How can sinus-related tooth pain be distinguished, and which findings should be shared in an ENT consultation?

Pain in the posterior maxillary teeth may have odontogenic or sinonasal causes, and both can coexist. First, ask about the location, radiation and duration of pain, its triggers, nasal obstruction or discharge, and previous dental treatment. Assess the relevant teeth using pulp sensibility tests, percussion and palpation, periodontal examination, and evaluation of existing restorations.

Choose imaging according to the examination findings and the clinical question. Periapical radiography may be useful; use cone-beam computed tomography when indicated, weighing the additional information it can provide against the radiation dose and the patient's benefit. Sinus mucosal thickening or proximity of the roots to the sinus alone does not determine the cause of pain or establish active sinusitis. An odontogenic cause should not be excluded on the basis of a single image alone.

Consider dental findings and sinonasal symptoms together and request an ENT consultation when needed. The consultation can include the duration and side of symptoms, clinical test results for the relevant teeth, previous procedures, any identified dental infection focus and available images. If a dental source is present, plan appropriate dental treatment; coordinate assessment and management of sinonasal disease with the ENT clinician.

The need for and choice of antibiotics or other medicines depend on the diagnosis, the patient's condition and the relevant clinician's assessment. They should not be regarded as a fixed multiple-antibiotic regimen for every patient.

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