Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 8/2/2006

Question
I was recently seen at the ER for what was diagnosed as a sinus infection. However, I have no fever, no cold symptoms, no ear ache, no stuffiness. I have simply, overwhelming pain in my cheek and my top teeth on the right side, and swelling in the gums and cheek. Is there a way to determine  if it coould be something more serious than a sinus infection?
I went to my doctor for a follow up appointment this morning and she told me to take sudafed. I am on 120 mgs of sudafed, 2500 mgs of tylenol (in 24 hours), 2400 mgs of ibu, and 600 of naproxen. I am on dose 3 of a z pack. I have tried heat and ice. I am near tears now, and have been for 48 hours. When can I say this is definitively not a sinus thing, but a mouth thing? At what point do I call a dentist, or an ENT?

Answer
Jennifer -  You are obviously in a situation that is not uncommon.  The most important thing to do at this time is for you to be seen be a doctor who treats this type of problem frequently.

With your symptoms of tooth pain and gum and cheek swelling on the right side the cause could either be the teeth or a single tooth or it could just be a sinus infection.  My suggestion is to be examined immediately by an oral and maxillofacial surgeon in your area.  This doctor can take a single xray in the office that can define if any teeth are the cause or just place the blame on the sinus.  

If the sinus is the cause then you should also be place on an antibiotic.  If the sinus is the main cause, the surgeon may refer you to an ENT doctor for further evaluation and treatment.  

So call immediately and be seen as soon as possible. If you have any further questions please get back to me.