Trigeminal neuralgia/tooth ache after root canal - has anyone had a root canal repeated?

[Thomasthetank]

Hi, I've recently been diagnosed with possible trigeminal neuralgia by my GP after suffering electric shock type pains in the left hand side of my face/gums/teeth and am being referred to a neurologist because of my age (40). The neuralgia symptoms have occurred for about a year but have worsened recently and I've been started on Carbamazepine.

I had root canal on a second premolar tooth at the start of the year, the tooth was very painful prior to the treatment and took a long time to settle afterwards. For the last week the tooth has been constantly throbbing, aching and my gum around the tooth has been stinging. Tapping the tooth, cleaning my teeth and eating/talking is painful. It is a different pain to the electric shock type trigeminal pain I get in my face. I went back to the dentist today who x-rayed the tooth and couldn't see anything wrong with the original root canal treatment or any signs of infection.

I've now got the choice of paying £600-800 (which we don't have at the moment) for a private dental specialist to assess my tooth and repeat the root canal to see if it makes any difference. Alternatively my NHS dentist can either extract the tooth or have a go at repeating the root canal herself although she doesn't think there is anything she could do differently to the tooth. I don't want to extract the tooth if there's a chance the neuralgia could be causing the pain but I also don't want to be in constant pain from this tooth which is far worse than the neuralgia pains.

Has anyone had a second premolar removed? I'm worried it will be really obvious that it's missing and I don't really want to start messing about with the healthy, non-problematic teeth either side to have a bridge put in.

Any advice would be really appreciated.

[MedusaIsHavingaBadHairday]

To be honest I wouldn't let the dentist anywhere NEAR your teeth, and certainly not before you have discussed it with the Neuro.If anything it sounds like your medication dose needs to be upped..a lot... to see if that dampens the pain.

It sounds VERY likely to be related to the TN.. TN can have a severe constant pain as well as the shocks..mine did. I had three teeth unneccesarily removed before we realised.

Carbamazapine made me sick so I was switched to Gabapentin (which worked thank god) but I had to be on a HUGE dose to get all the pain..shocks, burning, sensitivity under control..I'm on a permanent maintenance dose now.

I recently had to have a minor filling and even that sparked the TN back up and I had to up the meds again. If the dentist can't see a reason for repeating the root canal (and personally I believe messing about with the face unless vital is a bad idea) I would see the GP..ask for more/different meds (to give you an example at my worst I was on 3600mg a day of Gabapentin..a HUGE dose) and try treating the pain that way first.

Hope it improves soon.. I am terrified of mine returning fully.

[ukatlast]

In your shoes I would try the private root canal retreatment. It has worked for me in the past. Make sure you go to an endodontist using a microscope though.
As Medusa said I wouldn't have an extraction though as it could be the trigeminal neuralgia causing the problem.

I would not be willing to sit around for months for an NHS neurology referral with extreme tooth pain. The retreat might bring instant relief. A decent endodontist should have a view on whether trigeminal neuralgia is involved. They will definitely know more about teeth than a neurologist.
www.dentalfearcentral.org/faq/root-canal/

[ukatlast]

Imagine how annoyed you will be if the tooth is extracted and the pain is still there. Horrible situation - hope you get sorted soon.

[ukatlast]

Could you see a neurologist quickly privately to get appropriate drugs?

[Thomasthetank]

Thanks for your advice, it's really helped. Medusa, I didn't realise you could get a constant severe tooth ache pain in just one place from the trigeminal problem, I thought it was just the stabbing aching pains. That makes sense now. Maybe I never needed root canal in the first place! The last thing I want to do is have expensive root canal work repeated without ruling out it being caused by the trigeminal neuropathy first. UK, you're right about paying for the work and still being in pain after, I keep thinking of all the things I could buy for my children instead.

My Carbamazepine is 100 mgs twice a day for this week, I'm due back next week and she will up the dose for me. I need to be on at least 800 mgs a day to help with the trigeminal pain according to the leaflet in the box. So far I haven't had any side effects such as nausea other than feeling slightly drowsy at times (I tried Amitriptyline for a month which made me groggy and the Carbamazepine makes me feel less so) so I'm hoping I can up it to the 800 mgs fairly quickly. I'll also ask about the Gabapentin as that will be the next thing to try if the Carbamazepine doesn't work.

I'm not sure how long my neurology appointment will take, the referral is due to my age as my GP says I'm too young at 40 to have constant attacks of pain. Medusa, what symptoms did you get before you managed to get them under control with meds? It's getting so I daren't go out in the wind etc because it will flare up again. I've read about operations but the risks= of things going wrong sounds
worrying.

[Thomasthetank]

Also meant to say that my problems with the trigeminal neuropathy first flared up after a bout of severe sinusitis requiring antibiotics and having two large deep fillings replaced in my upper wisdom teeth. We moved house and I had to leave my lovely Denplan private dentist behind (I did debate if I could drive 140 miles back for check ups!). We swapped to an NHS dentist in the area who told me I needed the two fillings replaced. He did the numbing injections and fillings very quickly, in fact he started straight after the injection when I wasn't yet numb and I was in and out in six minutes. I'm sure that this rushed dental work has contributed to the problems with my trigeminal nerve. I've since changed dentist to a lovely NHS one who takes her time and did the root canal work before I was diagnosed with the trigeminal neuropathy. Will have to see what the neurologist thinks.

[2kidsintow]

Hi, Thomas. I have TN and it first showed up as tooth pain. I had a tooth extracted in the end, then was confused when the pain kept on coming back. 2 separate dentists confirmed that it wasn't my teeth and that's when I went to the GP.

100mg of carbamazepine is far too low to get comprehensive pain relief. You should see some improvements when you up your dose. Take care about doing it slowly though as the side effects can be horrible.

I had to come off that drug because of the side effects and swap to gabapentin, which is working for me.

I was still getting terribly, agonisingly sore and sensitive teeth and bought a mouth guard as I thought I might be grinding them, or that my bite may have changed as a result of the extraction and that this was the cause of the pain.

Nope - as soon as the gabapentin started tackling my face pain properly (almost completely) then the sensitivity in my teeth died away to nothing.

Good luck with the referral. I saw my neurologist privately as I didn't want to wait, and had an MRI/MRA yesterday to look for abnormalities/compression of the nerve. Most times the pain isn't caused by treatments, but the treatments are done as a result of the pain starting and us seeking medical help. You said that you needed 2 fillings replacing - was this because of pain or because your dentist thought they needed it on looking at them?

[Gremlingirl]

Do painkillers touch the pain at all? I ask because I had a attack of trigeminal neuralgia a few years ago and that was one of the things that pointed to it being TN rather than toothache. Because TN is nerve-related, normal painkillers (I was mainlining ibuprofen!) don't tend to do anything.

[MedusaIsHavingaBadHairday]

I had the shocks..but first mine started with a sort of deep ache in my teeth that sort of burned ..along the facial nerve, and ended smack where the nerve ends mid face...in retrospect that was a clue it wasn't 'just teeth' but if FELT like teeth.

My dentist couldn't find a major problem but decided to remove a slightly cracked tooth..the pain stayed.. then another... you get the picture.

I was in almost constant pain with stabs on top.,. it was incredibly grim. Amazingly it was my GP who first realised..she'd just been to a conference on nerve pain.. and she had me on first carbamazopine, then gabapentin even before I saw the neuro.

As I said.. it took a huge dose to get it under control for me, and even now (and we are talking 5 years later) I have to maintain a lowish dose and up it at the first sign. Cold winds can still trigger it and ANY dental problems or work spark it up. I am now missing several teeth (thankfully at the back but you can see if I really grin) and can't risk a bridge or implant as it is almost certain to spark the TN up.. :(

Once you have enough medication in your system I'm willing to bet your tooth pain will vanish.

Oh and the weird side effects of massive doses do wear off... though I was VERY spaced out for a while!!

[2kidsintow]

In part, I'm glad I was a wimp. I was offered the choice of root canal or extraction and opted for the extraction as it was quicker, wouldn't be seen if I smiled and it was a tooth that had been very damaged when I was younger.
If I'd had the root canal, I'd have been going back to the dentist and being in the same dilemma as you.

Don't re-do the root canal.

As for a wait on the neurologist - it really depends as to where you are and whether the GP has flagged it as urgent referral.

I paid to go private. It gave me peace of mind because my neurologist confirmed the diagnosis and gave me a second opinion about my medication and dosage. In England, they are supposed to have seen you AND done any initial investigations - e.g. the MRI/MRA scans they should refer you for - within 18 weeks. Here in Wales it can be a 26 week wait just for the initial appointment.

[Thomasthetank]

Thanks everyone, the Gabapentin sounds well worth a try if i get no relief with the carbamazepine. Normal pain killers don't touch the pain, even hospital strength Ibuprofen and codeine etc prescribed by dentist. The amitriptyline took the edge off the pain so that i could concentrate on other things for some of the day rather than than agonising pain but I was too knocked out on a low dose even after a month. I didn't have any pain until i was told the wisdom teeth fillings needed replacing. I'm back at my gps this week so will try to get the referral as urgent rather than routine. I'm definitely not doing anything to my teeth!

[Thomasthetank]

Medusa, that's exactly what i was trying to explain to my dentist. I'm sitting here now and my teeth at the front of my mouth are burning, coupled with intermittent stabbing pains. Burning teeth is a really hard thing to describe.

[Dodgeball]

I just started having an excruciating burning/tearing feeling in my back lower gum. I ended up going to the endodontist for a root canal, which was two days ago. The nerve pain is still there.

I'm trying to figure out if this is TN related or teeth related. I only get the pain when I try to drink and eat---seems like moving my tongue Around the area triggers the pain inside my mouth. Sometimes talking. I'm at the point where I have to pretty much drink from a straw to eat soup or shakes and drink, which helps a little....or endure the pain.

Does this sound like TN?

[ootsideinbacktaefront]

It's really comments for people to get lots of extraction etc.. Before a diagnosis of T. A.

[colhoo]

I have intermittent stabbing shooting pains and what seems like low level toothache, but higher into my jaw and cheek. I am seeing Dr tomorrow and think it will turn out to be TN related.

I just wanted to say to check with doctor before allowing any dentist to talk you into having an extract, root canal and charging a fortune for it. I have little faith in dentists - I had root canal/crown by private dentist 4 years ago and 2 weeks after complained of pain, for which he gave me antibiotics. I returned several times over the years with same complaint. Four years later, went for the same problem, got antibiotics and was offered two things – an extraction (which they pushed me for even before the antibiotics had finished, or charge £800 + for a further poke around root canal to see if it could be improved, but without any guarantee that there would be a result. They rang me twice after, both within weeks, about the extraction and I informed them not at this time.

Three months later, visited family in Europe. Had pain. Brother in law a dentist- he checked the root canal and low and behold he was amazed to find that the UK dentist had left two pieces of broken instrument in my rear tooth. That would not have been an issue had the root cavity beneath been cleaned out and sterile, but the UK dentist had blocked the path to the nerves by jamming it with the instrument and left it, resulting in putrifying crap underneath, causing infections. ( That rogue dentist never one mentiond to me that this had happened and led me to believe it was all clean.) I then received extensive sessions to free the broken instruments, which was very difficult and risked breaking the tooth altogether, including sessions of lazer to kill off bacteria and a new replacement crown..

Now I know why the UK dentist had wanted to extract it, as they had caused the problem and it was easier to remove it. They would have taken nearly a thousand pounds off me and pretended to do something for nothing. It then made sense for their urgency to extract it. Most dentists do all they can to retain teeth rather them remove them. Needless to say not going back there.

[christiangal]

So I had some pain when I drink cold or hot things so I went to the dentist and they determined it was my bottom left molar. They did the cold test on it and I about jumped out of the chair. So they said because it was a molar I needed to go to a specialist. I went to The Specialist a couple weeks later and she performed the root canal. She said I would be mildly sore but I should be completely back to normal in 5 days so I got home and as soon as the novocaine wore off the left side of my jaw was excruciatingly painful! I couldn't even move it to eat anything. Luckily I had gotten Vicodin from her so I started taking those and it helped a little bit but it started getting progressively worse. One week later I called and they had me come in to my regular dentist and he checked my teeth and said everything looks good you have a small mouth we probably just over-extended your jaw and it's just going to be sore for a while. He told me he was not going to give me any pain medication because I didn't need it even though I told him nothing was touching the pain. So the following Wednesday 5 days later I went to my primary care doctor. She thought maybe it was my jaw and then it had triggered TMJ. I told her I never had jaw problems before though. So she prescribed a muscle relaxer and a prescription strength ibuprofen. the muscle relaxer helped a little bit. By Friday evening the left side of my face went numb I called the on-call nurse and she said I needed to go to urgent care. Saturday morning I went to Urgent Care and that doctor again thought it was my jaw and gave me a shot of Tramadol in my butt and a prescription for prednisone steroids. Then I called the dentist again and they had me do an emergency appointment that day with a different Dentist. He did all kinds of tests poking me on my face tapping my teeth and said he had no explanation why I had such severe jaw pain and facial numbness. He also did a Panoramic X-Ray and said that not only that all of my teeth look fine so did my jaws .he said to come in and see the oral surgeon on Monday as an emergency. So that is today. So I went in and it was the lady that did my root canal she did all kinds of tests and could not figure out where this pain was coming from and suggested that I come in day after tomorrow to see an oral surgeon and I told her I thought she was the oral surgeon because that's who they said I was going to see today. She said no she's an endodontist and just does root canal therapy. So she left me in the chair for 40 minutes came back apologized and said that she called two different surgeons on the phone and neither one of them had any idea as to what was causing this pain. They suggested I see a neurologist. I asked her what she thought about the possibility of nerve damage and she said that my face would have been numb from the beginning not have gotten numb 2 weeks later. So I emailed my doctor all of the events from today and she still said it sounds like trigeminal neuralgia. However she's ordering an urgent MRI and neurology appt.. I have no idea what to think anymore this all started as soon as the novocaine wore off but the dentist is trying to tell me it's a coincidence. On a bright note the tooth that I had the root canal on isn't bothering me anymore!

[SinisterBumFacedCat]

Hi Op, if you are in the U.K./South ask your GP to refer you to the Eastman Dental Hospital in Kings Cross, London. They specialise in this and will properly diagnose you before finding the correct medication, they will also do a full examination. Waiting list for appointments aren't too bad and it's NHS. Even if you are not in the south it's worth it, GPs notoriously over diagnose TN when there are a number of dental/facial pain conditions. That might explain why the carbamazepine isn't touching it. Gabapentine works for me. Try not to have any more dental work as you'll probably just aggravate it more. It's a nerve problem with the pain receptors in the brain, not the teeth, which is why epilepsy drugs and anti depressants, which slow down your system work, but anti inflammatories and opioids are useless. If treated properly it will reduce.