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.

37 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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    1. Im suffering with this but the pain is travelling down my throat as well as my teeth and jaw. Dont know what to do.

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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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  9. I am writing in opposition to "Anonymous - 10 February 2014 14:11".

    Homeopathy is bullshit! It's irresponsible to reference it in passing, providing false hope to people suffering from neuralgia or anything else, and maybe separating them from their pocketbooks in the process.
    http://rationalwiki.org/wiki/Homeopathy

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  10. I have been to the dentist for cleaning and x-rays three times in the last 6-8 weeks and each time the dentist swears there is nothing wrong with the teeth (no abscess, no cavity, etc). I have been having pain though for quite sometime. Some of the time the pain is just there and I can "ignore" it and sometimes the pain is so bad I want a cure right then -- I am crying and just don't know what to do. I have been to specialist, and endodontist and neurologist and ENT and internist and dentist and no one has come up with what is bothering me. Think that this might be what is wrong.

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  11. The people who have suffered from the oral disease should take Chiropractor North Ryde from the doctors to become normal because the oral disease gives the lots of pain to the people which effect on their health and also their work to get ride from this condition people should take physiotherapy.

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  12. I'm literally crying right now, if bashing my head against a wall would help, I would do it. This story is like mine, I chewed a bone and traumatized my lower left molar. Tooth was sore but settled but would have pain flare ups. Went to dentist and tooth is sealed, no cracks to fix so nothing to be done but the pain would not go away. Dentist suggested root canal but the pain drifts. The past 2 days the pain is in my jaw hinge then radiated to upper teeth now lower teeth. The pain is hard to isolate to one spot. One second I'm holding my jaw crying in pain and then a minute later the pain's gone. A typical toothache for me is a constant knawing pain but this comes in bursts and goes again. Tonight's been terrible, I'm having attacks every 10 minutes, forget being able to sleep. I slept 1 hour yesterday, the pain is so bad it jolts me out of deep sleep. It's a lonely isolating thing. The pain is a 12/10 and I can only describe it as feeling like a rat crawling through my carotid artery, I feel tight pressure with knawing pain which travels up my neck and into my jaw then up the side of my face to my left temple. Along with this pressure I feel like I'm being punched in the face and shocked with electricity, not fun at all. This is so debilitating and being new to this level of pain is frightening. I upped my Ibuprofen dose and it does NOTHING. Don't know what to do, I'm going for root canal tomorrow but reading this post think maybe I'm kidding myself. I really can see why they call this the "Suicide" affliction. I never would do that but can understand why someone would feel that way.

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    1. You should see a facial pain expert. I had this and after 2 roots canals and many X-rays, I saw a facial pain specialist and was diagnosed with trigeminal neuralgia. I am being treated with gabapentin which is an anti-convulsions drug. It works and when they get the dosage right it can help you immensely.

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    2. I have found that a heating pad can bring relief if left on all night.

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  13. I have had almost same exact scenario. Happening out of the blue. Started as pain in throat, itchy feeling in ears and then BAM I was eating something and the pain began. It was in the top back teeth ... then switched ... back n forth with severe jaw pain. I went to my orthodontist and she took an x-ray, but since I couldn't pinpoint which tooth I thought hurt she didn't take anymore. She cleaned my teeth and sent me on with a Rx for penicillin. I ended up in the ER the next afternoon,with pain so horrific I thought I was going to die. They took xrays and told me I had TMJ and gave me anti inflammotry meds n predisone. I was told I would feel much better by morning. Not at all correct!! Went back to my orthodontist, where she finally said she believes it was TN...went to my general practitioner 2 days later and she agreed with the diagnosis. I am scheduled to have a MRI next week and a appointment with a neurologist after that. I'm glad to have an answer to the pain, but depressed to hear it usually gets worse as time goes on.

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  14. I have had almost same exact scenario. Happening out of the blue. Started as pain in throat, itchy feeling in ears and then BAM I was eating something and the pain began. It was in the top back teeth ... then switched ... back n forth with severe jaw pain. I went to my orthodontist and she took an x-ray, but since I couldn't pinpoint which tooth I thought hurt she didn't take anymore. She cleaned my teeth and sent me on with a Rx for penicillin. I ended up in the ER the next afternoon,with pain so horrific I thought I was going to die. They took xrays and told me I had TMJ and gave me anti inflammotry meds n predisone. I was told I would feel much better by morning. Not at all correct!! Went back to my orthodontist, where she finally said she believes it was TN...went to my general practitioner 2 days later and she agreed with the diagnosis. I am scheduled to have a MRI next week and a appointment with a neurologist after that. I'm glad to have an answer to the pain, but depressed to hear it usually gets worse as time goes on.

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    1. I was diagnosed this week with Tigeminal Neuralgia this week! So painful! Thankfully I only suffered for one week! My Osteopath was able to treat it successfully in two sessions! There is help!

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    2. My mother suffered terribly with TN for a couple of years. So many drugs and drug side effects. Depression, pain and anger. Then she had the Gamma Knife procedure. It's not guaranteed but it worked for her and she truly has a life worth living - now. It's been 5 yrs now and she's not had any relapse.

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  15. I have the exact same thing. Only eases up with ice cold liquid on that side of my mouth, when the liquid starts to warm, it starts throbbing again. I was diagnosed with TN years ago and now it has flared back up. The dentist told me to go to a massage therapist or chiropractor and get a deep tissue massage. I did and it worked. I'm in so much pain right now it's not funny. Been up all night fighting this crap😞.

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  16. I have a cousin who fell victim of this disease. Fortunately with meditation, the pain subsided and then gone away completely. This cousin of mine is also suffering from diabetes. A week ago he had a paralysis attack. He survived of the attack but now he cannot swallow anything. Nothing even a single drop of water goes through his throat. Can anyone help us to advise his treatment. He is being feeded through a food pipe that is put into his stomach.

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  17. I've been too my dentist so many times because I have been experiencing a lot of tension around my front tooth. She took so many xrays and nothing showing. I feel something going on with the tooth, she said it's either all in my head, she even said that it could be stress.my dentist hygienist cleaned my teeth recently and I wanted to jump out of my skin, I never had felt pain like that until she touch the area, I said I want to see the dentist right now, dentist came in took a look and said nothing wrong it's fine. I'm at my widths end.I cry myself to sleep, she also blames my medication for Asthma as one of the problems.

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  18. I have had toothache-like pain for over 2 weeks but it is intermittent, right sided, involves jaw and eye socket and ranges from sharp and throbbing to dull and heavy sensation
    Have previously had numbness in this area. If this is toothache I couldn't tell you which tooth either upper or lower is affected.

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  19. Mine started after a cold. Though it could have been a blocked sinus, but doctor said not that. The pain on the right side plays along my teeth like a piano, up and lower back teeth, also can include ear ache. Been over 4 weeks and find it difficult to chew, oon left as right side scares me. Only benefit is helping with weight loss program. It is also at a time of stressful events. Ibroprufen has helped, but don't want to be addicted to drugs.

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  20. I'm kind of curious. Two years ago I had an attack, it was like an electric shock to my lower jaw line on the left side. I especially feel it in one tooth which happens to be broken. This pain is super sporadic, there doesn't seem to be on specific trigger. When I first had the attack I had all four of my wisdom teeth removed and after the sweeping went away so did the pain..until a few weeks ago. I get a sudden twinge of pain that lasts maybe a second, although quite excrutating it happens maybe 3-4 times a day. I'm a super freaked out when I Google the symptoms all it shows is TN. Could it just be the tooth considering it's such localized pain? I am going to the dentist to have that tooth removed..I hope I'm not making a mistake.

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  21. My mother suffered terribly with TN for a several years. She went to dentist regarding severe tooth pain. Thank God he sent her to a neurologist. Her dentist said many people get unnecessary root canals or extractions due to wrong diagnosis or just plain desperation to relieve the pain. My poor mom was on so many drugs and different strengths until they found something that was tolerable. Drug side effects, wooziness etc, depression, pain and anger makes for a miserable life. Then she had the Gamma Knife procedure. It's not guaranteed but it worked for her and now she truly has a life worth living again. It's been 5 yrs now and she's not had any relapse. Good luck to anyone suffering with this. I can't imagine what is it's like to feel like my face is being beaten with a baseball bat and shocked with a cattle prod at the same time. She would be shaking with pain, screaming sometimes.
    Now smiles and laughter and a good life..... so far so good.
    All the best wishes to anyone suffering. Good Luck!

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  22. I am struggling with this right now. A TENS Unit on low (no twitching allowed) non-stop and lidocaine patches/heating pad as tolerated in addition to my normal daily pain & anti inflammatory meds barely takes the edge off and I’m still dying. Each day gets worse, I now cannot chew or eat solid foods, talk to people or move around. I’ve been bed bound. Sleeping helps the pain stop so naps & bedtime help give a break. Was seen in ER on 7/4/18 thinking tooth abscess, the antibiotics have done nothing. Saw PCP next day who thought TMJ or Viral. I see Neurologist on 7/10/18. I have had short electric stabbing searings in face before (first one while sleeping) so this isn’t brand new. This time though, it started 4wks ago with what I thought was a dull toothache and ramped up overnight to this full blown episode that has gotten worse over last 6 days: each day a bit more severe. The electric spasm episodes are several and the rest of the time is a throbbing toothache headache pain. Entire left side of face. Initially felt like a toothache in bone under left eye along with a sinus infection minus any congestion or runny nose. Back side of head very tender and sore, temple area above left ear. Sinuses to nose, upper and lower teeth and jaw, swollen lump and extremely tender under left jaw. My past MRI showed 3 lesions which Neurologist dismissed MS. Epstein-Barr Virus positive blood tests and in May a random painful rash which I presume was Shingles. My PCP suspects this is viral. It is beyond excruciating!!!! Opiates, 2000mg Reflan And antibiotics don’t help the pain much at all. I cry with these intense cramp/searing pains but try not to as it adds to the pressure. Face throbs, is swollen and tender to any touch at all.

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    1. Hello about two week ago I started with tooth ache on my left side. Started with one episode a day and then got more. Then started to feel unwell and went to dentist who said I had no problem with my teeth after X-rays. I then had a very painful lump on back of head s well as swollen glands so u thought I had an infection and saw gp. They thought it was a jaw problem which is what the dentist also thought. They have me muscle relaxants which helped when I was in bed but as I wanted to get back to work I came off them. Went back to doctors again but still they had no idea. On the morning day I attempted to return to work in the hospital but soon realised I was not well enough. I decided to visit A&E as pain in my teeth and face was making me feel unwell. After further X-rays it was decided I was suffering with TN. The gave started me on carbamazepine however the tooth pain is not getting any better and can’t hrlp thinking it’s s tooth problem as although all my teeth hurt one at the front (which has had previous trauma) is so sensitive and struggling to eat. Just find many of my symptoms so similar to yours.

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  23. My mom is suffering from the same she was diagnosed with Trigeminal Neuralgia. I know how hard and painful it is. Aside from medicine that was given to her by her doctor. We are now trying the essential oils and so far it also helps her ease the pain. I just hope and pray that everything will be alright.

    Throbbing Pain – Is It Actual Pain Or is It In My Mind?

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  24. ALL THANKS TO DR WILLIAMS
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  25. This comment has been removed by the author.

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  26. I JUST STARTED TO HAVE THIS ISSE 4 WEEKS AGO. ROOT CANAL AND WISDOM TOOTH EXTRACTION 10 DAYS AGO. NOW OTHER TEETH ACHE BAD. WHO WOULD I GO SEE FOR A DIAGNOSES? I HAVE INSURANCE.
    SHOULD I START WITH DENTIST AGAIN?
    randylan2@hotmail.com

    ReplyDelete
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