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Dentistry/Strange problem with severe pain

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Question
Hi,

I have had a strange dental problem with teeth numbers 5, 6, and 18 for about the last 5 years. These teeth are causing severe and at time blinding pain with changes in air pressure. All teeth have had root canals that were delayed for a varity of reasons and when the root canals were performed, the roots were necrotic/half dried out. The pain in teeth 5 and 6 were initially diagnosed as trigeminal neuralgia, however I have none of the symptoms of trigeminal, other than the pain being in the general area of the trigeminal nerve. This pain, (5 and 6) would spread in a line, #5 going up my face, through the eye socket and into the scalp. #6 would go from the tooth along my cheek and into the back of my head. I finally convinced my dentist to extract #6 and that line of pain stopped after the extraction. #18 doesn't bother me that badly, it seems to just go down into my jawbone and not spread out.

I have seen several dentist as well as a neurologist who have not been able to figure out what is going on.

Do you have any suggestions to what I should look at next? I really would like to avoid having #5 pulled, but the pain is getting to be too much.

Thank you for your time

Bill

Answer
Teeth Numbers
Teeth Numbers  
Hi Bill,

I am sorry you have been having so much trouble with your teeth.

How did you know specifically which teeth numbers are hurting you?  Most patients don't know that sort of thing.  And you specifically knew the path of pain from each tooth, to somewhere else in your head.  I also had to google a numbers teeth photo (see attached), as a reminder of which teeth you are referring to.

Having possible nerve damage in your mouth is sort of like trying to figure out where the electrical problem is in your car. Very tricky and even excellent doctors or dentists can have differing opinions on what it is.

See if you can find a dentist who is also a Board Certified MD.....It should be noted, that most dentists have the word "Doctor" in front of their name, but that does not necessarily mean they have the "MD" designation.  You mentioned that your root canals were delayed for a variety of reasons....what were those reasons?  Depending on the problem, it is usually a good idea to address those issues expediently.

Well anyway, like I said, see if you can find a dentist or Board Certified Oral Facial Maxillary Surgeon with an MD.  Of course there are many good dentists out there without the MD designation....but in your case, we are also talking about possible nerve damage.

Next, you have already done the right thing by visiting a neurologist.  I would get a second opinion from a Neurologist.  If the Doctor decides he wants you to get an MRI, ask him specific questions about that.  Not all MRI's of the head are the same.

Other than that, I would proceed in a very conservative manner. Tinkering with your bodies nerves or "electrical system" is a complicated endeavor and positive results are difficult to achieve.  Maybe get that neurology second opinion before pulling tooth #5.

Let me know what happens.  I am curious to know what you are going to learn going forward.

Best regards,
Jonathan
Twitter:  @JonPatientPOV  

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Jonathan at PatientBabble

Expertise

My area of expertise from the patients point of view would be Dentistry/TMJ plus the speech challenges that these jaw and bite problems sometimes represent. Over the years I have seen a multitude of dentists, orthodontists, oral surgeons, speech therapists, neurologists and other health professionals who all had an opinion about my TMJ/bite problem. I AM NOT A DOCTOR...but would purely be a patients point of view type person. I "get it" when people say they tried to explain to their dentist what their TMJ/bite problem is and that they are misunderstood. I can listen to people's trials and tribulations and there is a good chance I have been down that road before. I can make suggestions as to what people can do at home, or what questions to ask their doctor or dentist when they visit. I will try and recall information or experiences that may be helpful to you.

Experience

About 25 years ago, I had my wisdom teeth out and since then my bite has never felt "normal." For whatever reason, the first sensation I remember was not that my bite was off.....but rather that my normal tongue and speech patterns had been impeded. I spent years going to different dentists, who lumped me into their generic version of what they knew about TMJ. The majority of dentists believe they can treat TMJ, but only those whose primary focus is TMJ treatment, are really any good at it. Any dentist, can take an impression of your teeth, send that impression off to the lab and have them make a night guard. That is the easy part. The tricky part is what the dentist does with the night guard, once receiving it from the lab. The dentist has to do a "fitting" where they tailor the night guard to be evenly balanced and comfortable in your mouth. Sometimes it can take a few visits, because further adjustments need to be made to the night guard appliance, to get it just right. I have found that dentists, who have had the most practice, do a better job at fitting your appliance. It's almost like an art form.

Organizations
Jonathan's Blog is: https://patientbabble.squarespace.com/jonathans-blog

Education/Credentials
College Graduate with Bachelor of Arts Degree

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