trigeminal neuralgia after wisdom tooth extraction

[raquel414]

i have been diagnosed with TN  after having had a wisdom tooth pulled back in march of this year. my neurologist says this is very common. why does this happen? i am horrified. this has changed my life drastically.

[Michael Lim, MD]

As Sanjay said, prior dental procedures are often a cause of trigeminal neuralgia.  The exact mechanisms for TN are unknown.  There are treatments for your pain and I suggest that you see your doctor or neurologist.

[sanjay155]

Hi  raquel
    Yes I also have a history of trigeminal neuralgia which got started after I went to a dentist for cleaning my teeth. My case was very special since it started @ a age of 18 and i had only mild attacks. My pain stopped within 6 months. I started with 900 mg of carbamazepine daily and today after 10 years i just take 100 mg once in a week. Now I don't have any pain attaks.

[raquel414]

DR. Lim, thank you for answering my question, but,i have to tell you, I AM BEING SEEN BY NOT ONE, BUT TWO NEUROLOGIST(i want every opinion possible)....i was given Baclofen 10 mg....the 1st neoro gave me neurontin, and it made me very ill.....and pain meds. the pain meds. do not work,they just sedate me, and at the same time energize me..? weird... one neurologist even suggested that i have ATYPICAL FACIAL PAIN  from the "trauma" from having my tooth pulled.....does this (atypical facial pain) ever go away...?  was it something the dentist did..? he had put an imense amount of pressure on my jaw when he was extracting my tooth, he was hanging on my head to try to get the tooth out, all along the extraction tool slipping of my tooth, and cracking into the other teeth in my mouth...!!!! ATYPICAL FACIAL PAIN  is nerve damage right? my jaw /face muscles spasm, and my throat muscles spasm sooo bad it hurts...when i talk, it hurts more.....my teeth throb, and my gums feel like they are on fire!!! this is a nightmare...!!!! DR.LIM, PLEEEASE HELP ME UNDERSTAND WHAT COULD HAVE GONE WRONG.....

[Kaff]

Trigeminal Neuralgia, Is not from tooth extraction. It is similiar to Bells Palsy. I got this terrible headache and a numbness in the left side of my face, which sometimes ached behind my left ear. I was sent to a neurologist and did not help. My PCP came up with the TN. Nothing will take it away dear, it has to run its course. He did give me Vicodin to ease the pain a little. Sometimes my top left lip will droop a little. This last bout lasted about a week. I am not trying to scare you. Look up what you can on the Internet as I did. As questions???? Don't be afraid to ask doctor's in your area, even different neurologist. I am not a doctor and I do not pretend to be one, but I do know Trigeminal Neuralgia. I do have other illnesses, and know about them. TN is one that will knock your socks off when least expected. Thanks for reading this. Kaff

[tryingtosmile]

hi,
I am sorry if I sound disrespectful, but I have suffered from Trigeminal Neuralgia for many years and I over these years I have learned "a little" about it. First, it is NOT something that "has to run it's course" I'm not sure where you are getting this information. It is not at all like Bell's Palsy, and there ARE treatments. Yes it is a horrible thing to have and deal with but everyone is different in both the ONSET (which can occurr after dental procedures, most noted on any website), PROGRESSION, and TREATMENT. I am sorry for what you're going through as well but please be mindful of the information you send to others. Thank you.

[Kaff]

Well, I got the info about Bell's Palsy from Doctors and as for running "its course" from reseasrch and Doctors. The onset of this Trigeminal Neualgia is horrible, the headache and numbness on the left side not to mention the extruciating pain behind my left ear for about a week or so. If there is a treatment out there I would love to know what it is, believe me. I take Tegretal and Vicodin and that's what my Doctor's say is what they mostly can do for this. I haven't had any major dental work for several years, I take care of my teeth, so that is why I said it's not from dental work. Oh, I want to mention again about my lip drooping when the TN rears its ugly head. So I do and did research on this and still do. Thank you. Kaff....

[neuralgia]

Hey Raquel,
Your pain sounds identical to what I experience. My pain is in my lower left jaw area, under the teeth/gumline. When it started I had constant pain in that area and I was able to get that under control with neurontin and vicodin. It went away for about a year and then I recently started having typical trigeminal neuralgia-like attacks. The pain starts in the same area and quickly zaps/burns up my jawline to the area under my left ear. Almost like I feel my parotid (salivary) gland burn and then it doesn't go beyond that. It is usually triggered by eating and when it hurts, I can't move my mouth, talk, or touch that area of my face without making it worse.

I was diagnosed with atypical facial pain about 8 years ago after a great deal of dental restorations that I had to have done due to dry mouth from an underlying medical condition. It IS very common for trigeminal neuralgia to come about after dental work. I think the question, or argument/discussion ongoing in response to your post, is whether or not it would have come about regardless of the dental work, or if the dental work may have expedited the process? Who knows really, and from my experience, you just can't question it or it will make you crazy. As much as it would be nice to find someone to blame for the pain, you can't really hold the physicians that removed your wisdom teeth responsible (believe me, I went through the same battle).

As for your specific questions, atypical facial pain and trigeminal neuragia are different in their symptoms, but can occur at the same time. They aren't always necessarily nerve damage per se (they can be), but can also be that the trigeminal nerve just isn't communicating with the brain properly, which is why antiseizure meds and antidepressants tend to work in some people. They somehow help to rewire the connection and help that nerve to better communicate with the brain. When it is not under control, that nerve is constantly telling the brain to sense pain.

To answer your question, atypical facial pain is a nerve issue. It can go away, sometimes for good. But usually and unfortunately, it does return. Don't freak out. Stress can make it worse (or at least some sources/research supports the idea). Relatively speaking, this can be very manageable. It is just a matter of finding the doctors with experience in treating facial neuropathy that are willing to help find what works best for you. I work with a neurologist, an anesthesiologist, and an oral medicine specialist... and all three doctors communicate regarding my treatment.

And can you explain what you mean when you say neurontin made you ill? I only ask because I was on it at a very high dose for a long time, then went off of it for a while. Now, going back on it is giving me a load of issues. I just can't seem to adjust as quickly as I did before without having really bad side effects... side effects which are preventing me from functioning normally... which never happened before. What I'm getting at though is that if you were having side effects, they can be better dealt with if they increase your dose VERY gradually. If it was making you ill, however, then realize that if you can't take neurontin, there are MANY other antiseizure meds you can try. Some just happen to work better for some people than others. Additionally, there are antidepressants that work for some people (duloxetine and effexor are specifically being used for neuropathic pain). Pain medications work for me for the atypical pain (throbbing, burning, gnawing, ongoing pain), but don't work for preventing typical trigeminal pain (stabbing, shock like, quick to come quick to leave pain and quick to come again pain).

In addition to medication, there are a number of surgical interventions that may help. I have had a number of nerve blocks done (percutaneous glycerol rhyzotomy procedures) which have really helped.

Like you (or at least you sound to be), I was in really poor shape within the first year that I was diagnosed because we didn't have the pain under control... at all. I took numerous trips to the ER because if something wasn't done to help, I was going to lose my mind. Hang in there and realize that it is a matter of finding what works best for you. If you are having pain that is not controlled by anything and that is something that you are unable to handle, just go to the emergency room so that they can help you to get it under control for at least a short period of time. That's actually how I found my anesthesiologist.

Also, if you haven't already, look at the TN association website. I find it to really be helpful. It also has a link to support groups in your area. You can contact these people for information, support, physician referrals, etc.

Good luck.

[Kaff]

I just read your post and some are similiar symptoms to mine. I have headaches, and a numbness in my right cheek also. As I posted I had no dental work for years so I had ruled that out. If we go to the ER around here we wait for 3 hours, get a pill and a handshake and sent home. If we are lucky we get the good doctor and a little help. My PCP is the one who helped me. Well, I have said about all I can on this subject, I wish all of you TN suffers the best. Take care, KAFF

[amahnduhk]

I have had TN symptoms for over 5 years. After 4 teeth pulled cause we thought that was what was the problem I finally went top see a GP and      he diagnosed me last year. I take 2 neurontin 6 times a day, 2 tegretol a day 2  xanax a  day and hydrocodone only if I am just dying. The problem is the hydrocodone does nothing. Percocet helped a bit for a while. The tegretol makes your birth control not work and I got pregnant by surprise and lost it cause the meds are not good for a baby. I am not in constant pain anymore but I was 4 five years and I want to kick having to take all these pills. My next step is botox to see if we can kill the nerve. I am only 32 and I am TIRED. I was told the trauma from being close lined from behind by an abusive ex could have caused it. He hit me right in the back of the neck going down a hill to our car once we left Mexico and I blacked out.  

[Kaff]

Wow! Hydrocodone and Percocet are about the same thing. No stinking wonder you have so many other problems. Plus all the Neurontin and Xanax with the birth control. Goodness. Check with your PCP, have blood test, PLEASE. Make sure you have TN. I am no Doctor, believe I don't want to be. I am so ticked about what one did to my sister yesterday, It was a crime how he treated her. I do have TN as you probably read above. Please be checked again. Take care. Kaff

[shortcircuited]

A related discussion, How long did initial pain last after dental work? was started.