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Hi, Doctor. I Truly Hope U And Your Family Are

Posted on Sat, 27 Jun 2020

Question: Hi, doctor. I truly hope u and your family are well. It's been some time and I need some clarity. As u know, I have the AO on the upper right side in one specific spot but on the left I have some burning and throbbing in the upper left gum and a front tooth that is off and on very sensitive and also throbs. It has had root canal so ostensibly the nerve should be dead, yet it remains sensitive. In your experience with TN2 (this is what the neurologist diagnosed many years ago when only the gums were sore and not the tooth at that time), I'm just trying to determine if this front tooth issue is part of TN2 or a dental issue.

Answered by Dr. Dr. Erion Spaho (7 hours later)

Brief Answer:
More likely of dental origin.

Detailed Answer:
Hello again and thanks for asking me directly.

I have read your new question.

In my opinion, the issue is more of dental origin than the trigeminal neuralgia type 2.

This because trigeminal neuralgia type 2, in general, is not confined only on the gums, other areas of the face are affected by the dull constant ache as well.

So, an evaluation by an experienced Dentist and x-rays of the area should be done, in my opinion.

I hope this helps.

Feel free to ask if you have further questions.

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

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

Hi, doctor. Yes, I have seen and have been evaluated by a number of dentists, endodontists, etc with numerous x-rays which show a normal root canal. However, as u say, it still could be dental in origin. With the throbbing in the gums, the lit up sensitive front tooth, I also have pain going thru left nostril and an intermittent tic under left eye. Two part question - could u please tell me the usual symptoms of TN2 and also, I have both Neurontin and Trileptal.
Which would be the better of the two for this or would taking them together be ok. Also, any other med u have found to be effective for this? Thanks so much.

Answered by Dr. Dr. Erion Spaho (12 hours later)

Brief Answer:
Answered below.

Detailed Answer:
Welcome back.

Trigeminal neuralgia type 2 symptoms include constant aching, burning pain located near lips, eyes, nose, scalp, forehand, upper and lower jaw.

The pain may be triggered by touch, strong sound, etc.

Usually starts with symptoms of TN (stabbing pain) that with time becomes constant.

Trileptal is used as a first line drug for TN2, and may ease your neuralgic pain too.

Hope this helps.

Best regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Erion Spaho (49 minutes later)

Thanks, doc. Last question - going to neuro surgeon end of the month to discuss that botox injection you suggested for the AO. Would this same injection possibly help with the TN2 as well? The medication just isn't working.

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

Brief Answer:
It should work with TN2 symptoms either.

Detailed Answer:
Hello again.

Botulinum toxin injections in cases like yours aim to improve the neuralgic pain.

It should improve the symptoms of TN2 as well but works better in cases of local nerve irritation such as AO.

So, in my opinion, since the medication isn't working, it is worth trying botulinum toxin.

I hope you found the answer helpful.

Regards.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Erion Spaho (17 hours later)

Doctor, sorry to bother u again but your office just e-mailed, encouraging a question before this particular discussion closes out. I know u said this type of TN makes the gums burn and ache (which I have) but not often a tooth. Before I go for yet another root canal (on the same tooth) where even the dentist is hesitant to do (numerous dental procedures done) - is there a chance that the trig. nerve is so inflamed that it is referring pain to this tooth, making it throb and be very sensitized even to the slightest touch?

Answered by Dr. Dr. Erion Spaho (6 hours later)

Brief Answer:
Yes, it is possible.

Detailed Answer:
Welcome back.

Yes, it is possible for the branches of the trigeminal nerve to be irritated and the pain or sensitivity changes to spread in the adjacent areas including teeth.

The botulinum toxin injection aims to stop these amplificated impulses responsible for the symptoms.

Hope I helped you so far.

In good health.

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

Follow up: Dr. Dr. Erion Spaho (1 hour later)

Just a quick ques. since the pain is so bad and I have a month's wait yet to see neuro surgeon. Any topical u could recommend (R/X or otherwise) to alleviate pain? I have pure lidocaine here and of course, the Ora-Gel type OTC meds but the trig. nerve must be badly inflamed and they are not really helping at all. Oh, also, would best placement be directly onto gums? Thanks, doc and take very good care.

Answered by Dr. Dr. Erion Spaho (17 hours later)

Brief Answer:
Lidocaine may control the pain.

Detailed Answer:
Hello again.

I think that lidocaine solution applied directly on affected area, ( gums ) should control the pain.

It should be used periodically depending on the pain intensity.

Hope I helped you so far.

Take care and best regards.

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

Above answer was peer-reviewed by : Dr. Raju A.T