Friday, 16 March 2012

I have toothache. Is it Trigeminal Neuralgia?

Neuralgia


For those not in the know, neuralgia is where the brain is being told that nerve receptors are being triggered when in actual fact, they're not usually resulting in pain that shouldn't be there.

It is caused by an underlying condition such as shingles, inflammation, slipped disc or some other damage to a nerve.

The symptoms often manifest themselves as shooting, stabbing or other possibly extreme pains that can hang around for some time depending upon how the nerve has been damaged or is being irritated. The length of time the pain hangs around is also dependent upon the type of damage. The location of the pain is dependent upon where in the body the nerve is that has been damaged or irritated.

A trapped nerve is possibly the most common form of neuralgia as the damage may only be momentary - e.g. pinched, and has a tendency to rectify itself reasonably quickly. The pain however, can continue for some time while the nerve returns to normal. I would suggest that sciatica is a form of neuralgia affecting the Sciatic nerve that runs down the back of each leg.

Sciatica is not a condition in its own right nor is it listed as a form of neuralgia, although I would argue that the conditions fit the definition perfectly as sciatica can be caused by a slipped disc or similar, making it a manifestation of an underlying issue - causing pressure or damage to the sciatic nerve.

Tooth decay has also been defined as a form of neuralgia, but since the nerve receptors in the tooth itself are actually being triggered by and because of the decay, I'm forced to discount this particular one as a form of neuralgia.


Trigeminal Neuralgia


I actually want to focus on a specific form of neuralgia - Trigeminal Neuralgia, also referred to as TN.

Graphic courtesy of Wikipedia
This affects the Trigeminal nerve and most usually on the right side of the face, although this form of neuralgia is not exclusive to the right and can affect either or both sides.

It is called 'Trigeminal' because there are three branches on each side of the face, so the image (left) is a mirror image of the nerves on the left side of the face.

TN is most often associated with, but not exclusively to the maxillary and mandibular branches, the nerves that deal most predominantly with the teeth and jaw muscles; those associated with mastication  - chewing - but not facial expressions.

The kind of pain this can induce is nothing short of mind-blowing. If you can imagine how bad toothache can feel, this is toothache that affects several teeth on the upper jaw and several on the lower jaw - all at the same time. It has been said that it is possibly the most painful condition anyone can have and can feel like someone has attached all your teeth on one side of your mouth to the mains.

It is almost always chronic - in other words, once someone's got it, they've got it for life; generally worsening the longer the patient has it, adversely affecting their quality of life.

Sometimes the patient will go into remission, but generally, TN will return and whilst there are various forms of medication like carbamazapine and other anticonvulsants available, they're not remedial medications as there is no known cure, these drugs simply keep the symptoms at bay, although not always successfully.

There are some surgical treatments available, though many are only temporary, can be invasive and not without side effects of their own - like causing the affected side of the face to go numb or for the patient to lose all sense of taste. More techniques are being worked on all the time, but TN affects so few people (about 1 in 15,000 people, although according to Wikipedia, this figure may be significantly higher due to misdiagnosis), so funding is not as high as it could be. According to the Nation Health Service, in the UK, it strikes 1 in 20,000 to 25,000 and again, the figure may be higher due to misdiagnosis.


Help in identification

Is it toothache?

Trigeminal neuralgia of any form is incredibly painful and because it can be associated with the nerves in the teeth, it is often mistaken for toothache. For me, the first time I experienced it was over breakfast by a feeling that I can only describe as chewing on a bolt of lightning. The initial 'shooting' pain subsided to an ache that was extremely painful, distracting and had I not taken several painkillers in one go, probably completely debilitating. This pain remained with me for the rest of the day and through the next several, although there were no more shooting pains thereafter unless I was eating and chewed on the right hand side by mistake.

Naturally, I thought it was toothache and visited a local dentist several times over the course of the following week in an attempt to get it sorted out, taking up to twelve 200mg Nurofen painkillers each day to try and keep the pain under control. After x-rays and a general check-up, it was determined that there was nothing wrong with my teeth; certainly nothing that could have been causing the pain I described.

I was even sold a ridiculously expensive piece of plastic, which clipped on my upper front teeth and prevented me from grinding my teeth during sleep, as that was considered a possible cause. All it succeeded in doing was to cause me to dribble, waking me up in a right old grouch with a wet pillow. I tried it for the better part of a week, but constantly waking up in the middle of the night with this 'thing' in my mouth, a wet pillow and wet ear just didn't seem logical. It did come in a cool little box that glowed in the dark so that you could find it at night, but that lost its charm very rapidly, as it produced almost enough light to read by and had to be put in a drawer; kind of negating the reason it was in a glow-in-the-dark box.

So it's not toothache then?

There was apparently nothing wrong with my teeth and just prior to the next - the fifth - appointment, I cancelled, stating that I wanted to get a second opinion from my doctor. Obviously, if my teeth were not at fault, the pain had to be something other than dental. Not only that, but the dentist was private and was costing me a small fortune.

What really clinched a doctor's visit for me was the fact that the dentist could not understand how I could be complaining of toothache, yet could not tell which tooth was actually hurting. This is the big thing with TN and something I would say should have been recognised by the dentist upon discovering that my teeth were in good order.

I suppose it could have been atypical odontalgia or Tempormandibular Joint Disorder as whilst the pain may have appeared to have been localised - at least to begin with - I discovered that it had a tendency to move and not only did it move from one tooth to another, but caused several teeth to hurt all at the same time. As if that wasn't bad enough, it moved from one jaw to another, making both upper and lower teeth appear to be hurting, again sometimes all on the right side of my face at once from the upper and lower canine teeth to the back of the jaw.

As soon as I told my doctor, he immediately told me in his opinion I had TN.

I could have gone down the route of  having root canals and/or extractions, so I count myself lucky to have taken the decision to consult my GP. Some people are not so lucky and actually go through having teeth extracted, only to discover that it didn't cure the pain as removal of the teeth, the roots and the nerves within the teeth, does not stop the brain from being told that there is pain there.

To be quite honest I still don't know what it is and will have to wait for the results of the Magnetic Resonance Imaging (MRI) to see whether the nerve is actually damaged or whether there is another reason why I'm getting such debilitating pain.

9 comments:

  1. Just been through exactly this. Severe toothache, blasts of pain, subsiding then coming back, went away for a few hours then returned. Dentist could find no problems with the teeth. It was only when a different tooth on the lower jaw did the same think it made me think of neuralgia as I had suffered facial neuralgia before. Google and found this article which to me confirms what it is. Para-Codeine, Ibibrufen or similar should help I hope.

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  2. I think I may have this. I would describe my pain as acute radiating pain from my jaw to the inside of my mouth, to the teeth on that side and finally to my ear. Even the skin on my jaw hurts. Builds ro a crescendo every three hours or so and can last an hour. Does that sound anything like what you are experiencing?

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  3. I am also having this constant pain radiating upper and lower right side jaw with bouts of sharp, excruciating shocks. Saw my dentist yesterday and he gave me antibiotics and pain medicine as he was unable to see anything wrong with my teeth. What type of physician should I see that might be able to diagnose? Does this symptoms correlate with what you experienced? What brought you relief? Any help appreciated. Thanks.

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  4. Exactly my case explained here! Quite sad to understand that no cure for this TN thing :((

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  5. TN can be cured using homeopathy.

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    1. Have done some research and found that spigelia can help. Have not tried it yet. My husband is out trying to find it for me.

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  6. If TN could be cured using homeopathy there would be no-one with TN, no-one taking anti-epileptic drugs and no-one undergoing brain surgery, but there are. Many of us. Ipso facto, TN CANNOT be cured by homeopathy.

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  7. This is exactly my case right now. Although, I haven't yet checked by a dentist. I just did some research and linked all the things regarding toothaches. From toothaches to headaches, to the nerve itself. It's just too painful considering the fact that there's only 1 in 15,000 people experiencing this thing (Right, misdiagnosis but still) and there's even no cure to it.

    I know it may sound crazy but I hope I'm powerful enough to control my mind(brain) to temporarily stop receiving/sending signals between the nerves. :D

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  8. I have had TN for several years now. It was at the beginning when I was trying
    to be diagnosed when it was at its worst.. I take anti seizure meds five times a day, 200mg. Have been managing well. There are times when it flares up, but not to
    often. Went to a dentist, Oral Surgeon and my internist was the one that diagnosed
    it as TN.

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