My story: constant molar pain

Hello all,

My name is Mike, I'm 31 years old, living in New York.

I recently discovered this forum while researching some symptoms I have had over the past year and a half. I was hoping by sharing my story I could get some advice from others.

- In March 2013, I had some pain in my lower left first molar. I saw a new dentist as I had recently moved and he said it needed a root canal. While attempting to perform the root canal I was in constant pain from him hitting the nerve and he had to keep stopping to give me more anesthetic. It was so bad I was shaking. He eventually conceded that I needed to go see an Endodontist.

- I went the next day to the Endodontist he recommended and she said the tooth was infected by what the dentist had done yesterday and I needed to take an antibiotic and come back and see her in a week.

- The Endodontist performed the root canal a week later and at one point gave me anesthetic directly into the tooth to prevent what had happened last time with the dentist.

- Now before I had this root canal I had never really had any pain in my teeth. Since then I've found that all of my 1st molars go through fits of pain that comes and goes.

- In September 2013, the pain in my lower right first molar was so bad I went to a different dentist and he performed a root canal on that one. So now I had both bottom 1st molars with root canals and crowns.

- Since then the upper left first molar has been in pain on and off but this dentist can never find anything wrong with it, based on x-rays and his evaluation. He suggested the tooth goes deep into my sinus cavity and that could be the problem.

- I saw an ENT last November who did an evaluation of my sinus and did not believe it was causing the tooth pain.

- As you can imagine I've been in a constant state of worry, why are all my teeth failing me? I was convinced the upper left first molar was fractured. But the dentist could find no evidence of it.

- In July 2014 the pain started acting up ag

- In October 2014 I developed a horrible taste in my mouth every time I swallowed.

- Then on November 6th, 2014 I was eating when I felt a horrible pain near the upper left first molar. I couldn't touch it with my finger. So I went to the dentist thinking that tooth had finally fractured. Instead it was the upper left 2nd molar, the one right behind it, where a piece had broken off. He repaired it with a filling.

**Now this is where things have gone really down hill....

- Since he performed that restoration on upper left 2nd molar, the upper left 1st molar has been in a constant state of pain during the day (it doesn't hurt during sleep and generally starts hurting after lunch). It's not an excruciating pain. Just dull and goes through different sensations - throbbing, burning, tingling, squeezing, feeling heavy..no amount of ibuprofein makes any difference. This all happened immediately after the Novocaine wore off on the tooth restoration that night. Other symptoms I developed were a very sore cheek on that side (couldn't sleep on it) and sore lymph nodes at times. They didn't look different but felt swollen. Today would be day 15 and it's the same thing every day, never lets up. The only odd thing is that maybe 10% of the time the pain switches to the molar on the opposite side of my face (upper right 1st molar). Sometimes moving my head certain ways makes it hurt more. In the past 2 weeks I have seen numerous different doctors trying to get this pain to stop.

- I went back to the dentist twice since then and he suggests we can do a root canal but he really does not think it's the tooth. X-ray shows nothing wrong with it, it's not sensitive to hot or cold. He gave me amoxicillin to take for 7 days and on day 2 the bad taste went away in my mouth that had been lingering for weeks. I had thought the bad taste may be related to a tooth abscess. However I finished the amoxicillin 3 days ago and the tooth still hurts every day.

- So I decided to see a different Endodontist. She did a pandormaic x-ray of my mouth and also could not find any solid evidence that the tooth was fractured or abcessed.

- Then I went to a different ENT who did nasal endoscopy and found nothing, He suggested a Catscan of the sinus to be extra certain but I do not have any other sinus infection symptoms.

- That's when I discovered TN/ATN by researching online. So yesterday I went to see a neurologist. She did not think it was ATN/TN because she says it would be more of a shooting pain than constant ache, it's not bilateral (I mentioned it sometimes hurts on the opposide side molar), and wouldn't be isolated to one tooth. She did a basic neurological exam that showed no problems. She suggested a MRI of the brain to check if anything is compressing the nerve. She also precribed me carbamazepine.

So, my plan is to go for the brain MRI this week.But I haven't taken the medicine yet because I'm scared.

I'm very worried, depressed and in a constant state of pain. Looking for advice from anyone who has had similar symptoms.

Thanks for taking the time to read my story.

Mike

Hi Mike,

I'm not sure where to start. Your story is very similar to mine in a lot of ways. First of all do NOT have any more dental work unless there is clear physical evidence of a problem! It is very common for our journey to start off in the dental chair. I had an unnecessary root canal too. If I had a root canal in every tooth that hurt there wouldn't be any left! I feel like I have a mouth full of rotten teeth but they are all completely healthy. Nerve pain imitates other pain very well, from toothaches, to ear aches to sinus infections.

Your description and locations of pain are spot on for bilateral ATN. Mine started in one tooth, then several teeth on one side, then up the cheek, jaw and into my ear. A year later it started on the other side. Bilateral ATN is far more common then most Drs seem to realize. Having an MRI is the right next step. It is used to rule out other causes such as a tumour or MS. It can also show a compression on the nerve....not all of the time though.

And how you wake up pain free, it comes on in the late morning or early afternoon, is probably worse around supper time? and tapers off a bit before bedtime? with no pain in the middle of the night. That is also very, very common for ATN. So is the strange taste. Is it metallic or tastes like blood sort of? I had that. It radiated from that original hurting tooth.

Dental injury can also occur. Having lasting or worsening pain after a dental procedure. That is common amongst many with ATN...there are other classifications like Atypical Facial Pain, Atypical Odontalgia, Atypical Neuropathy. Basically it can produce the same symptoms but the cause, and some of the treatment differs. It is important to be careful and learn about how these classifications differ and what it means for treatment.

You need to start the carbamazepine. You have been dealing with this for a long time. Me too...mine actually started around the same time as yours. The pain is exhausting and it could continue to persist or get worse. These medications do have side effects but everyone reacts to them differently and many of us are very, very successful using these meds to control our pain. I first had TN when I was 29 and it came back almost two years ago when I was 37. I lead a full and happy life. I am not pain free but I would be a mess without medication. And if this medication is too much to handle or if it doesn't work there are others to try. Tricyclic antidepressants work very well for many of us with ATN type pain. I am on Nortriptyline.

This website is amazing. Post any questions you have and you will learn a lot through other people's experiences. You need to learn as much as you can and keep pushing for treatment and answers until you get them. It is usually fairly difficult to find a Dr. that really understands ATN as we experience it.

It sounds like you are on the right track. Wishing you pain free days ahead.

Jane

wow. sounds familiar. the easiest way to determine if it is TN is to start taking tegretol(carbamazepine). If it works..it is TN because antiseizure meds don't help tooth problems! And the tegretol often quickly stops the pain--within days even hours... If you can get the nerves settled down you can get into a nice long remission...sometimes even years! My pain was isoloated in one molar for months until I had a full blown three branch tn attack --then I knew something else was going on... usually you start on a low dose of carbamazepine that has minor side effects...I took 200 mg per day. Some ppl take as much as 1200 mg/day! ALSO--Be sure to call the MRI place and ask about getting the TN protocol. I almost wasted $$ getting an MRI that was the wrong kind b/c my doctor had never really seen TN before... the mri just makes sure there is no tumor or ms-- it often doesn't show the compression even if there is one... hope all goes well!!

Thank you for the responses!

justjane37 - The taste was when I swallow and it almost tasted like bad breath/blood. What's interesting is that I had it for weeks and the amoxicillin got rid of it in 1 day. I wonder why? You are so right about the pain. Starts after lunch..peaks after dinner. No pain during sleep. Last night in particular, after dinner the one molar tooth was hurting for hours. Then all of a sudden it switched to the back of my jaw and the tooth stopped hurting. Felt like someone punched me in the jaw. Today after lunch I am feeling pain more in the cheek. I took my first carbamazepine this morning. It was 100mg and I was told to take it twice a day. I worry that my neurologist may not be as clued in as ATN like you said. She didn't think it could be bilateral or have persistant/constant pain, just sudden shooting pain.

tacocat - The doctor said she was going to check for TN with the MRI. I looked at the sheet and it say next to the MRI structural lesion or vascular compression, so I think that's right?

Thanks again for the support. Wishing both of you well too. I've only had this a couple of weeks but it is a very tough ordeal with the constant pain as it makes it hard to focus on anything, like going to work or even just watching television.

Oh yes it switches all around all the time. I am the same. It might sit in one spot all day long...or it could be a tooth, then my ear. I have it on both sides and it switches sides just as fast too!

It is very, very hard to find any Dr that knows much about it. That is why you have to be a good advocate for yourself. If you have a Dr or Neuro that is willing to help and try different meds then that is one hurdle out of the way. Carbamazapine is the first line treatment. I have seen that it can be ineffective for ATN sometimes and that seems to cause trouble because then the Dr might not even believe you have ATN. That is where the tricyclics can come into play.

And this incessant, invisible pain breeds anxiety and depression. It is exhausting! I have been there a few times too many and we all completely understand!

Did you find that it took time for the carbamazepine to work? I took it today for the first time. One in the morning, one after dinner. 100mg. No difference. Tooth still hurt really bad and had some pain in the cheek bone under the eye.

I totally agree with you, today in particular was really trying. Day 15. I feel like I'm just getting worse, no improvements, I can't focus on anything or have any quality of life right now.

Hi bbuck, I sympathise with what you’ve been going through, I think I can say that most of us developed TN through having work done on our teeth, with me I had a wisdom tooth extracted and that was the start of this terrible journey I’m on… My advice is to see a neurosurgeon ASAP, if you have an MRI they might not find any nerve damage, but don’t just accept that, a lot of us had MRI’s and the results were negative, but it’s only when the neurosurgeon operates that the damage is found…
I don’t have any dental work done anymore, I just have to try and look after what I’ve got… I get my teeth cleaned and looked at, but no injections (on the advice of my neurosurgeon) I don’t want TN on my left side too, please don’t be scared of the meds, a very small dose may help, better than pain… Hope you get more replies from others, this is a great site, you’ll get lots of support, advice, help and love from people who have been where you are now… Information is power…
Hope to hear from you again, Anne