Question: Hello. Two part question. Recently had botox injection into the face for a facial pain condition known as atypical odontalgia, done by a neuro surgeon. Lip on one side is hanging down now where I have to lift it to brush teeth, etc and wondering if that will abate in time. Real reason for my inquiry, though, is that my neuro surgeon said that for atypical odontalgia ( which is a constant dull ache between two teeth) - that the best injection site would be into the gums but an ENT would be most skilled to do this. Just wondering if u have ever heard of this. Thanks so much.

Hi, doctor. First, to preface, I am very glad u are so familiar with AO, describing it perfectly. I have had AO for close to 40 years now on the upper right side and have had every dental procedure done known to man (actually, too many) which has exacerbated the condition, not mitigated it. Have had RCanals, gum surgery of every kind, dental implants, you name it. Have seen two specialist dentists who are well versed in AO and have had various nerve blocks (Stellate ganglion), prescribed many meds over the years (Elavil, Neuontin, Cymbalta, Lyrica, Baclofen, Trileptal and a host of others), none of which really help and make me ill. The reason for my question to u is my neuro surgeon attempted botox injections into the face but no result and commented that botox may be yet an option but he does not inject into gums and that would need a skilled ENT for some reason. Just wondering if u have ever done this (into the gums) and any adverse effects? I believe he said an ENT since injections may affect tongue, sinus, swallowing reflex, etc so an ENT is needed.