Deciding to have tooth extracted or not

I am looking for opinions here, what would you guys do?

There are no signs of inflamation in the gums and my dentist and specialist has told me everything looks good…

But i am in so much pain, especially as soon as i speak or smile, if my tongue touches the gums on the backside of my dental implant/front tooth or if my lip rubs against the gumline on my left front tooth.
I´ve gotten to the point that i am forced not to speak to my own daughter because it hurts, and she is only 9 years old…

Most of the easily reproducable pain that is consistent, is the pain in front of my front tooth, in the gumline there. But the worst pain is the pain on the backside of my dental implant.

My dentist doesnt know what to do so i´ve seen a specialist that thinks that the first step should be to remove the implant crown, to se if symptoms changes or goes away. The dental crown has to be destroyed to be removed since it´s cemented. Im not even sure if the screw can be used for another crown after that either…

While i feel like most of the pain is coming from the front tooth, but also i know that the gumpain is worse behind the dental implant…

Im on 1500mg gabapentin and take regular pain pills “as needed”…

I have had similar thoughts but I was advised by both my Neurologist and Dentist that the pain would only move into my other teeth so leave it. (At one point I begged my dentist to remove all my teeth, luckily he didn’t listen.)

However, as I was in so much pain I did have one of the teeth removed but I still get pain in the same area but obviously not from the extracted tooth. Would I advise it, well personally I have reduced some of the pain and now I can also say that the particular tooth wasn’t the root cause of my pain. It has made discussions with my Neurologist slightly easier as now we can rule out it being a dental issue.

Good luck with your decision.

Hi Dave
Thanks for your reply.

Yeah mentally i am really struggleing with acceptance that this isnt dental related, im not sure what could even convince me other than removing both the implant and the front tooth since its coming from that area.

On the other hand, having the “i can always remove it if it gets worse” is sort of a comforting thought, and im not sure how i would cope when that is no longer an option…

But when it is bad and my mind is dark, i really do have the feeling like i have two options now
A - Do nothing, but suicidal thoughts because of the pain is already an issue, which i am not expecting to get any better unfortunately
B - Do something, and either the pain goes away and i can live on, or pain stays and by then im almost sure darkness will consume me since then i´ve exhausted the “backup” plan…

I’m going to see my dentist tomorrow, but i feel like she isn’t even listening to me anymore so tomorrow will probably be the day where i decide if im gonna search for another dentist or not.

I can understand everything that you mention but before I talk about myself, this is the advice I would give you based on my personal experiences.

Firstly a Dentist/Doctor can’t diagnose TN a Neurologist does. If there is a thought that it is a possible TN issue and it is not a result of facial/dental trauma you should have an MRI with contrast also possibly see an Ears/Nose/Throat specialist to rule out any issues there too.

The MRI will show whether there is a blood vessel touching the nerve and hopefully rule out a tumour and MS.

The MRI might not show anything at which point a Neurologist (who’s skilled in neurological headaches) will talk to you about the pain attacks; their frequency, the level of pain and the length etc. as sometimes it is diagnosed from ruling out other potential causes.

I know that most people a clued up on TN but there are also a group of conditions known as TAC’s (Trigeminal Autonomic Cephalgias); hemicrania continua, peroxysmal hemicrania, cluster headaches and SUNCT (short lasting unilateral neuralgiaform headache with conjunctival injection and tearing). Basically TN plus autonomic symptoms eg, flu/cold like symptoms, earache, tinnitus etc.

I have SUNCT and I have only come across one Doctor whom has knowledge of neurological headaches and that’s after 25 years of trying. I had to go into a previous Doctor’s office and tell them that they can either refer me to a Neurologist or call the police because I’m not leaving.

Fortunately they didn’t call the police. Three hospitals and six neurologists later I am now under the department of a world renowned professor of neurology and am getting more support and fortunately, although I still get 100+ pain attacks a day they are more bearable with the current medications.

Unfortunately finding the right medications for someone will take time and trial and error, there is no ‘one size fits all’. It took me almost a year to build up the dosage of Lamatrogine which has vastly reduced my pain from excruciating/torturous and these now only happen every 2-3 months.

My condition is also degenerative and I’ve been told that unless there is advances in medical treatments/medications there will come a point whereby I will be on a runaway pain train and morbidly, only death will stop it.

I do have a blood vessel near my trigeminal nerve but not enough to cause the issues. Personally I think it’s an issue of faulty wiring between my brain and the trigeminal ganglion region which could also be impacted by the hypothalamus and/or the pituitary gland. Unfortunately there are currently no medical tests to analyse that part of the brain so it’s just a theory.

I have been in those dark times and still am, I recently said to my Doctor that if the pain was in another appendage I would have it chopped off. If the pain was still there, well at least I tried but can’t do that with my head.

The pain doesn’t just make you feel physically broken but psychologically too. I try to stay positive and say well things have been worse, I’m only tortured every 2-3 months and the rest of the time if I literally do nothing all day, I can mitigate the pain. The anxiety of; is this the start of a pain cycle or will I aggravate it if I go for a walk is no way to live and unfortunately some people in this world have a fate worse than death and yes there are reasons why people with 5th cranial nerve issues have a high suicide rate.

Fortunately you have a daughter to stay strong for and before you go down the dark path you owe it to each other to try everything, even if that means having dentures… it might be a small price to pay but in the grand scheme of things who needs teeth when they’re dead?

Stay strong, get multiple opinions with several experts and if you see no light at the end of the tunnel and you need to talk it through, there is no shame in talking to a psychiatrist!

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Dear Swarls, I’ve been there, only mine wasn’t a dental implant it was a root canal. And I did beg a dentist to remove one of my teeth bc I was sure it was causing my pain. I was wrong it didn’t make a difference. I have trigeminal neuralgia caused by the root canal. That was 17 years ago. My advice would be find the best medication for you right now and do some more research. Everyone is different so make sure you are making the right decision. Being in pain can force us to make irrational decisions. You could try to find a doctor that can manage your pain until you find a solution. Over the years I’ve tried many things, meds, surgeries, therapy and prayers. One definite thing in my life is my spouse, he has been there for me and I don’t know what I would have done without him. Family support is so important. I recently had a procedure called Percutaneous Rhizotomy for trigeminal neuralgia. That was May 4, 2023. So far no pain and I’m off all meds. I’m praying this works for a long time. I also have had Gamma Knife two times and it worked for awhile. These surgeries are non invasive and can almost get immediate results. Good luck to you, you’re in my prayers.

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My pain started in the dentist chair so I assumed wrongly it was caused by the crown they put in. I had 3 root canals, and 2 teeth removed which did not help. I tried every medication and was bed ridden for 5 years. It was only then that a doctor requested a ct of my neck without contrast to look at an Eagle Syndrome diagnosis. As it turned out my 6 Nuerologist all failed to look for the source of my pain but this doctor found it. You can learn more about Eagles by joining the face book group and I recommend everyone with trigeminal nerve pain to learn about it and rule it out. My surgery saved my life and I have just successfully completed replacing the removed teeth.

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Time for a very dark update…. :frowning:

I just learned something about swedish healthcare that i didnt know before. The decision to remove the tooth, or even the root canaled tooth or the implant. Isnt up to me at all, i asked the dentist to remove the crown but she said ”we will not perform any procedures without a diagnosis” so she sent me home and the message was clear ”dont bother coming here anymore, we will not treat”…

After reading about it, it seems almost no dentists in sweden will remove a root canaled tooth or an implant if there isnt pus flowing around it.

So any pain that cant be explained by xray wont be treated :(…

Now i’ve been crying in pain since i woke up more or less and this realisation just made my whole world crash…

Ive been in uncontrollable pain since i got home, way worse than it was before. So state of mind definitely plays a role here.

Sorry about the poor grammar, im so upset im just writing whatever comes up…

I read your story before i think. My pain doesnt seems to be triggered by neck movement though.

Im gonna read into the eagle thing more closely though.

So happy for you that you pulled through and can live pain free again! Must give you a whole different appreciation of life after that.

Thats what i am so scared of. Pulling front teeth only to realise they werent the source of the pain is a nightmare. But then again this pain is living an actual nightmare already.

I would say don’t do it - have been through a lot of dental work related to the Trigeminal neuralgia - root canals, second root canals, apicoectomy, extractions, implants, Invisalign, osteomyelitis…. Every well-meaning provider thinks they have a solution. A few of them had some success, but in the long run I’ve lost more teeth, spent tens of thousands of dollars, and the pain has not improved. Once you start removing teeth/implants, new problems pile up. Unless you have a specialist who has a clear case it’s the teeth, the neurologist is probably right. You have enough struggle without also going through expensive dental work. The neurologist or neurosurgeon needs to do more to help you, then. I’m so sorry - really, literally feel your pain.

Quick update…

Called jaw surgeon and explained that my situation hasnt gotten better, and i was desperate for help. He called an inplant specialist that could get me a time today.

I was there 11:00 and they removed the crown on the implant, they said the crown survived the removal so they can put it back again. But the thought now was to have the crown off for a week or two to see if something changes.

I was so happy when i was driving home cause the sensitivity wasnt there, i was afraif to feel with my tongue but i did every now and then and i didnt feel any sensitivity. Then i had to take a phone call and after speaking 1 minute or so, i had a quick ”needle stab” in the gum, the pain was still there. After the call ended i screamed in anger and almost wanted to drive off a cliff…

So now im home and its 12 hours later, it hasnt gotten better, i can pinpoint the painful area with a toothpick with less than 1mm precision, but i dont understand why it hurts. As i can see the implant screw now, i can tell that the pain comes from the backside(inside) of the screw, right where screw meets gums, and then its painful all the way up to the top of the gum. So the painful area is about 1-2mm wide and 3mm long and is defineable precicely.

Then we have the pain in the front tooth next to the implant, it seems to be missing the support from the implant crown, because it hurts more than before now and is very painful with pressure.

Everything done today is reversible, even tho the implant will need to be repaired since they drilled to find the screw. Im gonna wait the week now and see if anything gets better, but since nothing has changed for the better so far im not having high hopes :(…

Maybe the fact that the pain now is so easy to point at could help the implant specialist to find something wrong.

Im starting to think that i am actually crazy, how can i feel pain in so many places…. :frowning:
It doesnt help that i had pain prior to when all this started, that i didnt bother calling the dentist for because it was so minor, so now i dont bring up those things because they will label me as crazy and stop helping me.

It’s my experience that gum/teeth pain before tooth extraction is worse after, only now I know it’s not my teeth.
I wish you all the best.
Have a blessed and pain free day.

Just for everyone’s information, Ben’s Friend’s has a very active Eagle group. Here is the link. Just mention when you request membership that you got referred from the facial pain group.

Sharon from ModSupport

Time for a new update then.

I´ve had the implant crown removed for about a week now and the pain in my front tooth has escalated while the pain from the gum around the implant crown has gotten a bit better. I would almost guess that the pain from the implant site is due to too thin gum around the screw, because it only hurts where the gum is thinner than the rest.

Anyhow, my jaw surgeon called today and we discussed a way forward, he wants to keep waiting for a few more weeks to see if the pain from the front left tooth subsides given more time without the implant crown “pressing” against it.

What’s really absurdly annoying is that the root canaled tooth is giving me painful stabs and a feeling of having something above my jaw hurting and burning…

Im up to 2100 gabapentin and it doesnt do any better than what it did at 1500. Going to be starting Amitryptiline in a few days.

We are really cursed with this facial pain bullshit… :frowning:

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