ATF / TN ???

   Like so many of the meesages I've read here, I too woke up one day
  (10 weeks ago)_with the worst tooth ache of my life, went to the dentist,
  had several teeth filled, extracted etc all to no avail.  One Doc dx tmj another
  said aft a third tic delarou.  An aloof neuro prescribed tegratol and said see ya around. 1200 mg did seem
  to reduce teh pain to a mild stiffness or soreness of teh left facial area
  My question(s);
  Imperically speaking, what would be the correct dx? I have pain on the left side of my face which is
  unworldly. The pain does not appear to be precipitated by any particular activity or event and I don't
  seem to have any trigger zones.
  I did have head trauma aprox 9 yrs ago (closed head woulnd) subsequent to mva. Teeth are in poor state and frequently have lots of lymph under
  my mandible but otherwise very healthy.  Recent MRI of brain appears normal.
  My neuro did mention one thing as being odd. I complained the pain travels as high as my eyebrow. He says
  this make dx more difficult.
  I've been reducing the tegratol and am down to 200mg per day. I'm a little worried about how fast I can reduce the tegratol???
  mainly.. with all the different dx's i'm confused?
  
  What's your opinion?
Dear Tracy,
Trigeminal neuralgia usually starts in midlife and is associated with intermittent, stabbing pains in the area of the cheek and jaw.  The episodes can last for seconds or reoccur so frequently that the pain feels continuous.  TN usually has some sort of trigger (touch, cold, chewing etc).  Another part of the differential for facial pain includes that arising from the jaw and teeth(caries, abscess).  TMJ is due to degenerative changes in the TM joint.  Associated findings include tenderness of the joint, limitation of jaw opening, and crepitus.  Sometimes the onset of "atypical facial pain" can be dated to a dental procedure.  Work-up is usually negative except for microabscesses and subacute bone infection.  Treatment includeds antibiotics and cureting the bone.  From your description, it sounds as if you have alot of dental problems and many recent procedures.  It would be difficult to make a diagnosis without an exam, however,  the pains that you describe sound less like TN and are most likely related to your teeth and mouth.  A negative MRI helps to exclude other causes of facial pain such as tumors, some vascular abnormalities and MS.  Tegretol is a medication used frequently to treat neuropathic pain.  If the tegratol was working, you may want to continue the medication until the pain is under better control.  You do not need to taper the dose if you wanted to stop the medication.  Discuss these options with your doctor and dentist.  If you are interested in getting an evaluation at CCF, call 1-800-CCF-CARE.  Good Luck.