Pain in the cheekbones or upper jaw that intensifies with chewing is a common and often confusing symptom. Many people are unsure if the source is a dental issue or a problem with their sinuses. This discomfort, localized in the midface, can range from a dull ache to sharp pressure, triggered by biting down. The confusion arises because the anatomical structures of the mouth and the sinuses are intricately linked, sharing common pathways for nerve sensation. Understanding this facial architecture is the first step in differentiating the causes and finding relief.
The Connection Between Chewing and Sinus Pressure
The sensation of pain near the upper teeth when chewing is explained by the close physical relationship between the maxillary sinuses and the upper molars and premolars. The maxillary sinuses are the largest paranasal sinuses, situated directly behind the cheekbones. Their floor rests just above the roots of these back teeth, often separated only by a thin layer of bone or a delicate membrane.
The entire sensory input from the upper jaw, teeth, and the maxillary sinus lining is carried by the maxillary division of the trigeminal nerve. Because these structures share the same nerve branch, the brain can misinterpret the origin of a painful signal, a phenomenon known as referred pain. When the jaw moves during chewing, it creates pressure changes and muscle contractions in the surrounding facial structures. If the sinus lining is inflamed or congested, this mechanical movement compresses the irritated nerve fibers, intensifying the pressure and pain.
Primary Sinus-Related Causes of Pain
The most common sinus-related cause of pain when chewing is maxillary sinusitis, which is inflammation or infection of the sinus lining. When the mucous membrane swells, it restricts the normal drainage of fluid and mucus through the small openings called ostia. This blockage causes an accumulation of fluid and air pressure within the enclosed cavity, pushing onto the sensitive nerve endings near the floor of the sinus.
The pain is often described as a dull, throbbing ache that affects several upper teeth on one side, rather than a single tooth. Sinus-related pain tends to worsen with positional changes, such as bending over, lying down, or jumping, as these movements shift internal fluid and increase downward pressure. Chronic sinusitis, lasting 12 weeks or more, produces persistent pressure and pain that may be exacerbated by the muscular action of the jaw during chewing. Other conditions causing significant tissue swelling, like allergic rhinitis, can also temporarily increase pressure and result in comparable discomfort.
Non-Sinus Causes: Dental and Jaw Issues
A number of dental and jaw conditions can mimic sinus pressure and cause pain specifically upon chewing. A periapical abscess, a pocket of infection at the tip of an upper tooth root, is a frequent non-sinus culprit. When infection from a necrotic tooth pulp spreads past the root tip, it creates pus that can erode the thin bone separating the tooth from the maxillary sinus. This inflammation can trigger odontogenic sinusitis, where pain is localized to a single tooth but radiates into the sinus area, causing pain with biting pressure.
Another dental cause is a cracked tooth or a fractured dental restoration, often called cracked tooth syndrome. This issue creates sharp, momentary pain precisely when the tooth is under the force of biting or chewing, as pressure causes the fracture to separate. The temporomandibular joint (TMJ) disorder is a jaw-related issue often mistaken for sinus pain because the joint is located close to the ear. TMJ pain is worsened by jaw activity like talking or chewing, and may include clicking or popping noises, with the pain radiating into the cheek and temple area.
Treatment and Management Strategies
Addressing pain in the upper jaw requires accurately determining whether the source is sinogenic or odontogenic, as treatments differ significantly. For general sinus congestion, self-care strategies are effective. These include steam inhalation or using saline nasal irrigation to thin mucus and promote drainage. Over-the-counter decongestants can also help reduce the swelling of the sinus lining, decreasing the internal pressure that irritates the nerves.
Professional intervention is necessary when the pain is persistent or accompanied by specific symptoms.
Consulting a Dentist
If the pain is localized to a single tooth, is sharp upon biting, or is accompanied by fever, a dentist should be consulted first. This suggests a dental abscess or a fracture requiring a root canal or other dental work.
Consulting an Otolaryngologist (ENT)
If the pain is diffuse, affects multiple upper teeth, and occurs alongside nasal congestion, colored discharge, or facial pressure, an otolaryngologist (ENT) is the appropriate specialist. Treatment for odontogenic sinusitis often requires a combined approach: the dental infection is eliminated first, sometimes followed by medical management for the sinus inflammation.