Wednesday 18 July 2018

Dear Dr Nina: Is the pain in my face from tooth ache or head cold?

Photo posed
Photo posed

Q: I've had a bad cold with an extremely blocked nose for the past week or so, but that's cleared up now. But since it's cleared up I've developed a lot of pain in my face and most particularly on the right hand side, which feels a lot like dental pain. The pain is worse when I'm lying down or leaning forward. I'm trying to figure out if the pain is from my teeth or if it's got something to do with the cold? Should I see a dentist or is this one for the doctor?

Dr Nina replies: Sinus infections cause a sensation of blocked nose, congestion, facial or dental pain and a post nasal drip. Hay fever (rhinitis) can cause nasal inflammation, which leads to congestion, which causes similar symptoms. However, the pain you describe may also be due to a dental problem.

It can be hard to decide whether a dental or medical check-up is required. As a rule of thumb, I would suggest that if your symptoms are isolated to one side of your face in the gum or tooth area, then a dentist is a good first port of call.

If you have more generalised symptoms such as headaches, earache, fever, altered appetite, altered sense of smell or any general sense of illness, then I would start with a visit to your GP.

Obstruction of the nasal passage by polyps, bony deformity inside the nose or, rarely, tumours, may also cause facial pain. Given your symptoms I would start with a good dental check.

You may require x-rays, which can usually be done then and there. If no cause is found then it is worth going along to your GP for a check-up. A simple examination and possibly bloods might identify a treatable cause. When a cause can't be found your GP may arrange further tests, scans or specialist review.

If the problem turns out to be a sinus infection then treating both infection and congestion provides best symptomatic relief. Involvement of the dental root implies a deep seeded infection and a longer antibiotic course may be more appropriate.

The treatment for rhinitis and sinusitis are similar but if there is true bacterial infection then an antibiotic may be required. Antihistamines reduce the body's allergic response, helping to limit the congestion, swelling and nasal drip associated with rhinitis.

It is preferable to use those that are less sedating by day, but a sedating one may have benefits if taken at night. Steroid nasal sprays help to reduce swelling in the nasal passages, thus reducing congestion and blockage. They are generally considered safe and they can be used on an ongoing basis if required.

It is important that remedies are used in the correct way and the correct order. If your nasal passages are very inflamed, using a decongestant such as pseudoephedrine or stronger steroid nasal drop for a few days before starting the nasal spray may render the spray more effective.

Pseudoephedrine, however, should never be used for more than a few days and should only be used under medical or pharmacy advice, as it isn't suitable for everyone.

When using a nasal spray aim straight back into the nose, not up or in, and breathe normally after using it.

This reduces the likelihood it will irritate the lining of the nose and also ensures it stays in the nose where it needs to be. Snorting the spray back delivers it to the throat reducing its efficacy.

Medical and dental issues can be closely linked. An untreated dental abscess can cause a nasty sinus infection and untreated sinus infection can impact on dental health. It may be that a visit to both health professionals is in order.

 

Q. My teenage daughter has a strange looking rash on her legs — it’s like lots of small white bumps. What could it be? It’s making her quite self-conscious

Dr Nina replies: It is almost impossible to diagnose a rash without looking at it and so I would always advise a visit to your doctor if you are concerned.

Keratosis Pilaris causes coarse, dry, sandpaper-like bumps that appear mainly on the arms, thighs and buttocks. These are usually white but may sometimes be red. It can run in families and although not a disease as such, is a source of distress to many of those afflicted.

This condition occurs due to a build-up of keratin in the hair follicles of the skin. Keratin is a tough protein that forms a protective layer on the skin when built up in the hair follicles forms a scaly plug, which leads to the bumpy texture of the skin. Dry skin makes the condition worse and it is more common in those who have conditions such as dermatitis and eczema. A dry environment such as that, which occurs with central heating, may also exacerbate the condition. When keratosis appears on the face it may appear very similar to acne.

As for many dry skin conditions, effective moisturising is key to management of this condition. Hydroxy, lactic and salicylic acid products will also help loosen skin cells and free up keratin plugs. Gentle exfoliation can assist clearing keratin plugs but vigorous scrubbing is likely to make the condition worse. Topical steroids are occasionally used and can help reduce irritation and inflammation. Retinoids are creams derived from vitamin A. They encourage cell turnover and reduce the formation of plugs, but may also increase skin dryness and irritation.

Keratosis Pilaris is not a dangerous condition and is not associated with any chronic damage or disease. Fake tan may lessen the appearance and can be a helpful summer cover up.

 

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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