Help for jaw neuralgia?

November 11, 2013 6:01 PM

In May, I went to my dentist for a deep root cleaning on my upper and lower teeth on the left side (with the right side to be done the following week). After the Novocain wore off, I had the usual mild soreness that has accompanied similar cleanings in the past. However, after a couple of days the pain started to migrate over to the right side (i.e., the side that had not been cleaned), at which point it gradually flared into an intense upper and lower jaw ache that was reminiscent of the pain of getting my braces adjusted or the pain that followed my jaw surgery about 9 years ago. The pain lasted off and on for about a month, then gradually went away – until...

...a couple months ago, when it flared up again on the right side of my face. This time, the flareup seemed random, and it lasted about 10 days, then faded. Today, once again seemingly randomly, it’s begun to flare up again (I can feel the telltale tingle above my right front laterals and into my sinuses, and the beginning of tenderness in my molars when I bring my teeth together).

I have seen both my primary care physician and my dentist, who both say that it bears some similarities to trigeminal neuralgia, except that the pain I’m describing doesn't match the pain that is usually associated with TN (which usually is described as having intense burning or shock-like pain, which is not what I’m experiencing at all).

My dentist suggested a pain specialist, who my PCP said she’d refer me to if it flared up again. I’ve sent her an email to request a referral this week, but I don’t know how long it might take to get an appointment with the specialist. In the meantime – has anyone experienced anything similar? Complication for pain control: I have a bleeding condition and generally have to minimize NSAIDs (ibuprofen, etc.), and specifically can’t take any NSAIDs currently because I recently had (a totally unrelated) surgery. Neither warm nor cold compresses have seemed to do much.

YANMDoctorOrDentist. Thanks.

posted by scody to Health & Fitness (7 answers total)

Response by poster: (Meant to link to trigeminal neuralgia info here.)
posted by scody at 6:02 PM on November 11, 2013

Best answer: You may want to try applying an ice pack to your temple on the affected side for an uncomfortably long time - it's helped with some trigeminal nerve-related stuff for me in the past. Can't hurt (except for iciness), might help.
posted by julthumbscrew at 6:24 PM on November 11, 2013 [1 favorite]

Have you noticed any weather changes with these things? As both me and my grandmother had facial pain such as you describe and I particularly notice it when the fronts come through. Sometimes I will get a cold sore (leading me to believe it is that virus) but not always. Sometimes it's just facial pain down my cheek. In which case, I will treat with a warm wash cloth to the face. And rest and soup and B vitamins. Have you been tested for the cold sore virus? Because that's been implicated in a lot of dental and other issues, and many people have it. So an anti-viral medication may help you.
posted by Marie Mon Dieu at 6:53 PM on November 11, 2013

Best answer: Often jaw pain that happens post-dental work is due to trigger points. Trying to keep the jaw open, not to mention receiving injections, can cause problems in the muscles of the mouth/jaw.

You might want to check the following jaw muscles. The red markings show where the pain is felt, and "X" marks the spots to work on. How to do this? Give each of the X marks 6-8 slow deep strokes (or at least to a point before it really hurts - it might not take much) ideally every couple of hours for a few days (i.e until the pain goes away). Some discomfort is necessary, but go to a level of "hurts so good" not "YEOW!".

Sternocleidomastoid

Masseter

Lateral Pterygoid - will require reaching into the back of your mouth. Keep your nails short.

Trapezius

Digastric - press up from under the jaw

Medial Pterygoid - see comments about the lateral pterygoid

I recently had trigger point work done for TMJ which required work on the pterygoids, and I swear I was back in the dentist's chair getting Novocaine shots for teeth extraction - 20+ years ago. Best of luck to you!
posted by sazanka at 8:08 PM on November 11, 2013 [6 favorites]

I'm a massage/myotherapist & attended a presentation last Sunday by a neurophysiotherapist on TMJ and I totally agree with working all of the trigger points sazanka listed, and any others you can find. Temporalis often likes to get involved, too.
I hope the specialist gets you in quickly. I'm interested to hear how you go.
posted by goshling at 11:01 PM on November 11, 2013 [1 favorite]

I have an intermittent but astonishingly crippling "TMJ" issue, and the one thing that helps is a muscle relaxant called methocarbamol -- sold OTC here in Canada ("Robaxacet" et al). Even fairly strong painkillers don't do much to help, but muscle relaxants are an entirely different story. Not sure if the underlying problem here is similar or not, but at least it is a simple low-investment thing to try. I am also helped by heat, but only quite a lot, like a heating pad on high for an extended period.
posted by kmennie at 7:34 AM on November 12, 2013 [1 favorite]

Response by poster: To follow up: intense icing on my temple and some trigger point therapy seemed to help -- things receded after a couple of days without becoming too intense. Fingers crossed that this was the last episode, but I definitely feel a little better-armed if it happens again. Thanks, everyone!
posted by scody at 12:25 PM on December 12, 2013