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A public service announcement, I guess... Just had this happen to me for the third time in my life, where either a dentist or an Ear Nose and Throat doctor misses a diagnosis of an old root canal tooth that's gone wrong, causing infection of the facial bone, which infection may have been going on for years. You'd like to trust them to catch these problems, but my experience suggests that when you are dealing with the upper tooth/maxillary facial bones close to your sinus cavities, it's not easy for them to diagnose! You may need to bring this issue up with your dental team, as I just did.

I've several times shared my tooth history with my current dentist yet he still blew my symptoms off last month, until I pressed him for a second opinion. Yesterday, I got an upper tooth root canal retreated by a endodontist, who confirmed they found a pocket of infection above the tip of that tooth. Maybe that's why I've had a stuffy head for months. The CT scan they took for this tooth showed a thickened sinus floor. No doubt, the body tries to fight off a hidden infection. It hadn't gone far enough to be "diagnostic" of a sinus tract, but it was making me ill.

It's just hard to believe this makes 3 dentists over my lifetime who have failed to connect my reported symptoms - saying I felt a bit under the weather, having a stuffy head and post-nasal drip, sore throat, tiredness, etc., to what their images were showing: a dark area, "radiolucent" above the tip of an upper tooth root, which dark area turns out to be bone loss from a significant bacterial infection! Yes, some sinus symptoms can be due to bad teeth, DUH!! I want to take out a billboard ad....

The closest call I had was the day I woke up, after I'd been taking ENT-prescribed antibiotics for a month treating a supposed maxillary sinus infection and noticed my face swollen grotesquely on one side by my nose. I had asked that ENT doctor if my infection source could have been a front tooth apical cyst I'd had surgery to remove 15 years earlier, and was told "that's a different tissue, so it's not the problem." That morning, I took matters into my own hands and called an endodontist myself. I was told to hurry right in and the oral surgeon said that had I not been operated on that day (repeat apicoectomy) I would not have survived, as the infection was about to travel to my brain. (The Ear Nose & Throat doc had also sent me for a CT scan, which showed a cloudy area in the sinus over that front tooth, but it still was diagnosed as a sinus infection. I guess it was, but the cause would not heal until the tooth rooth infection was cured.) A very close call.

So maybe this message is more for those of us with 20-plus year old upper tooth root canals, since things can go wrong over time: get yourselves scanned! You have to ASK for this, it is not part of routine dental cleaning and oral exams. Even bite-wing dental X-rays do not always capture the bone above or below tooth roots (some methods are better at doing this, nowadays).

In 2020, I got a "Panorex" scan, but it was a fuzzy image so it didn't show much. Then this January, I had a digital Cone Beam full mouth scan at my dentist's office, which revealed a pocket above the tooth that got retreated yesterday. At the time, my dentist didn't mention this "halo" or dark spot, as he was so focused on the other side of my mouth he wanted to check to do an implant - on another tooth I'd lost in the same way! (Former dentist had neglected to investigate a suspicious pocket which led to major infection of the palatal bone. I'd gone to our state dental college to try and save that tooth, but it was too late by the time they saw me.)

Yet my current dentist only studied his January Cone Beam scan last week after I made a follow up appointment to push him for another picture of that side of my face; his hygienist last month had asked about a growing gap between two teeth up there, which the dentist thought was no big deal. But afterwards, I started thinking about my history of subtle warning signs that doctors had dismissed, so I called and actually bugged him to take another scan. He pulled up the scan from January, noticed the pocket, said "It might be something, but you should see an Endodontist anyway, because I couldn't treat it if it is an infected root." Sure enough, it was. And he has 180 5-star internet reviews. He has all the state of the art technology. I'm a hard case, I guess....

OK. Hope this saves somebody the misery....

There's a lot of evidence showing that dental issues are more important than people think. Heck, Medicare is even starting to cover stuff.

What an ordeal!! I'm glad you were able to get things sorted out.

Thanks, just hoping things will calm down soon in my head! I did some research yesterday and came across some articles that describe this problem and they all agree IT IS OFTEN MISSED by both Ear Nose and Throat specialists and regular Dentists! Wow.

I searched "Maxillary Sinusitis of Endodontic Origin" and a 2018 article cited a study finding that a whopping 70% of one-sided maxillary sinusitis symptoms like I've been dealing with are "of endodontic origin," or in other words, caused by bad teeth! I printed it off to show whomever.

The American Association of Endodontists has recently published a paper on this issue to educate practitioners. I really urge y'all with older root canals to get scanned with the latest digital cone beam technology, as root canals do sometimes go bad, or the work wasn't done 100% right the first time, as one Endo doc told me about my two bad teeth. He said "With root canals, we get a good result if we do the procedure perfectly, but if it is not done perfectly the first time, and yours were not, then my retreating the tooth will have a lower success rate, so I cannot guarantee it; you may need to lose the tooth." I thanked him but went to another Endodontist to try and fix this, one tooth at a time.

And it was only my sixth sense that drove me to see the dentists, even with good check-ups every 4 months and no pain or swelling. Imagine if I'd just ignored it....(((shudder))) Fingers crossed.

I've reread your post a few times, and it terrifies me. I suspect this is what I'm walking into right now. I have an appt. with a periodontist Wednesday morning. I saw my dentist for a routine cleaning this past Tuesday and described to her some very dull aching in my from upper tooth - it comes and goes and is never bad enough to take anything for it. I notice it more if I eat something that is 'tough', like a bagel, steak, etc. (so for now I'm staying away from that stuff).

I have a very complicated oral health history - I was born with a cleft palate, and to provide a tooth where one was missing from my cleft, I have a three-tooth bridge from 6, 7, 8. Number 8 had a root canal because it had been damaged from a fall I took while in my teens (my braces were probably the only thing that kept the tooth from being knocked out completely). But now #8 is having the dull aching from time to time, and my bridge is loose. My dentist has warned me this will likely involve an implant with a fake tooth for #7, and they will leave #8 as is. I have lots of PTSD from the surgeries I had as an infant and toddler, so the thought of any surgery at this point is sort of freaking me out. But I realize (and the dentist also warned me of this) that there might be an infection going on.

Anyway, she is sending me to the periodontist because I already have an established relationship with his office and she wants the equipment he has in his office to do the CT scan she wants (she doesn't have that technology in her office). She said he will also be able to see the lower part of the sinuses in that scan. She said if she ever needed an implant, this is the guy she'd go to. She has worked collaboratively with this periodontist for many of her patients who need implants.

I realize if I have an infection, they will likely need to treat that before they start any implant work. Honestly, I'd rather just start this and get it over with. I have NO idea what is involved in getting an implant, but I know it involves drilling up into the bone. Anything more than that step, I've no clue what happens... how many appts. it takes, which dental professional is responsible for what, whether they put you out while they do it (I think this will be a necessity for me), etc. And what if I don't have enough bone up there to sustain an implant. Will I have to do a bone graft? Just typing that last sentence made my heart rate go up. I have debilitating fear of having complex mouth work done. Thankfully I had an appt. with my therapist last week after I saw my dentist and we spent some time talking about it, and I have an appt. with her this week the afternoon after I see the periodontist. I'm afraid that given my mouth history, the treatment will be more complicated, and for a period of time, I'll have to walk around with front missing teeth for weeks or months. 😥

(((number4))) I feel your anxiety, I do!

Just to help ease your mind a bit, I have discovered that things have vastly improved in the dental technology world since we were kids.

Besides growing up eating sugary cereals for breakfast which gave me lots of cavities, at age 8 the scooter style handle-bar bike I'd borrowed from a visiting French neighbor proved no match for big tree roots that had heaved up the sidewalk on our street. When I ran over the cracked sidewalk, the handle bar yanked out of my grip and I was thrown face-first down onto the tree root, breaking/chipping 2 of my new permanent front teeth, much to my parents' disgust. I still get shocked looks whenever I tell dentists how I had to sit still at age 8 for 4 hours in a dental college ward as my front tooth was ground on by an impatient dental student trying to fit a steel crown. And the tooth next to it, broken in half horizontally, never got capped until I was 13. That is the one that years and years later almost killed me due to the bone cyst that had developed over those years! But once they deal with the hidden infection, the bone around the tooth does slowly fill in and heal itself. (That's what they were checking me for with a cone beam scan, to see if my jaw bone had healed enough for an implant to replace another tooth I'd lost.)

Interview your dentist about their understanding of trauma and its effect on the patient. The endodontist I just had do the retreatment was the first dentist I've ever had for this kind of work that seemed to "get it." I had just the previous week picked a highly-rated endodontist in another town, based on great internet reviews, but as I posted, he sounded so negative about my teeth that I feared maybe he'd be less than understanding if I had a panic attack or something. So I went with the other endodontist and it was much less terrifying than I had feared; she understood my history! I did go back this week for a follow up and she said it just takes time for the healing. She prescribed a second course of antibiotics and lately I am seeing some improvement in my symptoms.

[This message edited by Superesse at 4:06 AM, Monday, July 29th]

Here it is, most of the way through September, and my upper root canal tooth issue is still not resolved. On Tuesday, I got an 8 week follow-up exam, then stood for a second cone beam scan to see what could be going on in there. It showed no change above the tooth the endodontist had retreated (by replacing the root canal) but that wasn't surprising, as bone healing can take up to a year, they said. But also, we saw a bit more shadow above the tooth behind it, number 3, and now it is recommended I have that tooth pulled, as I'm told it is too complicated to retreat!?

This is the exact thing that happened on the other side of my mouth, years ago...cannot believe this. I asked the endodontist if number 3's possible infection is hindering the bone healing above number 4 that just got retreated, but she didn't think it was necessarily related. How could it not be, I wonder, since they're side by side...infection moves around. So not willing to lose yet another tooth unless absolutely necessary, I asked to be shown the images on the cone beam scan. I got shown a raised bump in the floor of the sinus, right over number 3, that she told me she didn't think was like that in July.

OK, guess it gotta come out...except after I left there, I did some internet searching - as we always do, right? - and learned that it's quite common for our biggest molars to protrude into the floor of our maxillary sinuses, so maybe the bump is not that suspicious, after all.

Except I'm still not 100%.

(I think there is a LOT they don't truly know from Xrays, but they just make educated guesses.) Right now, I'm feeling like a textbook case of dental mistakes of the past and present! The endo tapped both teeth to see if I could feel anything different, and if there was a difference, the tooth they'd just retreated had more sensation on getting tapped than the one she guesses is going bad! That sensitivity would be from nerves in the facial bones, possible pressure from infection, thinking of number4's case.

Anybody have any advice for me? 🤕

possible pressure from infection, thinking of number4's case.

No advice for you... I do think some of dentistry (and medicine in general) is an art, and not a science. Practitioners go with recommending what are 'best practices' in any given situation, but they certainly aren't perfect practices.

I got a bit of a reprieve from my situation. After a CT scan and another x-ray, the periodontist did not see any infection. He did say I'm somewhere around 18-24 months out from starting the implant process. So it's allowed my mind to process the information.

I'm so sorry that you don't feel like you're making any progress with the healing. Can you give it some more time before making a decision? Can they rule out an infection definitely? I would think that two rounds of antibiotics would have knocked any infection out, but I understand your anxiety!

Thanks number4! And good to hear your update. Sounds reasonable!

I spent a few hours yesterday doing online dental research I shouldn't done but I did it because I'm not getting clear signals from either the regular dentist or the endodontist. And I learned quite a few details.

Found out that when teeth like my largest upper molars extend higher than the sinus floor on 2 dimensional X-ray, the dentist should realize that extracting them is almost a guarantee of creating a hole in the floor of the patient's sinus!

Later, I was looking back on my computer to the year I had an opposite side upper molar pulled on an emergency, and saw where my own notes stated "the floor of the sinus came with it." Wow, I just remember now how the surgeon had told me not to use a straw for a week, to help the "hole" heal up. Surprised that I wrote this, because at the time I'd thought it was just the "socket" where the tooth came out....but now, it makes me suspicious this extra bone loss was the source of pain I felt in the tooth directly in front for months afterwards. My dentist has never found anything amiss with that tooth, and said it's phantom pain. Sheesh, maybe a little nerve tissue got yanked with the piece of my sinus bone! I really do not want to do this, again.

Also, I learned that an implant to replace an upper molar underneath a maxillary sinus is trickier than almost any other site in the mouth. Never knew that as we age, the maxillary sinus grows and can grow downwards! One website warned that the dentist should confirm a minimum 13 mm of good bone below the hard bone of the sinus floor or the implant post will likely create a hole between the oral cavity and the sinus! Another detail I found good to know.

The main reason I'm being given for endodontists not wanting to re-treat the big molar is that tooth was root canalled using old tech silver "points" and they can be hard to retrieve. But it is not impossible, just can be a PITA. I found a position paper from the American Association of Endodontists about teeth like mine and why they are harder to re-treat. They have an online guide for dentists to decide if such a tooth is fixable and from the 3 pictured categories, my tooth doesn't appear to fall into either of the "questionable" ones. Like it has a better chance of being successful. No guarantees with retreated root canals. But it may be time for me to go doctor shopping for a third opinion!

Anyway, thanks to all who got this far for hanging in with me, and sorry if I'm traumatizing anyone. I get told my experiences are rather "extreme." But it isn't for lack of trying to get good dental care in my life; I'm just a hard case, I guess.

Edited for typos.

[This message edited by Superesse at 3:08 AM, Tuesday, September 24th]