What does this mean?
Inside your face, behind the cheekbone and within the forehead, there are spaces filled with air. When the lining swells and fluid collects in the space, tipping your head forward slides that fluid towards the front wall of the space. The fine sensory fibres running in that wall respond to pressure, which is why bending, coughing and straining raise the pressure within seconds.
This detail helps separate sinus pain from pain coming from the nerve of a tooth. In the sinus picture, several upper back teeth on the same side feel as though they have all become heavy at once; you cannot point out which one hurts, and the intensity changes through the day with the position of your head. Pain from the nerve of a tooth gathers in a single tooth, is set off within seconds by cold or heat, and can carry on for minutes after the trigger is taken away.
This home test is a clue, not a diagnosis. Bending forward can make the pain worse in an inflamed upper tooth as well, because the blood flow in the area changes when the head is tipped down. Migraine and cluster headache can also be felt as pressure in the face. That is why the result of the test is weighed up together with the examination, and with an X-ray where needed, rather than on its own.
Pressure that changes with position brings the source of the pain closer to the sinus space; where whatever fills that space came from is a separate question. The headings below look at that question.
Likely causes
What helps at home?
- Try each movement in turn and write down which one raises the pressure: bending forward, climbing stairs, coughing and lying flat each tell you something different.
- Keeping your head slightly raised at night may lessen the pressure in the morning; this does not change the cause, but it makes sleeping easier.
- Do not press hard on your teeth one by one to find out which one it is; it makes an already sensitive area more tender still.
- Do not ask for root canal treatment or an extraction on your own decision because the pressure will not go; a procedure carried out before the source is confirmed cannot be undone.
- If there is swelling or redness around your eye, or difficulty moving the eye
- If a one-sided headache with a fever and shivering has become severe within hours
- If swelling has appeared in your face and you are struggling to open your mouth
- If a stiff neck, confusion or vomiting has been added
- If the pressure has risen enough to wake you from sleep regularly
Frequently asked questions
- Does this test show for certain whether it is the sinus or a tooth?
- It does not. Bending forward only gives a clue. Sinus pressure changes noticeably with position, but an inflamed upper tooth can hurt more on bending as well. The decision is made together with how the teeth respond to cold and to pressure, the examination of the gums, and an X-ray where needed.
- Several of my upper teeth hurt at once; what does that show?
- Several upper back teeth on the same side becoming heavy together brings to mind the sinus space they all share as a neighbour, rather than the nerve of a single tooth. Even so it is not a firm distinction; advanced inflammation in one tooth can make the neighbouring teeth sensitive too. To pick out the tooth responsible, the teeth are tested one by one.
- I have had treatment for my sinuses, so why has the pressure not gone?
- If it carries on despite treatment aimed at the sinus, whether there is a dental source feeding that sinus is looked into. The roots of the upper back teeth lie very close to the floor of the sinus, and inflammation coming from there is not always expected to settle with ENT treatment alone. At this point a dental examination and the right imaging take their turn.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.