TN and TMD? -

1

Hi Everyone.

I haven't been here in a long while.

I am hoping maybe I can get some advice before my dental appt.

Things took a break- then came back and I've changed family doctors and dentists- and now I am really unsure as to what to do.

Things are flaring terribly. My left ear rings, my face hurts (left side) across my cheek, beside my nose, behind my ear- and 3 teeth on the upper left side - the one beside my front tooth- and the 2 teeth beside those throb. It hurts to eat- brush my teeth-- I had my teeth cleaned and was having minor- pain- ... started just easy walking- and BAM- everything has exploded.

I have to get a tiny cavity filled and see my dentist tomorrow - I had to cancel the last appt. to get it filled b/c of face pain.... they are going to use gas... but I am terrified of having it done anyway. At least it's on the right side and not left.

My new doctor says it is migraines. What I am dealing w/ is not a migraine. It has spread into my left shoulder blade, too. He gave me Vistaril which helped for a bit- but then it stopped helping and started causing twitching on the left side of my face. I am trying Topamax again- but in the past- it ALWAYS causes lip twitching and I know I won't be on it long.

I read on another site about some TN suffers (an ER doc has said I had TN but the other docs ignore this)- who also have TMD. I do have a cross bite and my teeth have shifted. I don't know if I have TMD, too. Based on what I've read, it seems possible- but my doctors are NOT going to do a thing until this dentist evaluates TMD and - I don't know about the TN. She has told me to get a tooth guard from the pharmacy- ... try it... I have it... It may help some but it leaves my jaw in a crazy position for a while after I remove it. I can't wear it long- b/c it brings in the other pains...

I know if I could have these 3 upper teeth pulled and know the pain would STOP, I would have them pulled.

I am going in for this filling tomorrow- They have blocked out an hour and 1/2 for this- b/c I freak in the dentist office. IF this dentist has time what do I say? This mess keeps going on... and I read and read-- and It seems to me I am dealing w/ both- but if I say this to her, she will give me that "look" - docs will give when they think they have a hypochondriac in the office.

Despite all the pain and ear ringing, I am able to sleep. When I wake up-- it all starts again.

Do any of you have both TMD and TN? If so, what key points should I hit on w/ my dentist tomorrow?? I know I have to have these 3 upper teeth checked. It was just two- now it is three... The pain is pretty much constant- but sometimes I get zapping too... I am not sure what to say at this point.

Any help would be so appreciated!!!

beekeeper

2

Dear Beekeeper,

A few observations if I may.

(1) I believe from many years of observation and study, that TMD is greatly over-diagnosed by dentists who lack training in the assessment of facial neurological pain. So question 1 for the dentist needs to be "how will you do differential diagnosis on TMD versus TN?"

(2) It's unlikely that extraction of three teeth will improve your pain -- and even more unlikely that pain over such an extent of your mouth is an outgrowth of TMD.

(3) The best indicator for TN that I know of is a rapid positive response to a prescription of one of the anti-seizure meds, specifically Tegretol, Trileptal, or Neurontin.

(4) If any doctor uses the term "atypical facial pain" respond immediately as "oh, you mean pain of undetermined origin, don't you? Surely you cannot believe that dental pain is psychogenic in origin? There is no such thing." And make clear that you will seek to have any such implication removed from your medical records because it can destroy your chances of getting more effective treatment.
(5) Pain in your left shoulder could be "referred" pain, but mechanisms in this sort of thing are are hard to trace. The symptoms you describe don't line up well with any case of Migraine that I've heard of in 20 years of talking with patients.

Do let me know how your appointment comes out and what the dentist hs to say.

Go in Peace and Power

Red Lawhern, Ph.D.

Resident Research Analyst, LWTN

I am not a licensed physician.

3

Hello Beekeeper,

I've been thru similar problems, TN caused by dental procedure, too much to write here but I wrote an article some time ago. If you want give me a call to talk about it... 415 452 8556 cheers Nikos

4



Richard A. "Red" Lawhern said:

Dear Beekeeper,

A few observations if I may.

(1) I believe from many years of observation and study, that TMD is greatly over-diagnosed by dentists who lack training in the assessment of facial neurological pain. So question 1 for the dentist needs to be "how will you do differential diagnosis on TMD versus TN?"

(2) It's unlikely that extraction of three teeth will improve your pain -- and even more unlikely that pain over such an extent of your mouth is an outgrowth of TMD.

(3) The best indicator for TN that I know of is a rapid positive response to a prescription of one of the anti-seizure meds, specifically Tegretol, Trileptal, or Neurontin.

(4) If any doctor uses the term "atypical facial pain" respond immediately as "oh, you mean pain of undetermined origin, don't you? Surely you cannot believe that dental pain is psychogenic in origin? There is no such thing." And make clear that you will seek to have any such implication removed from your medical records because it can destroy your chances of getting more effective treatment.
(5) Pain in your left shoulder could be "referred" pain, but mechanisms in this sort of thing are are hard to trace. The symptoms you describe don't line up well with any case of Migraine that I've heard of in 20 years of talking with patients.

Do let me know how your appointment comes out and what the dentist hs to say.

Go in Peace and Power

Red Lawhern, Ph.D.

Resident Research Analyst, LWTN

I am not a licensed physician.

---------------------------------------------------------------------

Dear Red,

I wanted to let you know what the dentist said. She did a panoramic x-ray and a standard of the 3 teeth that are causing pain. I also had to bite down on purple paper strips. Based on the panoramic and bite assessment with the paper strips -- my bite seems fine. There are no overt signs of wear- and she said where there was some *minor* wear on the teeth- this area would NOT make these upper 3 teeth hurt the way they are hurting. She said the root canal was still intact and the panoramic showed clear sinuses and the jaw joints looked fine, too.

She essentially ruled out TMJ/TMD.

She has had 2 other patients with symptoms like mine and she referred them to a neurologist. One had trigeminal neuralgia. The other lady had a nerve problem - some kind of entrapment- and they went behind her ear surgically and repaired it. It was not TN, but the nerve was causing the problem. Her face and teeth never hurt again. Both women wanted teeth pulled and had several root canals...

I am waiting for the referral to a different neurologist who treated both of these women. They are having to get his name b/c it's been some time since this happened to her patients.

SO-- It went well, I think!!!

I told her I had been bounced around so much- and asked if she would be working w/ the neurologist- ... She said yes.

So, I am out quite a bit of money, but maybe on the road to an answer... and maybe some way to stop this pain.

Thank you so much for your advice...

I will keep you posted.

Sincerely,

BeeKeeper