether it is your sinus or your tooth? Call or WhatsApp us at 055-985-8845 and describe what you are feeling. If it sounds like a sinus problem we will tell you to see your doctor first rather than book you in. If it sounds dental, we will see you and sort it out. The clinic is at Harav Kook 28/1 in Ramat Beit Shemesh, about half an hour from most of Jerusalem, open Sunday to Thursday 8:00 AM to 8:00 PM and Friday 8:00 AM to 2:00 PM, with after-hours emergency treatment outside those hours. You see Dr. Gabriel Joel, DMD, who trained in the United States, and the whole visit can be in English. Our toothache treatment page and emergency dental care page explain how visits work.

For independent guidance, the ADA's MouthHealthy explains what to do about a toothache, and the American Association of Endodontists has plain-language information on tooth pain and saving a tooth.