Re: trigeminal neuralgia

Posted By CCf Neurosurgery MD on October 14, 1997 at 12:47:50:

In Reply to: trigeminal neuralgia posted by Carolyn Meyer on October 10, 1997 at 03:41:54:







: I am a 55 year old female.  When I was 17 I was diagnosed with TN which caused
pain running beside my nose to under my eye on the right side and treated
with alcohol injections and avulsion of the nerve.  When I was 27, a doctor
prescribed Tegretol, Medrol, Dilantin, and Tolseram.  The pain left over the
next two days.  I kept an appointment I had previously made with Dr. Lever
F. Stewart at UVA to talk about surgery.  Since I had no pain then, he did
nothing except tell me not to take the Tegretol and Medrol.  I took the Dilantin
and Tolseram for 2 years without pain before I stopped taking them.  I did
not have any pain for 25 years.  Then I had similar pain on the right side
running from my lower lip toward my ear.  It felt like the old pain so a
family physician prescribed Tegretol.  It helped for about 2 years.  Then
I realized that the pain is triggered only when tooth #26 is involved.
The dentist saw infection and referred me for a root canal.  No change.
Then he cut the roots off 26 and cleaned the area out.  No change.  July
I went to the emergency room where they gave me an IV of Dilantin and
Medrol.  Partial relief for a couple of days.  Family doctor now has me
on 60mg Baclofen and 2 capsules of Dilantin per day.  The 2 increases
in Baclofen have not helped.  Pain is not as constant as in July, but eating and brushing my teeth are painful.  I have also seen
an oral pathologist, Dr. Bouquot, who says I am a candidate for NICO, but
not a good candidate.  
I've said all of that to ask, "Have you heard of TN that is triggered
by only one tooth?"  And the pain is only while the tooth is involved;
there is no minute of pain afterward.  Can a doctor determine that TN
is the cause by any kind of test, or are the symptoms all one can consider?
I'm on the verge of having the tooth pulled, but the dental peole don't
see how a tooth with no nerves inside can be causing pain.
Thank you.  Sorry this is so long.
Carolyn
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Dear Carolyn,
Trigeminal neuralgia is characterized by episodes of sharp lightning-like
pain in the region of the cheek or jaw on one side of the face.  Episodes
usually last a minute or two and subside.  Often a patient will notice certain
triggering events such as a touch, hair brushing, heat and cold.  The pain
has been described as quite disabling in the literature.
The diagnosis of trigeminal neuralgia is by history.  The first line of therapy
is medical.  If this fails, other things such as alcohol injections, avulsions
and formal surgery may be considered.  Recently, the Gamma Knife has been
used with reasonable success.
It is conceivable that your tooth is the trigger point for trigeminal neuralgia.
There are no tests to diagnose this disease save the history.  You should
talk with a neurosurgeon or neurologist as to what his or her opinion is at
this point.  A detailled history and exam is in order.  The physician may
choose to allow the infected tooth to 'settle down' prior to beginning any
new therapies.
Good luck.