Patient Profile: Left Facial Pain for Months
Mr. Lee came to our dental clinic complaining of left facial pain that had persisted even after a month. He had attributed it as a toothache, and had visited several dentists to treat the pain.
Little did he know that the cause was actually a sinus toothache. The dentists prescribed painkillers for his pain, which did not help to eradicate his pain entirely. Let’s take a look at this case study on how we came to this conclusion.
Dental Assessments Yielded Conflicting Diagnoses
Some of the dentists whom he had visited had found no abnormalities with his teeth. Others suspected that the pain might be from a cracked tooth. Sometimes crack lines can be too fine to show up on radiological scans or clinical examinations. The latter group of dentists advocated for root canal treatments or dental crown fabrications.
*Disclaimer: As of March 30, 2020, the ADA (American Dental Association) has officially recognised Orofacial Pain as its 12th dental speciality. Any reference to ‘specialisation’ is made in the context of the United States of America. Read more on our Disclaimers and FAQs pages.
Examining the Patient at Nourish Dental & TMJ Care
We carried out more dental tests and examinations on Mr. Lee when he visited our dental clinic. We found that there was sight sensitivity in his upper right molars upon tapping and pressure. But apart from that, no anomalies were found. Mr. Lee also reported that he had frequent nasal discharge and a blocked nose. We then carried out some dental x-rays and CT scans to find out what was wrong.
These tests revealed a dome-shaped abnormality at the floor of his left maxillary sinus. It was pressing against the root tips of his upper right molars. The ‘toothache’ which he was suffering from was actually caused by other factors. This may come as a surprise to some, but often our teeth is not the culprit for the pain.
Treatment for His Sinus Toothache
Mr. Lee’s pain finally stopped, after we treated his sinusitis and sinus growth, which turned out to be a cyst. As mentioned in Case Study #1, pain in our teeth can also stem from our head or neck. These anatomical structures are closely connected, and pain can translate along any part of these pathways.
Dental surgeons may come across such cases of sinus toothache or diseases during their practice. It is important for them to be able to discern and pick out the evidence so that they can give the correct diagnosis.
Pinning Down the Cause of Sinus Toothache & Other Dental Pain
It is also crucial to listen to the patient, as they know their pain best. If they are not good at communicating, guide them using specific questions until you get the answers you need. Only then can you investigate and pin down the true cause of pain with accuracy.
In Mr. Lee’s case it was headache and facial pain due to acute rhinosinusitis. This is inflammation of the mucosal linings of the nasal passage and paranasal sinuses, and has nothing to do with the teeth or a toothache.
With the correct diagnosis comes proper treatment. This saves the patient time, money, unnecessary dental treatments or prolonged pain. Sinus issues are one of the biggest causes of unnecessary dental treatments, such as teeth extraction, root canal treatments, and prosthodontics that work like bridges and crowns.
When in doubt, always consult a trained pain management dentist, who are also known as orofacial pain specialists.
How Nourish Dental & TMJ Care Can Help
Dr. Eric Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in these areas. You can find out more about him and our dental practice on our About Page. Visit Our Services Page to learn more about all dental and pain management services we provide.