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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 10789
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Frank: I have a complicated history of pain,

Customer Question

For Dr. Frank: I have a complicated history of facial pain, including what currently presents as possible bilateral neuralgia or atypical facial pain (per my neurologist) which (as best we can determine) is the result of separate precipitating events (occurring years apart). What I'm most concerned (and perplexed) about is what appears to be the return of severe, neuralgia-like pain on the right side of my face - which (with the exception of occasional painful twinges) has been quiet for nearly twenty years. I think that two factors seem to have provoked this, but I'd appreciate your assessment.
Firstly, it appears that when I have a tooth that's failing to the point where it ultimately needs to be root canaled (in my case, always mandibular teeth), it can provoke neuralgia/atypical facial pain. I understand that tooth pain can also mimic neuralgia and vice versa (which I've also experienced), but in my case, it seems that the ongoing irritation from a dying tooth (that usually takes an very long time to finally diagnose and treat, because pain is always presumed to be neuralgia by dentists/endodontists who are reluctant to treat until the dental problem has significantly progressed) can actually provoke a neuralgia flare-up that can last for days, weeks, even longer.
Am I wrong in thinking that the long-term irritation to what I assume is the trigeminal nerve - caused by pulpitis, infection, etc. - can cause sufficient irritation to the nerve to cause or instigate neuralgia, even when it's been dormant for many years?
The other concern I have is that on two separate occasions - during local (infiltration) injections on the left (mandibular) side of my mouth very near the midline, I felt something on the opposite (right) side. With the first injections (there were multiple in both instances), it was a shooting a 'zing, ' and the second injections (weeks later), it actually numbed several teeth on the opposite side. Within a day or two of both of these 'cross-over' reactions, I experienced a severe neuralgia-like flare up on the right (cross-over) side; the second episode has already lasted for many days and I'm worried it may be back permanently. I haven't had a full blown neuralgia/AFP attack in over twenty years, so I have to think these injections may have provoked it. I've also had multiple teeth that had to be root canaled on the lower left (delayed diagnosis) which relieved the tooth pain but appears to have stirred up atypical facial pain on the left.
Can serious dental issues and crossover injections sufficiently irritate the nerve so that it causes and/or provokes neuralgia/AFP? I understand that cross-over reactions to dental injections is uncommon, particularly on the mandible, but it certainly seems to happen to me. Are either/both of these scenarios possible?
Submitted: 6 months ago.
Category: Neurology
Expert:  Dr. Rick, MD replied 6 months ago.
Hi. My name is***** and I am online and available to help you today. Thank you for your patience.Question and answer is just one of the services I offer. I can also provide you with premium services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.When did this all start?Does it come and go?Do you have any other medical problems or take any medications?This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 6 months ago.

I think the other expert opted out because he's not an neurologist. I appreciate you jumping in - but I see you're an ophthalmologist. I think this is truly too complex for non-neurologist (even my own neurologist is challenged by this) - which is why I posted it to Dr. Frank's attention.

Expert:  Dr. Rick, MD replied 6 months ago.
I noticed that you had been waiting patiently so I thought I'd see what I could do to help.But I completely understand and will be happy to opt out so that one of our neurologists can assist you.Have a great weekend :)
Customer: replied 6 months ago.

I appreciate you're trying to help - but would like to leave this open for neurology.

Expert:  Dr. Rick, MD replied 6 months ago.
it should be open now.... I wish you the very best