Dental Issue or Atypical Trigeminal Neuralgia?

How can you really distinguish between dental issues and atypical TN? My neuro has diagnosed me with TN but he has never mentioned that there are 2 types (TN and ATN). I've only learned that by my own research. If I indeed have TN, it is definitely the atypical type (constant pain in my upper teeth that NEVER subsides). I have been told by a dentist and endodontist that I have no remaining dental problems and that my teeth look great, but I find it hard to fathom that this pain could be anything but related to my teeth! How do you know the difference??? I'm so desperate for some relief from this endless pain! I'm currently taking 2400 mg of gabapentin a day with only minimal relief. :(

Two thoughts:

(a) You may need to be tried on other meds like Trileptal, Amitriptyline, or a booster drug like Baclofen or Flexiril in addition to the primary drug targeted on your Type 2 TN. A neurologist should be your managing physician to do these trials.

(b) The fact that you have no radiological evidence of dental abscess is a relatively strong indicator that what you are dealing with is actually neurological rather than dental in origin. The fact that Gabapentin gives you some relief, is a reinforcement of this observation. Sensation in the teeth is served by the second branch of the Trigeminal system. But pain in the teeth can also be created by damage to that branch.

If you have had dental procedures in the past to CORRECT dental problems, then you need to be aware that your Type 2 TN might have been reinforced or worsened by dentist error, particularly if deep injections directly into the lingual nerve were involved.

Be aware please, that I am not a medical physician.

Hi Gin,

I have teeth pain that has never been corrected by dental procedure. In fact, my TN exists as a result of an extremely aggressive dental procedure. I've had teeth pulled, so sure that the pain must be related to tooth decay or damage, but have come to realize that one of the most perplexing and deceptive TN symptoms is disguised as throbbing, shocking tooth pain.

A lot of people take neurontin, and initially it seems to address the feeling that your teeth are going to explode right out of your mouth. With a lot of people though, it stops being effective, and they go on to try other meds while still worrying in the back of their mind that something's wrong with their teeth. I've been assured by dentists & endodontists that no cracks exist, no cavities, no problems are detectable with my teeth. When I take antibiotics or steroids, my tooth pain ceases. But as soon as the treatment ends, it all comes creeping back. I took a similar dosage of neurontin after finally giving up and trying other types of meds. After getting allergic reactions to the carbamazines and going halucinogenic on the tricyclics, I tried effexor and klonopin, along with opiates. These have made my pain more manageable.

What confused me is that a dosage of Z-Pak or prednisone Always made me feel better temporarily. When you have teeth pulled, have root canals and apicoectomies and the tooth pain persists, you can be reasonably sure that it isn't your teeth causing the pain, but referred pain from a different type of injury, namely nerve damage. Don't stop insisting on trying every med there is to test. Because if you find the one that eases even half your pain, you can work with that. And improve on it by adding peripheral meds. When your teeth hurt so bad you can't sleep, talk or chew, and you've done everything you can do to rule out dental origins, then you find a specialist in pain who is familiar with the intricacies of TN and can help you with finding a solution to your pain.

I'm still tricked by tooth pain because it's so prevalent and immediate. But if you experience the additional symptoms of intolerance to wind, cold air, chewing pain, shocking sensations, numbing feeling in your facial tissue, taste disruptions, ear pain, jaw pain, don't mess around with your teeth. You're on a high enough dose of neurontin that it should be working for you. If it isn't, try something else. Don't give up, you have to persist until you feel comfortable.

Thank you so much Red, Colleen, and Cleo for all of this great information. :)