Expert: Steven C. Scherr, D.D.S. - 9/2/2007

Question
I've been told by 2 dentists and an ENT that I have Trigeminal Neuralgia.  Problem is, I only have this pain when I'm not taking antibotics.

If I'm on antibiotics, the pain receeds and vanishes. If I stop, within 2 days, I get pain in my left side of my neck, lower left jaw (where I had a root canal years ago), my face, and.

After 5 days to a week, the pain spreads to my left shoulder blade, I get searing pains down my left arm, and then I get heart problems.  But if I take a simple antibiotic pill 500mg Ampicillina, within 6 hours, most of the symptoms start to go away.

If I take the antibiotics for 2 days (1 500mg Ampicillan twice a day), all symptoms vanish for as long as I continue taking the meds.  I have been living like this for upwards of 15 years.

Six months ago I had a CT scan of my head because my ear and face pain, on the left side, was so bad my ENT said it might be a bone problem.  But the scan showed nothing so he said I have TN.

Also, pain killers make no difference in the condition. If I take a very strong pain killer like Tylenol and Codeine, it helps for a few hours, but, I might as well take Asprin for all the difference it makes.

So, how can I possibly believe I have TN, if pain killers do little but antibiotics remove the pain completely? Isn't that obviously an infection  . . of something? What do I tell my doctor/dentist to look for and what sort of doctor/dentist do I need to get the addressed?

Thank you for your help!


Answer
Sophia,

I am sorry to hear you have been suffering with this.  There are many possible sources of facial pain.  As your problem cannot be diagnosed from afar, the best I can do is provide some direction.

Trigeminal neuralgia consists of periodic severe painful attacks in the head region that are often described as stabbing. piercing, or electrical in quality.  There is a period of remission between each attack that can last for minutes, hours, days, or longer.  The cause of trigeminal neuralgia is unknown.  There is evidence that some cases may be associated with enlargement of a small blood vessel looped around the nerve trunk. The vessel compresses the nerve, leading to the painful condition.

There is another form of neuralgia known as pre-trigeminal neuralgia that does not follow the classical pattern.  Pain may be burning, aching, or piercing.  The pain tends to be more prolonged and does not have the classical remission periods associated with Trigeminal Neuralgia.

Neuralgias can also be associated with a number of medical disorders including Diabetes, Herpes virus infections, Multiple Schlerosis, Lyme's Disease, and others.  Other forms of neuralgia may be associated with trauma.

One controversial form of neuralgia is known as NICO.  Even excellent and well respected health care professionals disagree about whether NICO really exists or not.  NICO are soft necrotic cavities that form within bones that some believe can be the source of pain.  These bone cavities are known to exist, the controversy relates to their role in the production of chronic pain.  As these bone cavities may be related to microinfections, the argument goes that the pain from NICO may be temporarily improved by the use of antibiotics.  Because the bone cavities of NICO are related to poor local blood supply, antibiotics are not a long term solution.  Treatment of NICO is by surgically scooping out the bone cavity.  The jury on this is still out.

There are a number of additional causes of facial pain other than neuralgias.  These include muscle cramps, TMJ (jaw joint) dysfunction, neck problems, sinusitis, arteritis, and rarely tumors.

I recommend you begin by seeing a good neurologist.  If they are unable to help, the next step is to find a dentist with advanced traing in TMJ and facial pain disorders.  As there is no recognized dental specialty in this field, you will need to look around to find the right dentist.  Good sources are a dental school, or referral from a physician or general dentist.

Sophia, I hope you are feeling better soon,

Steve