Root Canal Pain and Trigeminal Neuralgia

Brain and nerves
1

Hello.

I have a question about root canal pain and Trigeminal Neuralgia.

In the last three months I’ve had three teeth with root canal symptoms. They’ve all had cold/hot sensitivity that lingers, pain with biting/chewing, constant toothache pain and throbbing toothache after coming in contact with cold. All of these teeth have been treated with root canal treatments and have all felt better after treatment.

Now for the last 3 weeks I have another tooth, an upper right front molar, #3 that is showing the same symptoms. I saw my dentist who referred me to an endodontist and a neurologist. I’ve already had the consultation with the endodontist and he wants to wait and see what the neurologist says before deciding to do a root canal treatment or not.

I am able to differentiate two different types of pain. I have a constant pain on both sides of my jaw that has episodes where it gets worse and will go into the ears. Other times it’s just that constant jaw pain.

The other pain I can tell is separate and is coming from a specific tooth. The pain in the tooth responds to certain stimuli as mentioned above.

My appointment with the neurologist is coming up on April 27, 2018. He’s going to see me for these toothache related problems and chronic jaw pain. My dentist referred me for possible Trigeminal Neuraglia.

Have you ever heard of Trigeminal Neuraglia causing root canal type symptoms?

What advice can you give me regarding this? Are there any specific symptoms that would tell me if this was Trigeminal Neuraglia or not?

Thank you.

JJ

2

There are two types of trigeminal neuralgia, TN1 and TN2 or typical and atypical. Typical is usually symptomatic by wind, chewing, brushing teeth, talking and can cause lightning-shock or stabbing pain lasting for seconds to two minutes from a few times a day to hundreds. There are variations of this but this is a general description. Mine feels like stabbing screwdrivers in my gums and lasts two minutes on average 20 times day. 

Ayptical is a constant, burning pain.

In both types, it is almost always just on one side of the face. And in my case it is just the upper right jaw. When I started on this journey I thought it was a tooth issue and it kept jumping from tooth to tooth.  Actually when I look back I am very bothered both by the endodontist and dentist who are highly qualified and respected (and the dentist I actually like as a person very much) who asked me to pick which tooth I wanted the root canal on and later which extraction or both. Cost me $10,000. And I will have to wear fake teeth you can take in and out because you can’t get implants with TN.

So, when you say you are on your fourth root canal, I worry for you. You say it made you feel better after each one. We’re they all on the same side? All where your pain is? When I got my tooth removed I was gloriously out of pain for 18 hours and kissing the ground. That can happen from the anesthetic.

But I just reread your post. Do you have pain on both sides? That can happen with TN but it is rare. If you are seeing neurologist they should be doing a MRI and possibly putting you on carbamazepine. That is a first line defense against TN and if you respond to it, it also acts as a diagnostic tool. But if you think your pain is more closely affiliated with atypical trigeminal neuralgia, sometimes amitriptyline or gabapentin works better. However I am far from an expert or a trained medical professional but I am an experienced TN patient (unfortunately) and I have been doing tons of research trying to decide if my next step will be MVD surgery.

i hope this helps a little and welcome and at the same time, I hope you don’t have to stay. As not fun as toothaches and root canals are there would be an end and hopefully soon.

There is a wonderful bunch of people here so you’ve landed in a good place.

3

Hi Anyazora.

Thank you for your reply and support.

It's a bit of a complicated situation for me.  Let me give a bit more background.

In 2014 I had a double jaw surgery.  They corrected an overbite and crossbite on the upper jaw and a severe underbite on the lower jaw.  The upper was moved back and to the side.  The lower was brought forward a lot.  I basically had no chin before the surgery.

I've also been diagnosed with TMJ since before the surgery.  The TMJ worsened after the surgery.  The surgery did correct biting and chewing issues that I'd had.

I also have been told I have Gingivitis/early periodontal disease.  This causes me to have gum pain all over my mouth and red and irritated gums.  I recently saw a Periodontist because of a persistent bad pain in the gums in my lower front teeth.  Come to find out that the jaw surgery made my gums paper thin in places along my lower gums.  It's been getting progressively worse since the surgery.  The Periodontist told me that I have bone loss and paper thin gum tissue around 6 of my lower front teeth.  The remedy for this is an out patient gum surgery where he'll cut open the gums, put a medicated powder to regenerate the bone and place a donor tissue graft under my gums.  Then he will recover the gums with my own and stitch them together.  I've already scheduled the surgery for May 7, 2018.  Seriously not looking forward to it.

To top it all off I have a severe dental anxiety and phobia.  This whole thing is a nightmare for me even working with two doctors who I know and trust (my Dentist and Endodontist).  I'm still new to my Periodontist, so the trust isn't there yet.

So my concern is I'm having two completely different types of pain.  Each type of pain started at different times.  My doctors are confused and without any good answer as to what is going on.  I'm confused and frustrated.  To be fair though, two of the root canals I've already had the doctor was certain I needed.  They had all the classic symptoms, the problem showed up on the x-ray and once he did the root canal he said they were infected and he was glad we did the treatment.  The other tooth and the one currently causing me problems have all the classic symptoms, they test like they need root canals, but nothing shows up on the x-ray, hence my doctor's hesitation.

I can relate where you say the pain is jumping from tooth to tooth.  The confusing thing is that sometimes after the root canal treatment I can go months in between having another problem, so we thought it was unrelated at first.

That's the other confusing thing.  I've had two teeth on the upper right (one is the currently painful one), one upper left and one lower left.

The jaw pain is on both sides.  It's a constant jaw pain that will occasionally travel into one or both ears.

Thank you.

JJ

4

I’m very glad you are seeing the neurologist before your mouth surgery. Everything you are talking about would be horrible for TN and if this is TN possibly, needless surgery. See the neurologist before. You probably need an MRI. I’m thinking you might need to reschedule or postpone your dental surgery.....hasn’t Your Dentist weighed in about that considering he thinks it might be TN?

5

Hi.

What do you mean when you say it would be 'horrible for TN' ?

Also, I'm not sure if I can have an MRI since I have metal plates and screws in my jaws from the surgery.

Can they do something else, like a CT scan?

I hope I don't need to re-schedule the gum surgery.  I've already been waiting a month and a half for it and those gums are painful.

My dentist wants to 'rule out trigeminal neuralgia'.  I'm not sure if he thinks it is or isn't that, but he wants to at least eliminate it as a possibility.

I personally hope that it's not TN, because from what I've been reading it sounds like a severe condition with not a great outlook for treatment.

Thanks.

JJ

6

I’m sorry I should have been much clearer. I apologize. I met with an endodontist who specializes in TN. He told me when you have it you want to stay away from anything like tooth pulls, implants or root canals and that would include bone grafts. Your surgery sounded very much like it would cross into those lines. You need to stay away as a TN patient because it can really irritate your Nerve and make your symptoms much worse. But I recently had to have a tooth pulled by that same doctor because it was horribly infected. So,etimes you have to do it anywayor the alternative is worse. But the pain after was horrendous. It has died down though in the second week and I’m back to just awful pain. wink

I am just worried for you until they find out for sure what’s going on they don’t make anything worse for you, that’s all. But I am far from a doctor or a dentist Or an oral surgeon. However, I am a very informed patient who has beeen through these experiences. I just was suggesting you talk with your dentist, oral surgeon and neurologist first and make sure it is the right choice for you. I just don’t want you to suffer further.

Thats one of the unfortunate aspects of all this when people with TN are in pain and going to their dentists or endodontists, they are having teeth pulled and root canals performed. It happened to me. Several in a short period and I ended up so miserable I finally broke down right after Christmas and went to the ER, my entire body was shaking from pain.

i have MS though so it was easy to understand how I could have this. And they still the did MRI and MRAs. I don’t know how they handle that when you have screws bc in my understanding you can’t have anything metal in a MRI machine so they must have some way of handling the situation for people in your case. Is that resorting to CT scans? I have no idea but I would be curious. 

Two last things one is my atypical pain also makes it feel like my gums are on fire. That is neuropathic pain. Here is a good question for you, does your pain respond to ibuprofen or Tylenol? If it does, it most likely isn’t TN. I would say even opiates but I know people who get relief from opiates. For me though, they gave me Dilaudid and Fentanyl (strongest opiate I believe) by IV and it didn’t touch the pain. Not because the medication wasn’t strong enough but because neuropathic pain doesn’t usually respond to medication like that.

Lastly, I too hope this isn’t TN for your sake. But, please don’t take me or some of the things you read as classic examples. I responded well to the first line of defense: carbamazepine and it was really helping my pain. But, it made my sodium lower very dangerously and I can’t take a very high amount. Also I have both typical and atypical which can be trickier. Some people on this board are actually able to just take supplements and be OK. (And yes, I am very jealous lol.) So yes it can be an awful disease, but it can also be treatable. If you have it you need to find out why you do, MS, tumor, etc if you can. Sometimes that can be treatable and relieve it. 

Just please check with the dentist, endodontist and neurologist before the surgery. If your endodontist is any good he or she would be very wary about proceeding without a diagnosis. If he or she is not tell them to look up trigeminal neuralgia and know it’s signs so they don’t hurt anyone. All dentists, endodontists and oral surgeons should have an awareness of this.

Did I explain it better? I’m sorry if I scared you before without explaining. I just don’t want you to have to experience so,e of the things I went through.

Please let us know how you are doing and how it goes.

7

Hi.

Thank you for explaining that better.  That helps some.

Can I ask you, did you get any relief at all after the root canal treatments or did it feel the same or worse?

The reason I ask is that after every root canal treatment I've had, I've felt better.  The confusing part is why these four teeth are acting up around the same short time period.  Two teeth for sure needed the root canal treatments and the other two are the mysterious ones that are causing my dentist and endodontist to worry about something else.

My pain responds to both Ibuprofen and Tylenol.  Ibuprofen tends to work better, but can upset my stomach some so I alternate the two medications.

Thanks again.

JJ

8

In the last time when we found out I had TN and I bounced from tooth to tooth, no I got no relief from the root canals and I thought that was really strange. I have awful teeth lol. Bad Immune system. I floss and brush. My ex never did. Perfect teeth. Of course. But I’ve had several root canals and I find them quite painful for the evening after and as long as they give me a medication for it like Vicodin or something I’m fine but in this case no nothing worked and I kept going back for over a week and he kept giving me more Vicodin and I wanted to fix the problem. My dentist said just wait and his wife who also worked in the practice said everyone deals with pain differently. Lol. Well kinda funny kinda not. But when he pulled the tooth yes, I was blissfully pain free for a good 18 hours. Found out later that can happen with the anesthetic and I actually asked him out of desperation to do the anesthetic again but he wouldn’t . Which is too bad because it is a treatment some people use. 

But no for me the vicodin, the ibuprofen, Tylenol none of it was working.

However, if I go back further in time I had issues on this side before and had a root canal and then had the tooth pulled and then thought it was infected even though the dentist couldn’t see anything. I’m pretty sure that was the beginning of all this and then it died down. However every once in a while it would hurt and I would think I have no tooth there so it must be my sinuses.

Oh sorry last thing I forgot to say and I’m not sure if they are saving themselves or not but I really don’t think so because I saw two different endodontists that month. Both put me on steroids and antibiotics and painkillers because they said I had an infection and needed a root canal.

So for me, could be really just a big complicated mess. I know for sure I have a lesion on my trigeminal nerve. Was that causing my pain or was the infection? One of the teeth had a root canal already done on it, the other tooth was dead. I shouldn’t have been able to feel them. Did that tooth with two root canals need to be pulled? I can’t figure it all out. I know I wish someone would have put woman with MS and horrid tooth pain not responding to medication or treatment together (ding ding ding She might have TN) before all the work I had but at some point when I feel good enough to do so maybe I could help get that education out there for other people.

Do you have TN? God, I don’t know and I really really hope not. I know tooth pain and what you are going through sucks and I’m sorry but I’m hoping there’s a point where the treatment ends and you feel better. If you are responding to the root canals and Tylenol and ibuprofen, then that doesn’t sound like TN. If you have pain on the upper right and lower left, that doesn’t sound like TN. But, everyone experiences things differently and I’m sure there’s someone with a very valid experience of this disease who would tell me whoa woman hey, that happened to me. So your best bet is to see your neurologist and make sure they are familiar with this condition. Call your endodontist? Who is doing your surgery? Let them know what’s going on and ask them what they think? Thirdly, ask your dentist what he or she thinks about you proceeding with the surgery considering you are looking into TN. You said you are in a lot of pain and you don’t want to wait. I totally understand but please don’t do something just for that reason if it could make a situation much worse. Could your doctor give you a stronger pain medication to take when the pain is at its worst to help you right now?

I said lastly, but sorry as you can see I’m a talker, here’s my finally. The one saving grace for many people with TN is that is let’s you sleep. I have no idea why, it’s not like a toothache that wakes you up in the middle of the night miserable. You sleep soundly. It has not once woken me up no matter how bad it has gotten. Are you able to sleep? Or does your pain wake you up? But take it with a grain of salt because you might very well have two issues going on as well. It is possible to have true dental issues and TN of course.

9

Hi again.

Thank you for sharing your experiences with me.

I too have very bad teeth.  I've had various forms of tooth problems throughout my life.  It's frustrating for me sometime because I'm adopted and therefore have no family medical history to go by.  All of my health issues in my life I've learned with trial and error.

I'm trying to be positive here and hope it's not TN.  The more I read up on TN and think about my symptoms I highly doubt that it is TN, but that's why I'm seeing the neurologist to rule it in or out.

Thanks.

JJ

10

My journey with TN started in 2/2016 which i spent the rest of the year going to different dentists and endodontics's because we thought it was a tooth issue.  I know think is totally as a result of stress at work.  Every time I have a stressful event the TN hits me hard abt 2 weeks later. I've done acupuncture, chiropractic, massage therapy and wear VOXX socks.  The socks work on clearing the meridians throughout the entire body which have made the pain bearable.  With the Voxx socks I was pain free from 9/17 until 3/13/18.   I've taken Tegertol 5 or 6 times but don't want to treat my body with pharmaceuticals because of the side affects and I know they will negatively affect other areas of my body.

My neurologists thinks it has something to do with the old silver/mercury fillings in my teeth. She said when the body goes into flght/flight stress mode, the body emits cortisol which interacts with the mercury fillings and causes TN.  I wonder if anyone else out there has heard this? I have 7 silver fillings to change out. Problem is the fillings are so big that usually the tooth breaks which requires a root canal and/or crown. 

Two weeks ago I started using CBD oil.  I think it's beginning to give me some relief keeping the zings to btwn 3-5.  Has anyone else had success with CBD oil? 

11

Hi Sara, my name is Al and I have had TN for 10 years now . It took me about 2 years of suffering before the doctors came up with TN...everybody is different with this thing...I’m here just to tell you my Experience...almost every night when I start to relax I’ll feel a slight pressure in my head and then the right side of my forehead starts to heart really bad then the pain stays there but more pain goes into my sinus and my right eye is now hurting like hell then the pain moves into the right side of the row of my top teeth and I know my teeth are ok . So now the right side of my forehead my eye and teeth are all hurting at the same time.The pain that I have on a 1to10 scale is like 9 ..It last about 2 hours of excruciating pain before it subsides.....So Sara I’m no doctor but it sounds like you have teeth problems more than TN. ...now from saying that. DO NOT RULE OUT T N. There may be different ways to have TN. I just told you mine. Anyway you’ll get through it. The doctors that your dealing with especially a neurologist  are professionals.good luck to you .. life sucks when your dealing with health issues.

12

Hi Al.

Thank you for your reply.

I'm sorry that you deal with all of those TN problems.

I'm really thinking it's teeth problems also, but that's why I'm seeing the neurologist just in case it's something else.

Thank you for your support.  I'll keep you posted.

JJ

13

Hi all.

Just want to give you all an update.

I saw the Neurologist on Friday, 4/27/18. He examined me and we talked about my symptoms and history. He said that I do not have TN and my symptoms are dental related.

So, the next step is to see the Endodontist again on Monday, 5/7/18. I'm scheduled for a consultation and root canal treatment that day. The doctor wanted to rule out TN before doing the root canal treatment.

Thank you all for your replies and support.

JJ

14

Sarah, 

when end I was going to your post, I was thinking please no trigeminal neuralgia,please no trigeminal neuralgia. I’ve had a horrid last four days and been bedridden because of the pain. My family is pushing for the ER but I see no reason to go. It’s so bad I sometimes honestly wonder if you can die from pain.

So I’m so glad to hear that the neurologist doesn’t believe you have it and your symptoms didn’t sound like it to me,  but everyone is different.

i know you have a lot of mouth issues to go through still so I wanted to wish you well with that and your surgery. I hope you heal quickly and get out of pain.

warmest,

jennifer