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Ask Dr.Fazeli Niaki Your Own Question

Dr.Fazeli Niaki
Dr.Fazeli Niaki, Dentist - Prosthodontist
Category: Dental
Satisfied Customers: 69
Experience:  Doctor of Dental Medicine, MClin Dent Prosthodontics
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I have very severe lower left jaw pain radiating, cramps like,

Customer Question

I have very severe lower left jaw pain radiating, cramps like, throbbing pain starting from below my left ear lobe to almost reaching my chin.

My dentist took an xray and said my lower left wisdom tooth is a bit decayed but shouldn't be causing that much pain like I described. The pain score I had was 8/10 at night only when I tried to sleep. I get pain whenever I lay down. I press on my neck like probably salivary glands area, I can feel it throbbing pain, tender/painful to touch. The inner jaw bone is also painful to touch with my tongue. I don't get that much pain during the day, is about 2 - 4 pain score. When during the day when I did not lay down, the pain is not bad, I can touch them is like 1-3 pain score.

I don't understand why it is bad only when I lay down to sleep.

There is no bleeding gum, and my wisdom tooth is in full view, it is not trapped below the gum. The surface of it can be seen.
Submitted: 2 years ago.
Category: Dental
Expert:  Dr.Fazeli Niaki replied 2 years ago.

Dr.Fazeli Niaki :

Thank you for your question. I'll do my best to answer it for you.

I'm so sorry to hear about your mandibular pain.
There are many things that can cause atypical pain, it may involve a nerve being compressed. sometimes it is a neuropathic pain without a clear cause and sometimes temporomandibular joint disorder can cause pain of this type.
As a dentist specialized in Prosthodontics, on the base of history of your disease and your condition, I think your symptoms are most probably because of a Trigeminal Nerve Neuralgia.
It is a very specific kind of facial pain that involves the trigeminal nerve and it is fairly rare condition.
In such case the trigeminal nerve compressed by blood vessel at the pint where it leaves the brainstem and likely to your case, the pain worsens at night because when you are laying down, a blood vessel shifts to touch the trigeminal nerve in a different way from your standing positions.
So I highly recommend you to visit an experienced oral neurologist or neurologist and ask for help. In the case of Trigeminal nerve neuralgia you may need to have a CT scan or MRI to find out where the nerve is compressed.
Don't panic and worry about your condition, it is curable by medications that reduces the sensitivity of your nervous system enough that you don't have such pain at night.

Also non drug therapies such as relaxation and meditation can help to reduce pain level and enhance pain coping.
I hope you get well soon.


If you have any more questions, I am happy to help as much as possible so feel free to ask.

Customer :

My 2 dentists have recommended that I extract that lower jaw wisdom tooth. I am not sure if the pain is due to the wisdom tooth.

Dr.Fazeli Niaki :

No I don't agree

Dr.Fazeli Niaki :

a decay can not cause such irradiating pain along the jaw

Dr.Fazeli Niaki :

You have a night pain and it increases when you lay down

Dr.Fazeli Niaki :

I had couple of patient with the same symptoms and other dentist extract their healthy teeth 7th teeth

Customer :

And there is pain in my lymph node/salivery gland(i don't know what you call it), but is at the area of submandibular and parotid gland(at the point below my ear lobe) I also actually have a low grade fever on-off the past 1 week. My normal basal temperature is never above 37 degrees.. and now is actually 37 - 37.5

Dr.Fazeli Niaki :

so they are sign of inflamations

Dr.Fazeli Niaki :

it can be a different story

Dr.Fazeli Niaki :

but it doesn't have dental origin

Dr.Fazeli Niaki :

what about your mouth opening

Dr.Fazeli Niaki :

?

Customer :

Yes i can open

Customer :

i am worried that it is some gum disease or infection going from my wisdom tooth to my surrounding gums and making my teeth loose?

Dr.Fazeli Niaki :

no

Dr.Fazeli Niaki :

if it was so your dentist could see the bone resorption around the teeth

Dr.Fazeli Niaki :

root

Dr.Fazeli Niaki :

what did he say about the dental X-ray?

Customer :

it didn't actually start like that. When i had the pain at first, it was my right side(upper and lower) sensitivity to cold drinks, and even room temperature water. After the pain went off in 1 week - 2 weeks time, i started to have pain on my left and right upper and lower

Customer :

she said that she can see slight decay between my wisdom tooth and the tooth in front of it.

Dr.Fazeli Niaki :

such irradiating pain most of the time are neuralgia

Dr.Fazeli Niaki :

and cause can not be determined

Customer :

She said the decay is not able to cause such pain

Dr.Fazeli Niaki :

Yes that's the point

Dr.Fazeli Niaki :

so how they recommend to extract the teeth

Dr.Fazeli Niaki :

?

Dr.Fazeli Niaki :

I highly recommend you to do a CT scan

Dr.Fazeli Niaki :

if you visit a neurologist it will easily diagnosed

Customer :

on my upper wisdom tooth, it has been decayed to the core as seen on the xray. I had it removed on wednesday. But the pain seems to be coming from my lower left jaw, glands,

Customer :

I also have a tooth in front of my upper wisdom tooth that require possible root canal treatment

Dr.Fazeli Niaki :

and I think 80% it is from a neurologic factor not from a dental or gingival one

Customer :

could that tooth be the cause?

Dr.Fazeli Niaki :

yes

Dr.Fazeli Niaki :

it has the same process

Dr.Fazeli Niaki :

pressure of the vessels of root on the nerves

Dr.Fazeli Niaki :

and it will increase when you lay down

Dr.Fazeli Niaki :

it can be the reason

Dr.Fazeli Niaki :

37th tooth?

Customer :

but the tooth is located on the upper jaw

Customer :

why is my pain at the lowe jaw

Dr.Fazeli Niaki :

ahha

Customer :

*lower jaw

Dr.Fazeli Niaki :

no it is impossible

Dr.Fazeli Niaki :

pain can not irridiate from the maxilla to the mandibule and chin

Dr.Fazeli Niaki :

did you have any tooth extraction

Dr.Fazeli Niaki :

or any trauma

Customer :

yes my upper wisdom tooth

Dr.Fazeli Niaki :

which could lead to nerve damage before?>

Dr.Fazeli Niaki :

no

Dr.Fazeli Niaki :

in the lower jaw I ment

Customer :

however i had the radiating, cramps like, throbbing pain before my extraction

Customer :

Nope.

Customer :

Nothing done on my lower jaw

Dr.Fazeli Niaki :

and you can normally open your mouth?

Dr.Fazeli Niaki :

no pain or discomfort

Dr.Fazeli Niaki :

more likely it is a trigeminal nerve neuralgia or neuropathic pain

Customer :

when i touch my skin during when the pain is intense, the skin feel warm to touch, and the glands are very tender and painful to touch. Then i use my tongue to touch the "inner jaw" at the side where is painful, it feels even More painful when i use my tongue to touch it...

Customer :

yeah i can open my mouth

Dr.Fazeli Niaki :

It might be a salivary gland infection or stone but the symptoms are likely to neuralgia

Dr.Fazeli Niaki :

specialy your laying down and night pain

Dr.Fazeli Niaki :

and you don't have any swelling

Dr.Fazeli Niaki :

and you don't have discomfort when you are eating food

Dr.Fazeli Niaki :

I had 2 patients with the same symptoms

Dr.Fazeli Niaki :

a dentist extracted 37th tooth

Dr.Fazeli Niaki :

but it didn't help

Dr.Fazeli Niaki :

till visiting the neurologist

Customer :

the discomfort i had with biting food is with my upper tooth the one pending for root canal

Customer :

not the ones below

Customer :

i don't really feel discomfort

Dr.Fazeli Niaki :

yes I see

Customer :

i mean when chewing foods

Dr.Fazeli Niaki :

patient with the salivary gnad disorder usually has pain and swelling when eating food

Customer :

oh by the way

Dr.Fazeli Niaki :

so it is unlikely to normal parotid gland infection or cyst or stone

Customer :

when i had the pain at night while laying down, there is small swelling behind my lower ear lobe that will swell even more when i had the pain... is that also the neuralgia thing?

Dr.Fazeli Niaki :

yes sometimes there is very painful swelling at the trigeminal neuralgia

Dr.Fazeli Niaki :

your fever can be because of inflammation around your upper jaw tooth

Dr.Fazeli Niaki :

you told 37.5

Dr.Fazeli Niaki :

it can be normal in the inflammation of root

Customer :

What should i do? Get a CT scan of the head? or?

Dr.Fazeli Niaki :

no

Dr.Fazeli Niaki :

you should visit a neurologist

Dr.Fazeli Niaki :

and he will order a facial CT scan

Customer :

hmm

Customer :

is hard for me to get a referral to neurologist from public healthcare

Customer :

i think they will all refer me to a dentist..

Dr.Fazeli Niaki :

Also I want to mention that in some cases parotid gland cancer or tumour can have the same symptoms

Dr.Fazeli Niaki :

it is so rare by the way

Dr.Fazeli Niaki :

But I think the reason of your pain is not a dental issue

Dr.Fazeli Niaki :

and it is likely to neurological pain

Customer :

okay...

Dr.Fazeli Niaki :

If neurologist could not diagnose the problem

Dr.Fazeli Niaki :

visit an experienced oral pathologist

Dr.Fazeli Niaki :

not a dentist

Customer :

ya i know what u mean... i saw one earlier in the day...

Customer :

but hmm

Dr.Fazeli Niaki :

don't worry

Dr.Fazeli Niaki :

it is not a serous problem

Customer :

if say, i would like to try to remove that wisdom tooth, will it going to aggrevate the pain?

Dr.Fazeli Niaki :

but some dentists can make a big complication out of it

Dr.Fazeli Niaki :

I don't think so

Dr.Fazeli Niaki :

such pain can not have a dental origin

Dr.Fazeli Niaki :

unlikely to a Careis!!!!

Dr.Fazeli Niaki :

many dentist when can not find any reason for pain they just extract the wisdom tooth or other tooth and most of the time it doesn't help

Customer :

so even if i am standing up or walking around and i still have that pain, but it is not extreme, maybe say pain score of 2-3 out of 10? does that also point to neuralgia?

Dr.Fazeli Niaki :

yes

Dr.Fazeli Niaki :

it varies by the pressure of the vessels on nerve

Dr.Fazeli Niaki :

I must mention that, as a dentist sometimes the best way to treat a toothache is to not treat the tooth. Not all toothaches come from teeth, our job as a dentist is listen to the patient,relieve the pain and either treat the tooth or involve other doctors to treat the condition and source of the pain.

Customer :

Why doesn't neuralgia respond to paracetamol or codeine or tramadol..? After i take them i feel drowsy, so i lay down thinking i will go to sleep... and so after i lay down, after a while i get very intense pain

Dr.Fazeli Niaki :

We often see patients with pain that is difficult to diagnose and pain form different causes from a sinus infection to a neurological disorder and in some cases which likely to yours the complex network of nerves in the head face and neck.

Customer :

so i have to sit up again..

Dr.Fazeli Niaki :

you need an anti-convulsant medicine

Dr.Fazeli Niaki :

not an anti inflammatory or just analgetic one

Dr.Fazeli Niaki :

I recommend Carbemazepine in such condition

Dr.Fazeli Niaki :

it can help the condition

Customer :

usually it is of unknown cause? what if there is a cause, what is the more common one?

Dr.Fazeli Niaki :

in case of trigeminal neuralgia the cause is pressure on the nerve

Dr.Fazeli Niaki :

unknown for dentist

Dr.Fazeli Niaki :

it can be invastigate and a CT scan will show the exact point of pressure

Dr.Fazeli Niaki :

There are other things that can compress a nerve, including tumours. Other causes include diseases like multiple sclerosis, which cause damage to a nerve directly.

Dr.Fazeli Niaki :

but in your case night laying down pain can make us sure that it is a blood vessels pressure

Dr.Fazeli Niaki :

I hope you get well soon

Customer :

what is a blood vessel pressure? so it is not likely to be a tumor sitting on some nerves?

Dr.Fazeli Niaki :

when you are laying down, a blood vessel shifts to touch the trigeminal nerve in a way that is different from your standing positions.

Dr.Fazeli Niaki :

no it can not be a tumour

Dr.Fazeli Niaki :

unlikely to tumour

Dr.Fazeli Niaki :

I hope my answers helps you

Customer :

Thanks a lot Dr Fazeli

Dr.Fazeli Niaki :

you are welcome

Dr.Fazeli Niaki :

If you have any more questions, I am happy to help as much as possible so feel free to ask.

Customer :

Earlier today i have also went to research online and i saw this neuralgia word came up, and coincidentally my friend had recommended me to a hospital she went for her wisdom tooth extraction. That hospital has a oral pathologist trained in this area..

Dr.Fazeli Niaki :

I see

Customer :

I will come back to rate the answer another day... hope that you don't mind

Dr.Fazeli Niaki :

you are welcome

Dr.Fazeli Niaki :

I hope it helped

Dr.Fazeli Niaki :

np

Customer :

Thank you! I'll come back again after i check out with the hospital

Dr.Fazeli Niaki :

you are welcome

If you have any more questions, I am happy to help as much as possible so feel free to ask.

Dr.Fazeli Niaki :

yes?

Dr.Fazeli Niaki :

Do you have any more questions?

Customer :

It isn't neuralgia

Customer :

they said is related to my tooth that is pending for a root canal

Customer :

the root canal tooth is on my upper but my pain is lower

Dr.Fazeli Niaki :

could be

Dr.Fazeli Niaki :

that's why I recommend you for other tests

Dr.Fazeli Niaki :

by the way I hope you get well soon,

Dr.Fazeli Niaki :

I hope you get well after root canal therapy,

Dr.Fazeli Niaki :

by the way I don't think more than one hour time is a poor service!!!

Dr.Fazeli Niaki :

...

Customer :

but previously u were telling me is likely neuralgia

Dr.Fazeli Niaki :

As a dentist I told the probability

Customer :

somehow is not easy to nail the problem just from some words erm

Dr.Fazeli Niaki :

but each probability needs further test

Customer :

but i have a right to do a rating too

Dr.Fazeli Niaki :

I did my best,

Dr.Fazeli Niaki :

sure you can

Dr.Fazeli Niaki :

Hope you get well soon

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