HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

For Dr. Spaho - Hi, Doctor. Hope All Is Well.

Posted on Mon, 31 Aug 2020

Question: For Dr. Spaho - Hi, doctor. Hope all is well. I need to ask just one very important question since u have been with me through all of this for some time. I just got word that I finally can get in to see the neuro-surgeon for that botox injection. As u know, I have the atypical odot. on the right side and the TN2 on the left side and currently, both are bothering me quite a bit. Would there be any risk or down side in having doctor inject both sides during same appointment or better to do one at a time? Thanks so much.

Answered by Dr. Dr. Erion Spaho (18 hours later)

Brief Answer:
In my opinion, one side at a time.

Detailed Answer:
Hello again and thank you for your question.

In my opinion, it is better if you will have one side at the time done with injections.

This because there should be several points of injections on one side (up to 12) and some degree of local discomfort may be present in the first days.

The possible adverse effects of these injections are very rare and mild ones, so, don't worry about any serious adverse effects.

Anyway, the decision to do one side or both, remains a choice of the treating Doctor.

Hope I helped you so far.

In good health

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (3 hours later)

Yes, good point and one his nurses told me on phone today; that he will decide at appointment if one or both should be addressed. One more quick question I broached with the neuro surgeon who agreed with you that teeth and gum discomfort are oftentimes part and parcel of TN2 and mimic dental issues. Just one puzzling component for me is the primary pain is located in one tooth vs. many (the very front tooth; adjacent teeth quiet.) Could this be where the trigeminal nerve is most inflamed due to extensive dental work done on that tooth? And before I go and do something else wrong and have it extracted, of course the botox will be tried next, but could tenderness of that tooth all be attributed to TN? Sometimes, I can barely go near it, so tender to the touch and throbs.

Answered by Dr. Dr. Erion Spaho (20 hours later)

Brief Answer:
I would explain as follows...

Detailed Answer:
Welcome back,

Even if you extract that tooth, there is a risk for persistent pain or tenderness (phantom pain).

it is possible that one terminal branch of the trigeminal nerve to be irritated/damaged even though dental work and the symptoms may be similar to the TN.

So, I still think it is worth trying botulinum toxin injection, it may relieve significantly your symptoms.

Hope this helps.

Take care

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (3 days later)

Hi, doctor. Just an important two part question since botox injection is 2moro.
Some inflammation was removed on the gum very near the AO today and has exacerbated its intensity of pain/symptoms. Will this infringe on the benefit of the botox in any way or make no difference to the result? I'm hoping it will make no difference since if I cancel, surgeon's next appt is not until November.
Also, his nurse told me that the benefits really don't kick in immediately and that it takes some time (she said a few weeks) - and if so, why the delayed benefit? Thanks as always.

Answered by Dr. Dr. Erion Spaho (21 hours later)

Brief Answer:
I would explain as follows.

Detailed Answer:
Hello again,

The injections in your case, aim to improve the symptoms, so, since yours is neuropathic pain, there is no reason for botulinum toxin injection to fail.

The results are seen from 2 to 15 days after the injections, this is mainly related to the botulinum toxin mechanism of action.

In conclusion, in my opinion, in your case, it's worth it to try the injections.

Hope this helps.

Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (2 days later)

Hi, doc. Only have 2 hrs left on this discussion so wanted to ask u a question after having botox inj. few days ago. It seemed to help the TN2 but paradoxically, the atypical odontalgia on the upper right side is high in intensity of that constant ache. I asked his nurse about possible injections into the gums (he injected face) but she said he does not do inside of mouth. Wanted to ask u if gums is something worth pursuing or just stay with face trigger points? Also, one more quick question. With this AO and this aching, isn't this more a nerve in the brain firing vs. anything trigeminal? He wants to do one more try with Botox after 3 months. Just want to get your opinion on if it's worth pursuing.

Answered by Dr. Dr. Erion Spaho (2 hours later)

Brief Answer:
I would explain as follows.

Detailed Answer:
Hello again.

The injections of botulinum toxin for AO should be done on certain points on the gums.

The origin of atypical odontalgia is thought to be peripheral, not central, so, it's unlikely for a nerve to be irritated in the brain and symptoms to be located only in certain areas around the teeth.

In my opinion, you should pursue the injections on the gums too for the AO.

Hope I helped you.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Erion Spaho (41 hours later)

This is so with symptoms primarily located in gum between two teeth, intensifies when gum is manipulated and ache radiates into neck. Just to clarify (since neurologists have had a myriad of opinions on AO from being trigeminal in nature to fifth cranial nerve), you would lean most toward solely peripheral considering these symptoms and if so, I assume the meds I'm on best address any relief (Neurontin, amitriptyline)?

Answered by Dr. Dr. Erion Spaho (16 hours later)

Brief Answer:
I would explain as follows.

Detailed Answer:
Welcome back.

It seems that the trigger is located peripherally, in addition, this is the mechanism mostly accepted at the base of AO.

The drugs that you used are correct for this condition.

If the drugs fail to improve your condition, other more invasive procedures are indicated, that's why I suggested you to undergo botulinum toxin injections.

Hope I helped you so far.

Take care.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Erion Spaho (3 hours later)

Yes, doing a follow up now re: botox into gums but a daunting search. My neurosurgeon only does face so finding a specialist who injects into gums is difficult at best. Two quick questions. I assume the botox would be the better option vs. any kind of nerve block? And second, have u personally ever done injections into gums? Reason I ask is that they tell me it is a bit more tricky than face since care must be taken to avoid adverse affects in the tongue, swallowing mechanism, etc. However, equating risk with gain and hopefully, any effects would be temporary, I will continue searching for the approp. doctor. Thanks so much, doctor, for all your excellent advice.

Answered by Dr. Dr. Erion Spaho (22 hours later)

Brief Answer:
I would explain as follows.

Detailed Answer:
Hello again.

It is not a difficult procedure injecting the gums with botulinum toxin, it is similar to the face injections.

I don't work with these types of injections, however, here, at my workplace, colleagues that apply it report for satisfactory results.

There are studies too, that support the botulinum toxin injections as a safe procedure compared to other nerve block techniques.

So, find the right Doctor and have these injections done.

Hope I helped you. Greetings.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng