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Dr. Behere
Dr. Behere, Dentist
Category: Dental
Satisfied Customers: 1979
Experience:  Masters degree, years of experience with all kinds of dental problems.
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I have chronic pain in my lower right side jaw and gum

Resolved Question:

I have chronic pain in my lower right side jaw and gum area that has now lasted for 3 years ever since I had an ill fitting bridge placed. I have seen all the experts and tried all the meds. I''ve tried antiseizure meds, antiinflammatory, antidepressants,narcotics,injections of steriods and marcaine to the tmj area. I recently was very excited to get a botox injection to this site as I JUST KNEW this would be the answer, well, it wasn''t. I have done microcurrent therapy with some relief but it requires a great deal of time daily and I have a young family and a consumming nursing job that makes that tx almost impractical. I have spent hours surfing the web trying to google key words to find that one person out there with the answer and tx. Please someone direct me. My pain is daily, constant with a few variations. Sometimes the burning changes to intense ache and very rarely I have some shooting pain. Please, somebody give me another idea to check out.   Thank you. Dawn in Montana
Submitted: 6 years ago.
Category: Dental
Expert:  Dr. Behere replied 6 years ago.
Hello,

Thanks for putting up your question on Just Answer.

Before I answer, can you please supply the folowing information :

1. Were X rays of the TMJ made ? Any diagnosis given?
2. Do you hear a clicking noise when you open or close your mouth ?
3. Is the bridge still there ?

Regards,
Dr. Behere.
Customer: replied 6 years ago.
Yes, xrays and an MRI was done which was found to all be normal. No nueromas or and abnormalities. I have no clicking noises. The bridge was removed about 5 months after it was seated. When the bridge was removed the dentist noted that the pontif (sp) was especially large and the tissue under the bridge was weeping serous and the tissue was white and gray in color, almost like a mascerated look.
Expert:  Dr. Behere replied 6 years ago.
Hello,

Thanks for responding.

From what I gather, the illfitting bridge, in the 5 months that it was there in the mouth, has caused havoc with the tissues in the lower right jaw region.

What I dont understand, that if no organic problem with the TMJ was ever found, if all X rays, MRI studies were normal, no clicking noises, no pain in the TMJ, then why was therapy direceted towards the TMJ ?

In fact would say that you are lucky, that so much intereference in the working of the joint did not worsen the situation.

Now, you have tried antiinflammatory meds,antiseizure meds,injections,botox,microcurrent tx,root canals, apioectomty,MRI, narcotics, antidepressants, fentanyl patches.

Phew, thats quite a list.

Has anyone considered a flap surgery in the area where the bridge was ? It is possible that therapy was misdirected all this time. The bridge probabaly was improperly constructed and it caused a deep seated gum infection. The periodontist could open up the gums there, curette out the area( clean it) and suture the gums back on again.

Or , if the X rays show significant bone destruction there, the teeth involved could be extracted ( fi they have a poor prognosis).

We need to focus our treatment locally, in the are of the bridge. Thats where the problem lies. Taking tablets and capsules isnt going to do a great deal.

You mention that the pontic was very large when the bridge was removed. Maybe that is interfering with your occlusion ( biting arrangement). That should be reduced in size ASAP.

I know this is not the answer you were probabaly hoping to get, but sometimes the problem is very simple and can be overlooked in the wake of expensive and lucrative investigations like MRI.

Hope this answers your question. Feel free to contact me again for more information.

I wish you a speedy recovery !!!

Regards,
Dr. Behere.

If my answer has helped you, please click on the *ACCEPT* button and give me *POSITIVE FEEDBACK*. This tells me that my advice was indeed beneficial.
Customer: replied 6 years ago.
The tx has not been directed towards TMJ but instead the junction of the nerve branches, that is why I have rec'd the external injections in this area. When I have rec'd the marcaine and steriods the pain is instantly gone. I have had a complete blood work up and there has been no obvious elevations to indicate infection, of course that would not pick up local infections right? I have three teeth that are gone with only the last tooth which they were trying to save as an anchor in case I got another bridge. Could a local infection in the gum/bone cause this pain which seems to act like nerve damage? I agree that I need a local solution and I am searching, I am SO done with pain meds but right now it's the only way I can live and be sane. One more thing, I never have the pain upon first rising in the morning, almost like a positional/pressure issue. Can nerves respond that way? Sorry, so many ?'S. I'm just reaching out. There's so many people with great brains that I just need to pick. Also, no bone distruction and no improper bite as there is no teeth to oppose.
Expert:  Dr. Behere replied 6 years ago.
Hello,


A local infection in your gums/bone is not likely to mimic pai thjat is due to nerve damage.You might be suffering from neuralgia.

Is the pain sharp and stabbing ? Does it come on any random time during the day ?

Another question, is there is feeling of numbness or reduced sensation from anywhere in the mouth ?

Regards,
Dr. Behere.

If my answer has helped you, please click on the *ACCEPT* button and give me *POSITIVE FEEDBACK*. This tells me that my advice was indeed beneficial.
Customer: replied 6 years ago.
Neuralgia is my official diagnosis right now. I do get sharp stabbing pain but not as often as the CONSTANT burning and ache. I do also have some altered sensation to the lateral side of the tounge which is directly across from my injury/pain. Other than having the procedure of a complete perminate block such as having the nerve clipped or the radiofrequency ablation is there any other thing you have heard of. I even tried to talk my dentist into doing a daily block but he said no. Do you think that the old type analgum (sp) could have wept into the opening from an old filling while I had the opening under my bridge? I will look forward to your answer. I understand this is a quick question web site and I have probably exceeded my quota of ?'s. I just hope that you have heard of something new and upcoming so I have something to look forward to. Thank you again.
Expert:  Dr. Behere replied 6 years ago.
Hello,

You are prepared to take a daily block ? I think you are the most fiercely motivated patient I have seen till date on Just Answer.

I suggest a very simple solution, if you do indeed have neuralgia.

I have successfully treated patients with neuralgia adopting the following approach. It is non invasive, guarenteed and life long.

Start taking tab. Tegretol ( Carbamexapine) 100 mg, 5 times a day. That would be a total of 500 mg of Tegretol in a day.

If you get complete relief, tell yourself that you will have to take this tablet throughout life. If there is partaila or no relief, gradually keep increasing the dose, till you reach a maximum of 1200 mg a day.

I am positive that you will get relief at this maximum dose, if not lesser thant that.

Carbamezapine is a part of a a group of drugs called anticonvulsants. It works by decreasing nerve impulses that cause pain.

You can read more about it at http://www.mentalhealth.com/drug/p30-t01.html

and http://www.drugs.com/tegretol.html

Dont worry about exceeding your quota of questions, there is no such thing. You can ask me 50 more, no problem !!!

Again. im sorry, you probabaly expected ,me to tell you a miracle cure that has just been invented, but neuralgias are best treated by the way I have outlined above.

And I really dont think this problem has been brought about by the old amalgam filling.

Hope this answers your question. Feel free to contact me again for more information.

I wish you a speedy recovery !!!

Regards,
Dr. Behere.

If my answer has helped you, please click on the *ACCEPT* button and give me *POSITIVE FEEDBACK*.

A * BONUS* will be highly appreciated. This tells me that my advice was indeed beneficial.
Dr. Behere, Dentist
Category: Dental
Satisfied Customers: 1979
Experience: Masters degree, years of experience with all kinds of dental problems.
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