Neuralgia/atypical facial pain OR?

[Judythecat]

Hello, sorry that I keep asking the same questions, but I wondered if anyone could help reassure me, please?

I have a diagnosis of atypical facial pain, which is mainly on the left side of my mouth, but likes to keep me on my toes and can shift about. A month or so ago it flared up quite badly, and I rang, then went to the dentist two weeks ago. She did a full exam, and was happy the pain is neuralgia, and not my teeth - she said there was no need for an x-ray, and it would be doing one for the sake of it, not based on clinical need.

I am no better, and am conscious that sometimes I feel a kind of “zing” when I eat or drink something hot, which is new. The pain is all on the outside of the teeth, a kind of burny feeling, from the top left pre-molar to the front tooth (like the side where my cheek/lip sits against it, rather than inside the tooth.) Sometimes it feels like it is in the gums, when it is further forward it can feel like it's in my nose. There is no pain on biting down.

I only have one pre-molar on each side, top, and bottom, as I had four out for orthodontics as a kid - the pre-molar has a filling, but the teeth in front don’t.

The fact no x-ray was done is niggling me. Does it sound like there could be an infection knocking about somewhere, based on that ramble? Logically I trust my dentist and also know it is unlikely three “virgin” teeth have gone bust, plus one with a filling. But that zing...?

My gums were scored 0 other than one 1, so I don’t think it is gum disease.

Thank you for reading if you did. And sorry to keep asking silly questions! I am feeling more on edge because my friend needed an emergency appointment last week, and was told he had an abscess - his surgery added him to a waiting list for RCT, running back to the start of lockdown, and sent him off with antibiotics. (His tooth is at the front so he didn’t want to have it extracted, which they could have done there and then.)

 

[Judythecat]

Just adding - I thought the “zing” was coming from the previous-molar, and linked to heat. But actually I just felt it come from the very back tooth, when I haven’t eaten or drank anything at all for a while. So it MUST just be the neuralgia, right?

Honestly, I wouldn’t wish this condition on my worst enemy!

 

[Gordon]

It most likely is the neuralgia. You're not wrong, it's the most horrible disorder. I've seen a couple of people driven literally to the brink of suicide because of it.

 

[MountainMama]

I have the exact same thing happen, right down to the zing feeling. I am told it is neuralgia as well. It is a horrible condition that makes me paranoid. Mine will even make my teeth feel like they hurt when biting sometimes, but it isn’t really biting pain but the zing you talk about and then it goes away. I get it in my lower jaw where I have implants, so it is just pain in the jaw and gums but it makes it feel like the premolar next to them is extremely painful. I am just about convinced it has a crack or a cavity and then the pain just disappears.

 

[Judythecat]

@Gordon @MountainMama thank you for replying. It is just awful! I had a period where it was really calm, so having a flare up is so horrible. I think the restrictions dentists are under makes things harder as I feel guilty asking to be seen.

(I also realise my initial post reads like I only have front teeth. That is absolutely not the case!)

 

[MountainMama]

@Gordon @MountainMama thank you for replying. It is just awful! I had a period where it was really calm, so having a flare up is so horrible. I think the restrictions dentists are under makes things harder as I feel guilty asking to be seen.

(I also realise my initial post reads like I only have front teeth. That is absolutely not the case!)

I completely understand! I haven’t yet had a long period of no pain, but I have had a week or so, then it ramps up again. It is unnerving, especially when it really feels like the tooth is cracked or the nerve is going bad.
The restrictions on dentists here are not as bad (although that may change soon), but it still makes me feel guilty going in and getting it looked at only to be told nothing is wrong.

 

[Judythecat]

Just bumping this to say I am actually dying of pain. I know rationally it is the neuralgia, because it’s multiple teeth/gums, and only where my face hits them, but the crazy part of my brain is scared there is some horrible infection running riot in there. I emailed the surgery on Monday and am going in next Friday - I was too embarrassed to phone!

I went at the end of October and my gums were fine - 0 and 1 - could something realistically have developed since? The pain runs from the very back molar to the big front tooth, all on the top left. I have fillings in both molars and the pre-molar (other pre-molar removed as a child for orthodontic reasons) but the teeth beyond that are “virgin”.

 

[Seasidescotty]

Do you have medication for the TN? I was the same, at dentists numerous times when having a flare asking to check it wasnt my teeth. Head saying you believe the dentist but pain head saying must be wrong! Wasnt until i was prescribed Tegratol and it wrked that got relief, now take low maintenance dose or maximum 5 days without and flares again. Lidocaine ointment rubbed on gums can help a little too. See your GP as I feel your pain & hope get relief soon Lx ps keep a diary of when/long flares for etc so can tell dr

 

[MountainMama]

Judy, I can sympathize. My neuralgia flared up a few weeks ago, when we were moving (lots of stress) and it was bad enough that I was convinced my “virgin” teeth along with my filled molars were bad. I haven’t been able to get to the dentist since we just moved and I don’t have a dentist yet. On top of the neuralgia my TMJD started up and my right jaw joint has made it painful to chew.
Ugh, this stuff is awful! I haven’t been able to get to the neurologist yet, as moving canceled my appointment and I need a new referral. My oral surgeon suggested medication but I am hesitant to go that route due to the side effects. I think you said the same, if I remember correctly. As I type this, my upper right canine and premolar (both virgin) are kind of tingling and my molar (filled) burns.

 

[Judythecat]

Thank you for the sympathy and empathy! I do also have the option of meds, but I really don’t want to take them. I think stress makes it much worse, but maybe that isn’t physically possible?

 

[MountainMama]

Thank you for the sympathy and empathy! I do also have the option of meds, but I really don’t want to take them. I think stress makes it much worse, but maybe that isn’t physically possible?

Stress is not the root cause of neuralgia but it can make it worse. The immune system has a response to stress that produces chemicals, similar to when you have an injury. That can increase the pain response. It is fairly new research but it makes sense.
I know mine flares with stress.

 

[Gordon]

Judy, might be worth asking for a referral to your nearest Pain Clinic, usually run by an anaesthetist, they can do a lot for you.

 

[Judythecat]

@MountainMama i definitely clench my teeth more with stress, so that won’t help.

@Gordon I didn’t realise that was a thing, thank you. This came up when I googled:

Chronic Pain - Aberdeen Anaesthesia

Aberdeen Anaesthesia is the website for the NHS Grampian Anaesthetic Department in Aberdeen, North East Scotland.

aberdeenanaesthesia.org

Would my dentist be able to do that, or would I have to see a GP? I’m registered with my local surgery but have never seen a GP in the five years we’ve lived here (just the nurse for routine screening stuff). I don’t have “a doctor” as such.

 

[Gordon]

Your dentist should be able to make the referral. Can't hurt to ask. I was lucky in that the anaesthetist who did all my GA cases also ran the pain clinic, so I just used to hand him referral letters
By an amazing coincidence, I know one of the anaesthetists in that department extremely well... I'll ask him for you

 

[Gordon]

Spoke to Andy, he says that they will take referrals from your dentist but that there are very long waiting times. He does suggest that your medical GP would be worth getting to know too, since they'll be likely to be involved in any treatment the pain clinic suggest.

 

[Judythecat]

Thank you so much @Gordon . You are so kind and helpful. I’m not sure what the situation is re doctors with Covid, but I will definitely speak to my dentist on Friday.

 

[Gordon]

He also suggests drug therapy might well help a lot, either Gabapentin or Amitryptyline, neither of which a dentist can prescribe

 

[Judythecat]

He also suggests drug therapy might well help a lot, either Gabapentin or Amitryptyline, neither of which a dentist can prescribe

I was offered this by MF, but the consultant said the side effects would outweigh the benefits. (He said he had taken one of the meds for shingles and had been a complete zombie.)

It probably sounds daft, but I feel like I can manage the pain, it’s the anxiety it might actually be dental that is truly the worst bit. I hope that if I get the x-ray done on Friday and it’s negative the pain might ease off a bit.

 

[Judythecat]

Just updating to say I went to the dentist on Friday where I was poked and tapped and x-rayed, and all is absolutely fine. I completely forgot to ask about the pain clinic, but I am back for a checkup in January so will make a note to do it then. @Gordon sorry to ask, but are NHS checkups on the go again? At the end of the appointment she said she could book me in for a checkup and scale and polish in January now, but I should have asked if it was going to be private or not. (I had previously enquired about private since NHS checks weren’t an option, but think the cost plus scale and polish - which I didn’t ask about but do usually have as standard - might be hideous!)

 

[Gordon]

Far as I know, yes NHS checkups are back on.