I have severe pain in my upper left teeth - and sometimes they hurt to the touch - but not all the time. I also have pain in the upper corner of my left cheek and in my left eye.
I have been to my dentist - who did not xray my teeth(Feb 09), but he banged on each one to check if there was any pain (which he said there would have been if there was an infection) He therefore referred me to my GP who has diagnosed Neuralgia.... however, i cannot help thinking that for my teeth to hurt like they do (and to sometimes hurt so much to the touch that I cannot eat) - it must be something wrong with the tooth, and am worried about the possibility that the infection within the tooth has spread across my face and this is why I am experiencing such pain. The pain is occuring everyday, and I am having to take painkillers every day to cope with it. There is no lump anywhere and from what I have read, if there was an abscess, I would also have a lump??
What should i do??? Is it possible for the infection to have spread? If so, what symptoms would i have?!?!?
All suggestions will be taken seriously at this point!
Hi, kezy, I am sorry that you are suffering.
I suffer from Atypcial Trigeminal Neuralgia, Atypical Odontalgia, and Reflex Sympathetic Dystrophy Syndrome.
And I pray that you don't have any of what I have.
scottma is right.
When you choose orofacial pain specialist (dentist who is specializing in TMD and Atypical toothpain), make sure that he/she is familiar with Atypical Odontalgia. Majorities of orofacial pain specialists are not familiar with neuropathic pain, which would trouble you. If you have nerve damages, he/she would prescribe anti-convulsant such as Lyrica, Tegretol, Neutronin, etc. The right anti-convulsant will lower your pain in a week. He/she might start with Anti-depressants such as TCA or SSRI such as Elavil or Cymbalta. But anti-depressants will take at least 8 - 12 weeks to kick in. Orofacial dentist will X-ray and/or CT-scan your head to check infection and other problems.
If you see a Neurologist, you will get the above prescriptions right away, without purchasing an expensive splint. He/she will likely to order MRI and blood test to rule out other causes.
If you are so worried about infection, you should see the general dentist who is competent, and make him/her X-ray you first. And make him/her see if you have infection.
Do not make any dentist/endodontist do root-canal unless the infection is positively identified in X-ray.
If I were you, I would see a reputable general dentist, a reputable neurologist, and a reputable orofaical dentist who is specializing in Atypical Odontalgia. I mean all three of them at once, ASAP.
If you have an infection, the right anti-biotics will reduce the pain in 3 days.
If you have nerve problem, the right anti-convulsant will reduce the pain within 1 week.
Anti-depressant may work if your nerve damage is minor.
Never agree to any root-canals unless they are sure you have infection.
It is not only infection that causes your pain.
If 4 pills of regular over the counter medicines such as Tylenol and Ibuprofen do not help your pain, then suspect nerve problems.
If your pain includes "electric" pain that runs to nose and eyes, not only jaws and teeth, your trigeminal nerves are all affected.
Finally, only trust dentist/doctors who take time to listen to you and who take time to explain to you.
Any doctor/dentist who remotely imply that you have the pain due to your psychological or psychiatric conditions, by any means, run.
For example, depression would not cause this kind of pain.
But inept doctors tend to blame on your psych.
Anti-convulsant or anti-depressant that I talked earlier are used to calm down the nerves.
These drugs turn down the excited nerves.
You commented that Atypical Odontalgia is relatively easy to diagnose, if I remember.
As an orofacial professional, how can you tell a patient has an Atypical Odontalgia or not?
Please list all diagnostic criteria.
Also, do you think Atypical Odontalgia can be categorized in Atypical Trigeminal Neuralgia?
As you know, Classic Trigeminal Neuralgia is different from Atypical Odontalgia since the latter does not have remission or break in pain. But I believe that Atypical Odontalgia is just a subset of Atypical Trigeminal Neuralgia.
I am also puzzled by the clear definition of Post-Traumatic Trigeminal Neuropathy. My neurologists could not explain the distinctions between Post-Traumatic Trigeminal Neuropathy and Atypical Trigeminal Neuralgia.
But from my understanding, for Post-Traumatic Neuropathy, the pain is rather limited to the initial injury points. If so, Atypical Odontalgia should be a subset of Post-Traumatic Trigeminal Neuropathy, I think.
In my case, the initial dental trauma caused the pain in the face, neck, shoulders, arms, and hands simultaneously. In such a sense, my pain was not limited to the teeth. I have developped referred pain right away on the right side, then soon spread to the left since 20+ doctors failed to give me the correct diagnosis for 2 months.
How come majority of dentists have little or no knowledges about nerves that run in a human head?
How come most dentists send the patients to the endodontists even when there is no sign of infection?
Are there any way to educate ignorant dentists and doctors about orofacial neuropathy?
How can you tell Atypical Odontalgia patients from TMD patients?
I am deeply troubled by a particular TMD doctor who has no understanding of neuropathy.
I read that Atypical Odontalgia can cause TMD since the neuropathic pain would tense up the muscles around the jaws, which results in the same exact symptoms of TMD.
I purchased the splint; but it turned out to be simply "Placebo!"
I paid $950 for it, and I keep seeing this TMD doctor; however, I am seriously considering quit seeing him.
I see the neurologists, just to get the drug prescribed.
Other than that, I have no faith in my neurologists.
I am very afraid of my developing resistance to anti-convulsants, in the future.
And I am aware no neurological surgery would cure "Atypical" type of neuropathy.
I have tried to get off medications twice, and failed.
I am aware that it is risky and stupid to taper off the drugs at this moment, since pain would cause the domino-effect of pain.
Pain control is the priority!
However, I am still eager to have the future without medications since I do not want to end up with the failed trigeminal neuralgia.
I'd appreciate it if you could give me any insight.
I am afraid I may not answer all of your questions, because I am two finger typer. That's why my comments are almost always very brief. I am impressed with my son's typing skill. who can type with 10 fingers without seeing keyboard.
Chronic pain diagosis relies on patient's history heavily.Imaging studies and blood profile help exclude structural and organic pathology which may be the culprit of chronic pain .However, most chronic pain sufferers don't show abnormalities of these lab tests.
Pain quality, duration, temporal pattern, anatomic site, and clinical anesthetic block test, all of these are critical to establish a meaningful working diagnosis.
The most characteristic feature of atypical odontalgia is perisitent toothache,with dull aching quality. The pain is 24 hours aday, 7 days a week, almost no pain-free period. There is probably no known dental disease entity bahaving like this. I was fortunate enough to see 2 atypical odontalgia cases some years ago. Both of them were treated by amitryptyline for acouple of weeks, and no recurrence was ever reported so far. If you are highly motivated, there are three textbooks I would recommed for your review.
1.Bell's Orofacial Pains, written by okeson, 6th edition,qb publisher
2.Orofacial pain and Headache, written by sharav and benoliel, mosby publisher
3. Pain 2008 an updated review refresher course syllabus,editors,: jose castro-lopes, srinivasa raja, martin schmeltz,publisher iasp press
I believe your neurologist is more experienced and knowledgable than me. Following his or her treatment regimen probably will yield best outcome.
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