Last reviewed: July 16, 2026. This article is for general information and does not replace advice from a licensed clinician.
Editorial review and sources
Editorial review: osvilt.com Editorial Team
Last reviewed: July 16, 2026
This medical article is based on current public medical sources and follows the osvilt.com Medical Review Policy. It is for general information only and does not replace professional care; see our Medical Disclaimer.
Acute maxillary sinusitis is inflammation of the maxillary sinuses, the air spaces beside the nose and above the upper teeth. Because the maxillary sinuses sit near dental roots and the nasal cavity, symptoms can overlap with colds, allergic rhinitis and dental pain.
Short answer: Most acute sinus symptoms start after a viral upper respiratory infection and improve with supportive care. Bacterial sinusitis is more likely when symptoms are severe, last more than 10 days without improvement, or worsen after initial improvement.
What changed in this update
The article now uses current rhinosinusitis guidance, separates viral from likely bacterial patterns, and adds dental causes and complication red flags.
Common causes and contributors
| Cause | Clues | What it means |
|---|---|---|
| Viral upper respiratory infection | Cold symptoms, congestion, pressure, symptoms improving within about a week. | Most common; antibiotics do not help viral infection. |
| Likely bacterial rhinosinusitis | Severe fever/purulent discharge/facial pain, persistence beyond 10 days, or double-worsening. | May need clinician-directed antibiotics or watchful waiting. |
| Allergic rhinitis | Sneezing, itching, clear runny nose, seasonal or trigger pattern. | Needs allergy-focused treatment, not antibiotics. |
| Dental source | Upper tooth pain, dental infection, one-sided foul drainage. | Dental evaluation may be needed. |
| Anatomy or chronic inflammation | Recurrent episodes, nasal polyps, persistent blockage. | ENT evaluation may be useful. |
Why the word maxillary matters
Maxillary sinus inflammation can cause cheek pressure, upper tooth discomfort, nasal obstruction, postnasal drip and reduced smell. Tooth pain does not always mean the tooth is the cause, and sinus pain does not always mean the sinus is the only problem.
Antibiotics are not automatic
CDC outpatient guidance recommends diagnosing acute bacterial rhinosinusitis by severe, persistent or worsening symptom patterns, and notes that sinus radiographs are not routinely recommended. Watchful waiting or delayed prescribing can be appropriate in selected uncomplicated cases.
Supportive care
Saline irrigation, fluids, pain relief and sometimes intranasal steroids may help symptoms. Decongestant sprays should not be overused because rebound congestion can occur.
When to get medical care
Seek urgent care for swelling or redness around the eye, vision changes, severe headache, stiff neck, confusion, facial numbness, severe one-sided facial pain, high fever, immune suppression, symptoms after facial trauma, symptoms lasting more than 10 days without improvement, worsening after initial improvement, or repeated sinus infections.
FAQ
Is acute maxillary sinusitis always bacterial?
No. Most acute cases begin with viral rhinitis; bacterial infection is suggested by severe, persistent or worsening patterns.
Can a bad tooth cause maxillary sinusitis?
Yes. Upper dental infections can involve the maxillary sinus, especially with one-sided symptoms or dental pain.
Do I need a sinus X-ray?
Usually not for uncomplicated acute symptoms. Imaging is reserved for suspected complications, alternative diagnosis or chronic/recurrent problems.
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