Facial Pain

[Seaoftroubles]

Two weeks ago, l felt a sharp pain in my gum/ jaw and since then have had pain on the right hand side of my face. It comes in waves and alternates between aching and stabbing pain but with occasional periods of relief when l think at last it's on the mend. But sadly that doesn't last very long.
It's all along my lower jaw on the right side and last week moved up into my ear. It can be dulled down with painkillers but l'm taking them continuously, including prescription strength Co codamol.
I've seen the Dentist and the Doctor but neither could find anything to cause it. They thought it might be a flare up of TMJD which l do suffer from occasionally but this presented differently and comparing it to previous bouts of Tmj l don't feel its that. Both the dentist and the doctor gave me antibiotics in case it was an infection but they've made no difference.
I do have gum recession and have regular periodontal treatment to manage this and l also had an extraction 6 weeks ago, but that was on the other side and an upper back tooth and has healed well. I've also tried wearing my bite guard but that made it worse. I've read about Atypical face pain and wonder if it might be that, l'm really not sure where to turn next. Any advice would be welcome as this situation is very depressing.

Sorry that was rather an essay!

Get your GP refer you to a specialist. There is a London hospital who specialises in this, NHS so there will be a wait. It’s a matter of finding the right drugs to manage it and pain management. I’ve lived with this for years. It goes up and down. My medication, Gabapentine works well with minimal side effects, you just have to give it time to work. Antidepressants work well for pain for some people. As it’s nerve pain paracetamol does very little. If you are in the uk let me know, I will pm you the details of the hospital. It’s shit but there are also significant months of calm that make it easier to cope with. I always think in a flare up “this won’t last forever” and it doesn’t.

Thank you so much SinisterBumFacedCat, my Doctor said if l wanted a referral l would need to go through my dentist! I am in the S.E so will pm you.
Do you know what triggered your pain originally as this came on suddenly, although it centred round a sensitive tooth that had been troubling me since my last periodontal deep clean. But since then it has behaved as l described.
I do have some in date AmitriptyIine ( which l've used for depression in the past) so wonder if that's worth a try as it's also for neural pain? I agree paracetamol doesn't help but ibruprofen takes the edge off and Co codamol works for a while.

OP sorry to hear you're going through this, it's painful, draining and demoralising. I know, because I could've written your post almost word for word. I've had this for a few months and am only just about to be seen at a dental pain clinic (Guy's hospital). I've had thoughts about ending it all recently, after waking up morning after morning with the same painful pressure in my back teeth, jaw, ear and temple. All on the right, like yours. I've tried amitriptyline but it hasn't touched it. Like you, cocodamol helps but only takes the edge off and I don't like living on the stuff. I've tried all sorts of TMD physio exercises but they give very little relief and I've given up on them now. Like you, I've been diagnosed with TMD in the past and have a mouth guard, but this is something else.

I wish I could offer you some guidance but as things stand I'm lost in it all myself at the moment

Do the glands under your jaw feel tender at all? Some days mine really do. I've had antibiotics for my ear, two courses, but they did nothing. That was the GP trying to throw stuff at the problem, bless him, and he also tried antifungal drops but that didn't work either. My dentist was lovely, saw me a couple of times and really wanted to help but confessed he couldn't, so he referred me to Guy's. Had to wait a few weeks for a telephone triage appointment but the doctor there agreed they need to see me. Waiting for an appointment date but he was sure it'd be this month 🤞

baroqueandblue, l'm very sorry to hear that you are suffering so much pain, it sounds soul destroying . I'm glad that you've been referred and hope your appointment comes soon.
In answer to your question, no, my glands aren't up and there's no sign of any infection The antibiotics were ' just in case'. My pain is mainly in my r. h. jaw, bottom teeth and ear. And not always at the same time. I don't have any pain in my temples or head.
Sorry the amitriptylene didn't work, l might try anyway just to see. Do you ever have breaks from the pain or better days? I have variations in the pain levels and my hopes get raised but it's nearly always lurking in the background. Please update on here and let us know how you get on at Guys. All the best to you.

This is so interesting as I also could have written your initial post! I had the initial sharp pain incident a good 18 months ago and since then my left left side jaw/cheek has ached on and off as described.

Been to GP and told me to go to dentist, went to dentist who had a feel and said couldn’t feel anything but referred me to our dental hospital for a scan anyway.

This was pre lockdown so that never happened,

Now had a letter about a virtual appt with the dental hospital and I am not sure what that will achieve at all!!!

I now have daily pain. If I look in the mirror that side of my face is swollen - it’s subtle but it’s there.

Googling has suggested something in the salivary gland such as a stone.

I just hope I do eventually get a scan. I can only suggest you push for the same??

If it's true nerve pain then the pain killers you list would do nothing. I've been in complete agony after taking strong co-codamol. And even numb from a dental injection and STILL in agony in the same area from the trigeminal neuralgia I have.
So it does sound like a different cause like TMJ or something dental may be to blame.

So it’s not only me! I too could have written the post 😕
Two weeks ago started with intense pain in all teeth on left hand side, jaw, cheek bone and ear. Had x- rays at dentist which showed nothing, nights with no sleep when even Codeine 30mg do nothing. Had to go sick from work as any little noise movement was excruciating to the point that I was in tears several times.
I went to A & E in desperation as my GP would only do a telephone consultations, Trigeminal neuralgia has been mentioned and TMJD.
I too could see my face was swollen on one side, my glands felt tender all underneath my jaw.
The pain has subsided over the last couple of days but im now unable to open my mouth properley.
I’m terrified it will return and dare not eat anything that involves chewing in case it flares up again.
Just out of interest has anyone tested positive for Covid? I had it in April and have had numerous health problems since.

So many of us suffering with facial pain! curleyfries it does sound like it could be TMJD, especially the inability to open your mouth fully, that's a classic symptom. If so, it will pass eventually. Asparagus spears, your onset sounds much like mine but l don't have any swelling. I hope you get your scan.

DrMadeleineMaxwell, very interesting that you say real nerve pain wouldn't respond to pain killers such as Ibruprofen and the strongest Co codamol. I'm beginning to think, as you suggest, that my pain might be a combination of both TMJD and some dental issues as l definitely get some relief, albeit short lived. Have you managed to find something that works for your trigaminal neuralgia?

Forgot to mention, started Amitryptaline after visit to A & E, pain has subsided since but might have resolved anyway, difficult to know.
Seaoftroubles- when I glanced at your post I thought you were suggesting I try Asparagus spears as they might fit in my mouth 😂
Hope everyone gets some relief soon x

curleyfries! 😂 At least l made you smile ( if that's not too painful!) l think soup or scrambled egg might be better!

Thanks OP. I was initially prescribed carbamazepine, which is what the NICE guidelines specify. One criteria for the diagnosis of TN is that normal NSAIDS don't work. Another is that pain relief is achieved with carbamazepine. I didn't react well to it but do take gabapentin and have done for 7 years + now. Few side effects and very good, but not complete, pain relief.

Dental mouth guards if you grind your teeth and/or physio can help if it's TMJ. If you google TMJ physio there's a booklet you can download of exercises to try at home.

DrMadeleineMaxwell thank you, l will check out TMJ physio. I'm still unsure if this is entirely TMJD as unlike my usual flare ups, this time l've had no trouble opening my mouth, and the pain has been different. I do have a very old dental mouth guard as l used to grind my teeth, but this time l found it didn't help at all. Maybe time for a new one as its the worse for wear now.
It's good that you manage your pain with the correct medication but a shame you are never pain free. I really hope you will be in the future.

Mine was triggered by a very sever infection in my tooth, worst pain my body had ever experience, I think my brain just couldn’t forget it! Honestly, childbirth was a doddle in comparison . Amitriptylin was originally prescribed but it didn’t work well. Also tried Prozac twice and it is not for me, kept me awake, every side effect going, pain subsided but I just couldn’t function on it. Gabapentine works because it slows down a lot of your bodies responses, so nerve pain is muffled. Bite guard, I use a soft jelly one that is actually a temporary guard traditionally used for bleaching, it is less hard, doesn’t push in around my gums and a lot cheaper! Sensitive toothpaste rubbed into my troublesome gums before bed, (oral b is better than sensodyne for this) and teepees to maintain gum health. If your getting swelling though that does usually mean there is an infection somewhere and antibiotics might help, it’s just you also need to address the facial pain. It will get easier, if you are at level 9-10 pain it will ease off.

Thank you SinisterBumFacedCat, l think my recent episode was also triggered by a very sensitive tooth. I shall definitely look into getting a soft bite guard as my rigid one seems to make things worse. I am under the periodontist so have regular sessions with her and, on her advice, use teepees and as you suggest rub sensitive toothpaste round my gums. It's never ending maintenance isn't it?

It’s bad enough keeping on top of all the paperwork too! I have pm’d you the details of the hospital Op. Ask your GP to refer.