Some 6,000 troops have been deployed in the north-eastern state to dig through mudslides and clear away rubble in an effort to reach cut-off villages.
Hundreds of people spent a second night in the open as aftershocks continued.
In the immediate aftermath of the quake heavy rains and landslides held up the relief effort. But a break in the poor weather meant that army helicopters were able to drop food supplies and transport medical teams to some affected areas.
Unblocking roads Nevertheless, officials say the biggest challenge is reaching those villages in the most isolated areas of the mountainous state amid fears that people may still be trapped under debris.
Convoys of vehicles left the state capital Gangtok on Tuesday morning but the AFP news agency says that progress was tortuously slow along precarious, badly-damaged roads.
Troops and road workers managed to restore the main highway linking Sikkim with the rest of India.
But elsewhere soldiers and emergency teams were using explosives to try to force their way through blocked roads.
"I've been here for six hours, waiting for the army to clear the road," Pema Doma, who was waiting for news of her parents and son in the Mangan area, told AFP.
"I'd walk if they would let me," Doma said. "The anxiety is killing me. What if he's screaming for me? What if he's calling for me and I can't even hear him?"
The death toll from the area is expected to rise Indian Home Secretary RK Singh told reporters.
Tibet damage Similar efforts were under way in Tibet and Nepal where homes have been destroyed as well.
The magnitude 6.9 quake struck the mountainous state of Sikkim at 18:10 (12:40 GMT) on Sunday, according to the US Geological Survey, and was followed by two strong aftershocks.
Several earthquakes hit the Himalayan region this year, but none caused major damage.
Just over the border in Tibet's Yadong County, just 40km (25 miles) from Sikkim, the earthquake caused hundreds of landslides, disrupting traffic, telecommunications, power and water supplies.
China's official Xinhua news agency said that seven people had died and 24 others had been injured in Tibet. Landslides have also disrupted power and water supplies.
Nepal's government said seven people had died, including two men and a child who were killed when a wall of the British Embassy collapsed in the capital, Kathmandu.
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