Possible Lingual/Inferior Alveolar Nerve damage which has led to Trigeminal Neuralgia

[S3B]

Good afternoon everyone (I am from South Africa, so excuse the time difference for those experiencing it),

I am new to the forums, and you can call me Seb. I am just here to enquire about some recent dental issues I have encountered which has left me in a state of chronic pain. I will get into details a bit later, considering I first just want to get to the bottom of the situation.

I'm suspecting I might have sustained damage to my the Lingual/Inferior Alveolar Nerve on the right side of my face (my perspective) which might have led to a condition referred to as Trigemnal Neuralgia (TN), commonly known as "Suicide Disease". I'd like to enquire about the necessary steps I'm supposed to follow in case I had an injury to any of the nerves which might contribute to said condition. Who do I see to determine if this is in fact nerve damage; a Neurologist or Oral and Maxillofacial Surgeon? Are there tests they can run to ascertain 100% if I have indeed sustained a nerve injury? Would you be able to PHYSICALLY SEE this perhaps?

I have already gone back to the dentist, but she told me to wait 2 weeks and has put me on Celebrex 200 for the time being. Can this potentially heal over time, or am I screwed for life? I know in some cases, nerve damage can be permanent. My pain is EXCRUCIATING, and it doesn't stop (which has me worried, and is the main reason I came to this forum). It's like a stinging/aching pain, and it feels like it's in the back of my mouth behind the 3rd molar where the dentist injected me (x3 times, due to not anesthetizing easily). I don't think it's the tooth that had to get an inlay that's causing the problem (this tooth seems fine now). It almost feels like I'm still getting injected, or alternately, stabbed in the nerves in the back of my mouth.

PLEASE, if anyone can help me, it would be much appreciated, even if people can link me to other threads. I am in a state of constant chronic pain and I haven't been able to function normally. I have even cried a couple of times, up to the point where I am not even able to cry anymore. This is really a SERIOUS issue to me. Any help would be MUCH appreciated.

Thanks you in advance.

Regards,
Seb

P.S. A GP has also put me on Panafcort (Prednisone) 5 mg x 24. I was supposed to take 12 this past Thursday after I had just seen the GP, and then another 12 yesterday (Friday), 24 hours later. I haven't taken ANY thus far, considering I am doubtful when it comes to Prednisone and cortico-steroids (I have been on them before and suspect they might've contributed to my lower-immunology and persistent allergy (Chronic Idiopathic Urticaria). Is it a bad decision abstaining from what the doctor's recommended if I'm doubtful?

 

[MattKW]

It used to be thought that pain relief would be achieved with alternating paracetamol and a few hours later with ibuprofen. Paracetamol taken with ibuprofen is now the best method for most dental pain. So the companies have brought out premade tablets, e.g. Maxigesic, Nuromol. You have to follow the instructions to keep within the daily limits, especially because of the potential paracetamol toxicity. It's not a nice way to die.
Previous products like paracetamol with codeine or ibuprofen with low-dose codeine are being phased out e.g. Panadeine. The small amount of codeine meant that patients didn't always get the relief they wanted, so they would increase the tablet intake but could easily OD on paracetamol before they got a decent dose of codeine.

 

[Busybee]

It used to be thought that pain relief would be achieved with alternating paracetamol and a few hours later with ibuprofen. Paracetamol taken with ibuprofen is now the best method for most dental pain. So the companies have brought out premade tablets, e.g. Maxigesic, Nuromol. You have to follow the instructions to keep within the daily limits, especially because of the potential paracetamol toxicity. It's not a nice way to die.
Previous products like paracetamol with codeine or ibuprofen with low-dose codeine are being phased out e.g. Panadeine. The small amount of codeine meant that patients didn't always get the relief they wanted, so they would increase the tablet intake but could easily OD on paracetamol before they got a decent dose of codeine.

I've not heard they are phasing them out in the UK. I've found great relief from any inflammatory pain with nurofen plus. Ibuprofen alone doesn't hit the spot for me. I didn't want to recommend combining paracetamol & ibuprofen at the same time as I am not a medic. So thank you for confirming that.

 

[S3B]

Good morning everybody,

I'm sorry if this post is a tad long, but I'm just giving you an update on what has transpired in the meantime.

It's been a while since I last gave anyone any feedback regarding my tooth ache (yes, I'm referring to it as toothache now, because with time the pain has localised to said problem tooth and I can honestly say that I don't think it is specifically nerve/jaw-related anymore). Well done MattKW, it seems like you were right in the end!

Considering I STILL had (and have) pain (and it's been 6-7 months since the last inlay on this tooth was performed), and had seen other dentists in the meantime for 2nd opinions (amongst them endodontists). The endodontist I've decided to work with, sent me for a CBCT scan @ another practice with said technologies recently. I'm waiting for their feedback now as to what will happen next.

I'd like to find out, logically, what the next possible steps I should take would be (i.e. what can the endodontist do to help me alleviate pain). All the dentists and endodontists (I even saw a periodontist 'cause I also have some mild gum recession) mentioned that the inlay looked fine, and that it was done properly (also, the the nerve and pulp seemed fine). Unfortunately I still have pain though, and I am MOST DEFINITELY NOT going to walk around with said pain for the rest of my life I'm afraid. If they can't find any problems with the inlay, wouldn't the next option be a root canal and a possible crown? Wouldn't doing the root canal take away all sensation? I've heard that this is usually an option if people have persistent toothache, but can't really get by with fillings and regular dental work. Also, do you HAVE TO get a crown after a root canal?

I'm thinking that maybe this tooth has reached its end in terms of how many times they've worked on it. As far as I remember, they've done work on this tooth roughly 4-5 times (I'm busy finding out the exact amount from all my past dental records). I'm scared with my 2nd last inlay, maybe the one dentist went TOO deep and ventured into DENTINE territory, whereas the inlay after that which was done by the last dentist who worked on said tooth, was of better quality, but alas the damage had already been done and she just filled it up and made it look better.

The pain is persistent, with a mild ache, which @ times gets worse. It has severely impacted on the quality of my sleep, and I wake up with toothache every morning. Also, when I rinse or drink liquids, I can feel tooth sensitivity akin to gum recession with dentine exposure from over brushing.

Lastly, is it possible to request your dental records from dentists that you've seen over the years? I.e., can they directly email it to me, or do you have to go pick it up yourself?

Any help would be much appreciated.

Thank you in advance.

Regards,
Seb

 

[MattKW]

I would be very wary of performing any interventionist work for you because of your complex pain issues. I'd strongly suggest that you talk to your endodontist or medical practitioner and see if referral to a pain clinic is the next step. I'm no expert, but you don't sound like you strictly have trigeminal neuralgia. There are many other causes for facial pain, and you need a team approach. I went to a couple of lectures on it only last week.
Altho you are allowed copies of any dental and medical records, the pain clinic doctors will get copies of records more easily than you. Ask your endo, current dentist, and general practitioner for copies of their records as a starter. If the pain docs want more they will chase up farther back. Pls keep me updated, and best of luck.

 

[MattKW]

I've not heard they are phasing them out in the UK. I've found great relief from any inflammatory pain with nurofen plus. Ibuprofen alone doesn't hit the spot for me. I didn't want to recommend combining paracetamol & ibuprofen at the same time as I am not a medic. So thank you for confirming that.

It's only a matter of time before the UK follows Australia. The USA is still the big problem.