tooth extaction and TN
 

Hey all,
Background:
My wife was having some minor tooth/jaw pain that slowly escalated over a period of 2 weeks. She then got a cold and subsequently a sinus infection. She began experiencing facial pain that was so severe we made a few trips to the hospital. After no diagnosis that seemed correct, doctors threw her on carbamazepine for TN. It may have worked, it is tough to say as she still wakes up in the night in pain (I think this is from grinding). The pain has now localized to one tooth and a number of dentists concur, the tooth is a problem. She has no feeling on one side (can't feel cold during the ice test), but pain when the ice is applied to the other side. They believe half of the root is necrotic and want to root canal or extract tomorrow.

She has been on antibiotics for 8 days now for the sinus and the pain seems to have subsided in the tooth. She is now hesitant to have the tooth worked on, but my feeling is that if the root has died something needs to be done anyways. TN can not be ruled out, and we can't say for certain if the carbamazepine has worked or the antibiotics have helped. I guess my question is, should she have the work done? Does this sound like a tooth related issue? The pain was always face and teeth and jaw and eventually localized to the tooth. At night, possibly after grinding the bad tooth, she wakes up with pain in the upper jaw and the sinus above. Sound like a tooth thing, or is there more going on here?

Thanks!

Hi tyler,

It is not unusual for an infected and/or fractured tooth to cause TN like pain. If both dentists conclude that the tooth is in trouble, then the tooth could be the main culprit and the sinus infection/pain may be a secondary issue related to the tooth. It is not unusual for an infected tooth to infect the sinuses.

To root canal the tooth ultimately means she will be keeping an unhealthy tooth. The root canal procedure can only treat the canals that are visible and accessible. The remaining microscopic canals remain infected with necrotic tissue. She will be addressing this tooth again in the future and her pain and sinus condition may become chronic from the infection remaining in the tooth.

To amputate the necrotic root means the other root harbors infection which ultimately means the same scenerio as above.

To remove the entire tooth means to remove the source of the infection. This means the sinus will no longer be irritated and will have the opportunity to clear up with antibiotics. As for the TN pain...... this may nor may not subside completely. There are different causes for this type of pain and if it is solely tooth related, hopefully once the tooth is gone, so is the pain. If she has a tooth grinding problem, that needs to be addressed asap because that could be a contributing factor to her TN pain.

Tyler, please let me know if this information was helpful to you. Keep us posted on how she's doing.

Bryanna

HI, thanks for the response!
She had the tooth extracted and the dentist said there was infection and small cyst at the root. The pain had subsided prior to the extraction likely due to the antibiotics she was on for the sinus. She is still taking carbamazepine, so we cant rule out TN for certain, but it certainly seems like it would be reasonable to blame the tooth.

I'll keep you posted!

Hi tyler.

It's a good thing she had that infected tooth removed. A cyst at the end of the root indicates that there was a long standing infection. I'm glad no one tried to talk her into root canaling it......whew!

I hope she can come off of the carbamazepine soon and hopefully her TN (like) pain will be gone.

Please do keep us posted!

Bryanna

Hi, thanks again for the reply.
She has a tiny white looking bump - it almost looks like a little bit of bone near the extraction site. Should we be concerned with this? There is no swelling, the site hurts a little still which I assume to be normal - what could this be?

Hi tyler,

The white bump could be a few different things...... a piece of bone spur; a small ulceration which will go away on it's own or a fistula which is similar to a pimple that infection is draining through. I assume she has a post operative appointment with the dentist within the next week? If not, she should make one so he can evaluate the extraction site.

She should still be rinsing with warm salt water 3-4 times a day and continue to do that for another 2-3 weeks minimum. The rinsing helps to clear food debris from the site and the salt aids in the healing process.

Thanks for keeping us informed...... please continue to do so :-)

Bryanna

I had an old root canaled tooth REinfect and i was having all sorts of weird face pain. At the time we didnt connect the two things, and it was suspected mild TN. I have MS, so thats not uncommon in my disease. After the clean up of the infected tooth, and fixing the mess it left behind, all my weird facial things simply went away. I was so relieved to know it was my tooth, and not my mylin being eaten away.

I hope things resolve with some good dental care.

Hey, quick update! I took another look at the white bump - it is actually just where the suture is re-entering the tissue. The sutures are white and almost look like fishing line...

So far so good - some face pain, but different from before. It is more of what would be expected after having a tooth pulled vs. the previous mystery pain!

Fingers still cross...post op with the oral surgeon on Tuesday, MRI next month, and neurologist in june...still cautiously optimistic that it was dental.

Whew..... glad it wasn't a "bump" of some sort afterall!

Crossing my fingers too for good news next week! Please keep us posted.

Have a nice weekend!

Bryanna

What I wouldn't give for my pain to be just dental in origin. Not that I'm downplaying tooth pain, but that can usually be remedied easier than TG. Thankfully tho, I have finally found relief for my TG with Trileptal (oxcarbazepine)...at least for the past couple days.

Best wishes for your wife's health....and yours.