Even my Internist does not know if I have a sinus infection or abscess.

Hi, my problem started Oct 22, 2015 with a sore area above an upper back tooth, near the upper part of the root of the tooth. My tooth did not, and still does not, hurt to chew on. I have not had any sensitivity to hot or cold foods either.

My dentist did an Xray at that time, not seeing any abscess. He did state that I have a slight fracture in that tooth. He prescribed a ZPack in case it was a sinus infection and it improved greatly. Two weeks after that antibiotic, the discomfort began to return, but was again only noticeable when I put pressure on the spot with my finger. My internist called in an antibiotic as I have a history of sinus infections and tooth pain with them. Again, there was improvement.

Fast forward.

Since Oct 22 I have had 4 rounds of antibiotics (ZPack twice, Bactrim, and Avelox). Each time the pain disappeared, only to reappear. It has now reared it's ugly head again and this time my gum area in that spot is swollen. It still does not hurt to chew. But it does hurt to smile, and is more uncomfortable than before. I have begun Bactrim again (14 day supply this time) and my internist has scheduled me for a CT scan of my sinuses. Be he is stumped. It could be my slightly cracked tooth.

I saw my dentist again in early December for semi-annual checkup, cleaning, and xrays. The xray still looked clear. I don't know whether to find a new dentist (an endodontist?), go ahead with the CT scan, or not. I am concerned about the infection spreading into bones. My dentist had said that if the problem turned out to be in the tooth, he would want to pull it. I don't want to lose a tooth! Please advise. Thanks

Reply:

Hi there, I'm sorry you are dealing with this issue. It sounds so frustrating!

I do think a CT scan could be helpful. Dentists use dental CT scans for dental implants. It's amazing what a CT scan shows that regular XRays do not. I have seen CT scans used in cases like yours where there is no sign of an abscess on a regular dental Xray. CT scans sometimes show infection when it wasn't obvious in a regular Xray.

Is the scan you are having one that will also show the teeth? I think that would be best and a good question to ask.

Depending on what the scan shows, seeing an endodontist may also be a good idea. They are experts in this area and see difficult cases like yours routinely. If the tooth is infected an endodontist will be able to advise you on whether you can save the tooth.

If you decide to have the CT scan be sure to get a copy to share with your care providers...internist, dentist and endodontist.

Thanks for writing and good luck,
~Shelly

Comments for Even my Internist does not know if I have a sinus infection or abscess.

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Jul 15, 2018
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CT scan
by: Anonymous

You need a ct scan because xrays don't always show infection.

Jun 13, 2018
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similar issue
by: Anonymous

Hi, I have a similar problem....

A very nervous patient here. I have an issue and it's really worrying me.

Around 7 or 8 years ago I bit down on a cake that had a hard boiled sweet in (I didn't realise this) and my top left 2nd from back molar really hurt for days (this tooth also has quite a deep white filling in). I got it checked out and all was ok. Even though it was sore.

Maybe a year later, the same tooth, for no reason, really started to ache severely. It was around my 6 month checkup and got it checked out. X-rays were taken and all looked ok. I then got a whole mouth xray done and my sinuses (especially my left side) showed that they were really cloudy and were overlapping my nerves and roots, and my dentist thought that this could be the cause, even though I had no other symptoms of sinusitis. My dentist suggested we treat my sinuses first as the only other option would be to take the filling out to see if there are any fine cracks under it. (I also clench my teeth very hard at night and the dentist said this could also prove to be the issue so got a splint made, which I have worn at night ever since).

I took a few courses of antibiotics, and eventually (I remember it took quite a long time, and a few revisits to the dentist) the pain went away completely!! Obviously I was relieved!

Maybe a year or 2 later (5/6 years ago), I was getting severe pain in my front left tooth. Again I went to the dentist and he felt it was the same issue - prescribed antibiotics to treat a sinus infection. I can't remember if these helped but eventually the pain completely disappeared (again I do remember this taking a while to clear up). No pain since.

OK, fast forward...

3 weeks ago, I bit down on chocolate on the left hand side of my mouth, that had been in the fridge. I didn't think anything of it as I didn't feel any pain, but the next day I started to get a slight dull pain in the same top left molar that gave me issues all those years ago. I left it for a week before going to my GP, explained my history, and then got prescribed antibiotics to treat a sinus infection (he didn't inspect me - just went off my history). I also started using a FESS flush that I felt decreased the pain slightly, but after 2 courses of antibiotics the pain was still there. I knew it was time to visit the dentist.

To be clear, the pain is pretty much a constant dull ache pain. There is no pain when I chew on that side, and there is very little sensitivity to hot or cold temperature. In the morning when I wake up there is hardly any pain at all for around an hour, and then gradually the pain appears - ranging from mild to quite painful, but it seems to be constant. The pain also sometimes moves to my left front tooth - the same tooth that was sore also all those years ago.

1 week ago I went to a new dentist (only as I have moved since) and explained my history. He tested the problem tooth and all looked fine. He x-rayed my teeth and my whole mouth. The x-ray showed my left sinus a little cloudy and again the cloudyness was overlapping my roots and nerves. He also suggested that he feels it's a sinus infection and not the tooth and I should see my GP again and maybe ENT. He also said that the only other option would be to take the filling out and see if there are cracks underneath.

With all of this information I went to see a different GP who said that most sinus infections are viral so antibiotics wouldn't work anyway and put me on a steroid nasal spray instead.

That's been a week and still the pain is in my back tooth and also sometimes my front. The GP is putting me on a waiting list to see the ENT specialist, however there could be a 10 month waiting list.

The catch 22 I have is if I wait for that amount of time and there is nothing wrong with mu sinuses, is my tooth in the meantime getting worse and form infection?

If I decide not to wait to see an ENT and let my dentist take the filling out only to find nothing wrong with my tooth, will all this playing around with it weaken the tooth and create more issues?

I'm so confused that it's overtaking my life and making me quite depressed, I'm so scared of the dentist and really don't want unnecessary treatment, and at the same time I don't want matters to become worse by just leaving it, waiting for ENT. How long should one take before actually investigating the tooth further?

Are my symptoms the same of a cracked tooth under the filling? If not any suggestions what else it could be? Is the front tooth also sore due to referred pain? Would the x-ray I had done last week show if my tooth was forming an infection? My dentist wasn't in any rush to start taking the filling out.


I'm also going away on holiday in 2 months, for 3 weeks and the last thing I want is to take the pain away with me.

I'm so sorry for the long post. I honestly don't know which way to turn and really hope that there's someone out there can help (even if just a little). I can't remember what it feels like NOT to have a toothache.

What was your outcome?

Thanks for listening...

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