[SFNgirl]

4 months prior to diagnosis of small fiber neuropathy, I had an extensive gum graft. While testing for various neurological causes of nerve pain, I also had an attack of my trigeminal nerve, which remains unexplained. I now have pain and burning almost body wide from the SFN. Prior to the gum graft, i have never had any neurological issue or pain. Has anyone heard of gum work causing neuropathy?

[Vowel Lady]

Yes, I have heard (many times) of gum and/or dental working leading to nerve pain (trigeminal neuralgia or atypical trigeminal neuralgia). I have not heard of it causing bodily pain. However, I wouldn't be totally surprised. AND I suspect it could worsen any underlying illnesses, particularly any autoimmune problems.

I had very bad pain after some questionable dental work. Further dental work was conducted in an effort to correct this. At some point, I had a tooth pulled and a dental graft put in. Oddly, afterward, I was determined to have Sjogren's Syndrome. I already had some mild symptoms of this auto immune disease prior, but the symptoms worsened immediately after the graft was placed. But, worse than this, my bad pain actually worsened and became 24/7 horrible pain. It was then diagnosed as atypical trigeminal neuralgia. I suspect my situation is a little on the complicated side, but sadly, not all that uncommon. Seems what often happens is that nerve pain is "set off" at the dentist's offfice by some error, but it is not diagnosed properly. Then, frightingly, further dental work is performed in an attempt to correct the problem, only worsening the nerve pain.

REgarding dental grafts, I belong to a website where Sjorgrens Syndrome is discussed and there is concern that dental bone grafts might excacerbate autoimmune sickness.

[Bryanna]

Hi SNFgirl,

Did you have a gum graft or a bone graft done? If it was a gum graft, where did they take the donor tissue from? Where in your mouth was the grafted tissue placed? Was this graft done to cover gum recession? Have you had these done in the past?

I'm in dentistry for 35 yrs and I believe that there are quite a few people who encounter various degrees of "neurological" pain after some dental procedures. Not necessarily because the procedure was done incorrectly but because there were other underlying issues that were not diagnosed or realized prior to the dental work being done. Other times yes, it could result from something that the dentist did during the procedure. Unfortunately, many people never say a word about what they have experienced post operative unless they are specifically asked how they did after the procedure. So I think this problem goes undiagnosed or eventually misdiagnosed more times than is realized.

Most of the time from what patients report... the neurological symptoms subside completely in time. The length of time varies from person to person. Other times the problem will have various symptoms and pain for a very long time... could be permanent in some cases. I think underlying disorders not related to dentistry may be a predisposition for some people. But that is just my own speculation.

How did you come about the diagnosis of Small Fiber Neuropathy? Where was your trigeminal nerve pain? Again, what type of graft was it and where was the graft done?

Bryanna

Originally Posted by SFNgirl

4 months prior to diagnosis of small fiber neuropathy, I had an extensive gum graft. While testing for various neurological causes of nerve pain, I also had an attack of my trigeminal nerve, which remains unexplained. I now have pain and burning almost body wide from the SFN. Prior to the gum graft, i have never had any neurological issue or pain. Has anyone heard of gum work causing neuropathy?

[SFNgirl]

Hi, thanks for both replies vowel lady and bryanna, also have posted on PN area but thought this was relevant.

To answer questions, I had a gum graft last summer for gum recession along most of my lower gum line, about 9 teeth long. Was a long procedure,3 hours or so. They took the tissue from both sides of the roof of my mouth. Have very thin gums, but did not have gum disease. The one odd thing about the procedure is that the Novocain wore off quickly (doc said i must be overprocessing it) so the doc gave me several new shots of Novocain every 20min or so for 3 hours into my gums and the roof of mouth. Was a lot of shots.

My nerve pain started out of blue in October, thought was a disc issue from running, until the odd freezing/burning sensation appeared in left leg, then foot, lower and upper back, numb hands and eventually right leg and foot. Met neurologist in late November and started huge number of tests. In midst of this, had a major attack of pain in my face. I thought it was jaw pain, like tmj, as it hurt to open my mouth at first then became a full blown pulsing, throbbing, stabbing pain all around my face in front of my ear, behind it, into my cheek and a bit along the lower jaw line. It was unrelenting, screaming pain, unlike anything I have ever felt, with addl sharp pains added if even moved my tongue, my head, etc. I ended up in ER and diagnosed w TN. Gave me morphine in ER, sent me home w Vicodin, which I had to take regularly for about 4-5 days, then went away. My neurologist had no idea how to connect it to the rest of body stuff I was being tested for but he did ramp up my gabapentin dose he had started previously, ultimately I ramped up to 2700mg.

After all that, in January, I was diagnosed with idiopathic small fiber neuropathy from skin biopsy (decreased skin fibers in sweat glands) and autonomic testing (qsart and tilt table abnormalities). My neurologist has suspected an autoimmune process of some sort, whether in reaction to some unnoticed recent infection/virus or latent systemic disease, but hasn't identified it. The only odd thing is that I have frequently had lightheaded ness upon standing for as long as I can remember but just assumed was from low blood pressure. Neuro not sure if that was any kind of red flag or shouldering issue of autoimmune disorder just now becoming full blown. He ordered a few month trial of steroid infusions on this theory but no luck. He continues to think about rare autoimmune stuff.

I'm intrigued by both of your comments on this concept of an underlying disease that perhaps the gum work ignited. I don't know enough about how it works but given this background, seem possible? Nobody really knows how the face ties in other than rather than TN they now think somehow my trigeminal nerve may have been irritated by the SFN, but perhaps it was all irritated by the gum graft and perhaps I got an infection during the procedure but didn't realize it. Issue is we did so much blood work and my docs cannot tie it to the procedure and there was a 4 month lag in btwn procedure and my first signs of nerve pain in my low back. I did see a rheum at Cleveland clinic along the way who suspected sjogrens and that I was predisposed because of the postural hypotension, hypo mobility, etc. but I have none of symptoms or associated antibodies that would suggest sjogrens. Mrs D on PN forum wondered about lupus given I have also had toe and finger discoloration periodically throughout this. But again, none of the tests have proven it.

Thanks for the thoughts in advance and sorry for long post

[Bryanna]

Hi SNFgirl,

Wow... you are having a really tough time. Auto immune disorders can be so complicated and it can be so difficult to pinpoint the actual cause as it end up being a variety of things.

The gum grafting that you had done was quite extreme. Nine teeth is more than half of the entire arch! Thin gums is often a hereditary condition and due to the fragility of the tissue, the grafting of donor tissue can be complicated.... perhaps that is why it had to be done over such a large area. The amount of local anesthetic injected "at the sites of the surgery" was probably minimal compared to the number of injections. The dentist was probably infiltrating minute amounts into the tissue to keep you numb... which is typical for that procedure. He may have given you quite a bit initially to anesthetize your lower jaw and tongue. He infiltrated the palate in various areas prior to removing the donor tissue but those injections are not very deep. Some people absorb local anesthetic more rapidly than others. It also depends on the type of anesthetic that's used. All and all it was a lot to go through for sure!

Could all of that have been a trigger to your present symptoms? Maybe but I don't know how you would be able to determine that. Have they ruled out oral infection for certain?

Bryanna

Originally Posted by SFNgirl

Hi, thanks for both replies vowel lady and bryanna, also have posted on PN area but thought this was relevant.

To answer questions, I had a gum graft last summer for gum recession along most of my lower gum line, about 9 teeth long. Was a long procedure,3 hours or so. They took the tissue from both sides of the roof of my mouth. Have very thin gums, but did not have gum disease. The one odd thing about the procedure is that the Novocain wore off quickly (doc said i must be overprocessing it) so the doc gave me several new shots of Novocain every 20min or so for 3 hours into my gums and the roof of mouth. Was a lot of shots.

My nerve pain started out of blue in October, thought was a disc issue from running, until the odd freezing/burning sensation appeared in left leg, then foot, lower and upper back, numb hands and eventually right leg and foot. Met neurologist in late November and started huge number of tests. In midst of this, had a major attack of pain in my face. I thought it was jaw pain, like tmj, as it hurt to open my mouth at first then became a full blown pulsing, throbbing, stabbing pain all around my face in front of my ear, behind it, into my cheek and a bit along the lower jaw line. It was unrelenting, screaming pain, unlike anything I have ever felt, with addl sharp pains added if even moved my tongue, my head, etc. I ended up in ER and diagnosed w TN. Gave me morphine in ER, sent me home w Vicodin, which I had to take regularly for about 4-5 days, then went away. My neurologist had no idea how to connect it to the rest of body stuff I was being tested for but he did ramp up my gabapentin dose he had started previously, ultimately I ramped up to 2700mg.

After all that, in January, I was diagnosed with idiopathic small fiber neuropathy from skin biopsy (decreased skin fibers in sweat glands) and autonomic testing (qsart and tilt table abnormalities). My neurologist has suspected an autoimmune process of some sort, whether in reaction to some unnoticed recent infection/virus or latent systemic disease, but hasn't identified it. The only odd thing is that I have frequently had lightheaded ness upon standing for as long as I can remember but just assumed was from low blood pressure. Neuro not sure if that was any kind of red flag or shouldering issue of autoimmune disorder just now becoming full blown. He ordered a few month trial of steroid infusions on this theory but no luck. He continues to think about rare autoimmune stuff.

I'm intrigued by both of your comments on this concept of an underlying disease that perhaps the gum work ignited. I don't know enough about how it works but given this background, seem possible? Nobody really knows how the face ties in other than rather than TN they now think somehow my trigeminal nerve may have been irritated by the SFN, but perhaps it was all irritated by the gum graft and perhaps I got an infection during the procedure but didn't realize it. Issue is we did so much blood work and my docs cannot tie it to the procedure and there was a 4 month lag in btwn procedure and my first signs of nerve pain in my low back. I did see a rheum at Cleveland clinic along the way who suspected sjogrens and that I was predisposed because of the postural hypotension, hypo mobility, etc. but I have none of symptoms or associated antibodies that would suggest sjogrens. Mrs D on PN forum wondered about lupus given I have also had toe and finger discoloration periodically throughout this. But again, none of the tests have proven it.

Thanks for the thoughts in advance and sorry for long post

[mrsD]

I have to wonder about the Herpes Zoster virus!

Did you have chicken pox?

Zoster can reactivate with various stress triggers, and it is very painful. The blisters don't always come out. But it lives in the nerves for life.

You can have Zoster titres measured to see if that is what is going on. Elevations will indicate activity of the virus. Herpes Simplex can be run at the same time. They are related, and can activate anytime. But the Zoster one is the most painful.

You can try taking 2 grams of l-lysine a day for a couple weeks to see if anything changes. That would point to a viral trigger as well.

One does not have to have the full blistered outbreak, and unusual presentations do exist. I can't recall if I posted this option to you on the PN forum? Sorry, if this is redundant.

Lidocaine is a sodium channel blocker. Often when it wears off, there can be rebound pain, as the nerves resume their jobs.
It could be that this process was overstimulated by the gum pain/trauma and those nerves got "stuck" in the on position!

[Bryanna]

Hi Mrs D,

Good thinking!

It can't hurt to have the titre done that's for sure!

Thanks!
Bryanna

Originally Posted by mrsD

I have to wonder about the Herpes Zoster virus!

Did you have chicken pox?

Zoster can reactivate with various stress triggers, and it is very painful. The blisters don't always come out. But it lives in the nerves for life.

You can have Zoster titres measured to see if that is what is going on. Elevations will indicate activity of the virus. Herpes Simplex can be run at the same time. They are related, and can activate anytime. But the Zoster one is the most painful.

You can try taking 2 grams of l-lysine a day for a couple weeks to see if anything changes. That would point to a viral trigger as well.

One does not have to have the full blistered outbreak, and unusual presentations do exist. I can't recall if I posted this option to you on the PN forum? Sorry, if this is redundant.

Lidocaine is a sodium channel blocker. Often when it wears off, there can be rebound pain, as the nerves resume their jobs.
It could be that this process was overstimulated by the gum pain/trauma and those nerves got "stuck" in the on position!

[SFNgirl]

Originally Posted by Bryanna

Hi Mrs D,

Good thinking!

It can't hurt to have the titre done that's for sure!

Thanks!
Bryanna

Thank you Mrs D, You did not mention herpes zoster or l-Lysine in previous suggestions on PN thread, so I will definitely add it to your others. I'm pretty sure I had chicken pox as a baby. I did have a full blood work up by my primary, my neuro and again by infectious disease, so I think they included herpes zoster, but I am going to be sure to ask. I will say early on when all of the nerve pain started, I kept coming back to the description of postherpetic neuralgia which sounded spot on, but I thought you had to have had the rash first, anyway, I know I mentioned to my doc then. I will check. I also have lupus on my list of follow up after our exchange regarding the finger and toe discoloration...I have just finished weening off of gabapentin, from 2700 level, it really didnt seem to help much and i just felt so tired and "drugged" all the time. Considering giving lyrica a try. But also ready to start a new approach to this thing, going back through your input to me (as well as others over many different threads), plus re-starting an exercise program which stopped when I stopped running because of all of this. Time to get on with this new life and bounce back, after spending several months just hoping for a magic bullet to give me my old life back. Thank you for the inspiration to face reality and a different way to approach this.

[Bryanna]

Hi SNF girl,

When we don't feel well physically, we often don't feel well mentally either. Before you know it, we've let the problem drain the life out of us. Then something is said or done that gives us hope and we suddenly become alive again!

Stay in this positive mind set and you will stay strong and focused. Keep your ducks in a row... stay organized with the information and always ask questions of your doctors. It would be great to get back to exercising but do so gently to avoid shocking your system .... like go walking instead of running

Keep us updated okay. We can always start a new thread if you wanted to

All the best to you!.......
Bryanna










There are always alternative optionsthen someone comes along and offers their insight

Originally Posted by SFNgirl

Thank you Mrs D, You did not mention herpes zoster or l-Lysine in previous suggestions on PN thread, so I will definitely add it to your others. I'm pretty sure I had chicken pox as a baby. I did have a full blood work up by my primary, my neuro and again by infectious disease, so I think they included herpes zoster, but I am going to be sure to ask. I will say early on when all of the nerve pain started, I kept coming back to the description of postherpetic neuralgia which sounded spot on, but I thought you had to have had the rash first, anyway, I know I mentioned to my doc then. I will check. I also have lupus on my list of follow up after our exchange regarding the finger and toe discoloration...I have just finished weening off of gabapentin, from 2700 level, it really didnt seem to help much and i just felt so tired and "drugged" all the time. Considering giving lyrica a try. But also ready to start a new approach to this thing, going back through your input to me (as well as others over many different threads), plus re-starting an exercise program which stopped when I stopped running because of all of this. Time to get on with this new life and bounce back, after spending several months just hoping for a magic bullet to give me my old life back. Thank you for the inspiration to face reality and a different way to approach this.

[SFNgirl]

Thank you Bryanna, I can't tell you how much I appreciate the thoughts and having all of you to keep me feeling positive. It's tough, today was a difficult one, but tomorrow will be better. I will keep you posted, and hopefully one of these days I can be of some help to someone too!