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Dear Dr Ryan,
First, thank you for any advice you can offer.  I am a 42 year old, healthy woman with all wisdom teeth. Almost a year ago, I had a left ear ache and pain radiating to my left top teeth.  It only lasted a night.  Months later, it happened again, but it was worse.  I had shooting pains, like someone stabbing my left teeth with a screw driver, ear pain, and temple pain – a “triangle” of pain on the left side. Sometimes, the pain was so bad, I'd just cry.  With some meds and a heating pad, I always beat it though.  However, months ago, the pain came back even worse, so I figured it was time to see the dentist.  The reason I hadn’t yet was because my teeth never hurt, nor did it ever feel unpleasant to brush or chew.  In fact, strangely, chewing gum helped.  In April, I saw the dentist, who took some “special” xrays of the area and told me that everything looked fine.  He showed me the xray and pointed to this bold, white, squiggly line and asked me if I was having any sinus issues.  No.  He did say I have a cavity in the upper left second molar but it would not cause the pain I was experiencing.  Over the months, the pain would occur here and there.  Sometimes, the pain would wake me from sleep.  Again, meds, heating pad, pressure, or massage helped.  Two weeks ago, the pain returned and has not ceased.  The pain became so bad, nothing was helping.  Not only did I have the normal triangle of pain, but the left side of my tongue had a tingling numbness, my throat was sore, and the left side of my neck was achy.  I have had no fever, bleeding, or swelling.  I went to my PCP a couple days ago, and she wants me to see a neurologist as she thinks it might be trigeminal neuralgia.   She gave me Gabapetin and Tylenol 4.  This morning, I awoke to pain again, but it is centralized to the left wisdom tooth and the gums behind it.  It is painful to the touch and to bite down, but manageable.  It feels like really sore gums and all my other symptoms are least for now.   Could all this pain over the year been caused by my wisdom tooth?  Did the dentist miss something?  Should I call my PCP, still go to a neurologist, or call the dentist?  Btw….when I did my research; a lot of the symptoms of TN didn’t match mine.   I am confused and need guidance, please!
Thank you kindly.

Lynn, thank you for your question. I think there is enough evidence to support that there is an issue with the tooth. I would suggest seeing a board certified oral and Maxillofacial surgeon. They will be able to diagnose the difference between a wisdom tooth problem and TN. PCP do not usually have any training in the oral cavity and will not be able to determine if there is a tooth problem. An oral surgeon will be we'll versed I. Both of these conditions. Clinical evidence will most likely show that there is a problem with your wisdom teeth. There is a possibility that it could be both but better rule out the wisdom tooth issue first before starting medications that have many side effects. I hope that helps.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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