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Cheek biting, bruise, trigeminal neuralgia, botox, scalene blocks, anticonvulsants, ambien

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Practicing since : 2002
Answered : 2565 Questions
I am a 59/yo female who is constantly biting on my right cheek (not on purpose) and it feels like a constant opening burning bruise, every waking moment. Pain pills don't help (though Ambien does let me sleep). I think the buccal mucosa is also getting caught on some ragged teeth. My diagnosis from many specialists is atypical facial pain or trigeminal neuralgia. My dentist suggests that I get a plastic surgeon to evaluate redundant buccal mucosa. I'm so freaked I'll always be in pain (4 years and counting) and no one will figure out the cause or treatment. I'm interested in Botox, too. I've had scalene blocks (didn't work). I cannot tolerate anticonvulsants. What are your thoughts?
Posted Tue, 24 Apr 2012 in General Health
Answered by Dr. Robert Galamaga 39 minutes later

Thanks for your query.

I can appreciate that this has been a very frustrating thing to deal with. You have tried many different modalities to try and mitigate the symptoms and still you are experiencing some degree of continued problems.

I would suggest that you requested a referral to see a oral and maxillofacial surgeon. This is a particular specialist who has expertise in the structure and function of of the jaw as well as the teeth. This expertise is also inclusive of problems, which occurred inside the mouth such as that which you haven't described.

I am not familiar with any successful clinical trials which have demonstrated that Botox would be affective in your case. It is certainly possible however that there have been some case reports of success. There may also be a surgical option where a surgeon could consider some degree of intervention to help improve the way your teeth interact with the side of your mouth.

I am sure you have also considered wearing a dental appliance at night to see if this will also improve the overall symptoms which you have been dealing with. If you have not considered this option I would consider that as well.

Thank you very much for your query. I appreciate the opportunity to provide you with some more information regarding your current issue. I am available for any follow-up questions. Should you need.


Dr. Robert.
Above answer was peer-reviewed by
Follow-up: Cheek biting, bruise, trigeminal neuralgia, botox, scalene blocks, anticonvulsants, ambien 2 hours later
Thank you very much for your suggestions.

I was also wondering if it's possible that the cheek inflammation is an allergic reaction to something I'm eating. Would an allergy normally show up as an inflammation in one part of the body, and would it be worthwhile to see an allergist? Would a cheek biopsy be of any benefit? I had a gastric bypass 7 years go and "toss my cookies" more than I would like from eating too quickly; I sometimes wonder if the vomiting has caused damage with my cheek. It's maddening that none of this shows on imaging.

Basically, I need a Dr. House to put me in a little room, do every test known to man, and figure me out -- I'm desperate:). Thank you again for your help.
Answered by Dr. Robert Galamaga 2 hours later
Hello and thanks for the followup.

As for the inflammation aspect of this you are absolutely correct. We cannot ignore this aspect as even a small amount of inflammation can cause subtle swelling of soft tissue which in your case might cause you to bite the cheek more often.

If you are experiencing frequent vomiting, this can also play a role in perpetuating the inflammation because gastric secretions irritate the mucosa of the mouth as well.

Regarding allergy, this is a consideration thought I would expect to see more of a systemic manifestation - that is to say, your entire mouth and GI tract might be affected. It is not unreasonable to obtain a consultation with an allergist and perhaps they could run a panel on you to see what foods and or environmental things you could be allergic to.

I don't know if we need to call on Dr. House just yet or order every test in the book. I think a comprehensive evaluation by an oral surgeon and perhaps an allergist may provide you with some answers and perhaps some solutions as well.

I am surprised to hear that you are vomiting so much with the gastric bypass. Perhaps a dietician could work with you there to focus on modifying your feeding behavior to preserve the therapeutic effect of the bypass and also to help improve your overall health.

Again, I hope this information has been helpful to you. I am available for followups if needed.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Cheek biting, bruise, trigeminal neuralgia, botox, scalene blocks, anticonvulsants, ambien 2 days later
Your information has been very helpful; I appreciate it. I agree that I need to control my food intake better; most of the problem is forgetting to take smaller bites and chewing thoroughly--I've gotten much better at this but I sometimes wonder if the damage was already done earlier.

I've had extensive evaluation by a university oral surgeon who said he had nothing more to offer me after a couple of local blocks :(. My neurologist says I'm too atypical for his conservative treatment. My dentist is suggesting that I see a plastic surgeon with regards to reducing some of my buccal mucosa so it doesn't get caught in my teeth. This somewhat makes sense to me; after losing 110 pounds quickly with facelift because my skin was hanging so badly...maybe I have redundant cheek skin?

At any rate, my next steps are the allergist and plastic surgery consult. Thanks again for your advice; it has helped to write all this out.
Answered by Dr. Robert Galamaga 1 hour later
Hello again,

It has been my pleasure to assist you. I wish you all the best and continued excellent health. I think you have a good plan in seeing the allergist and plastic surgeon. Please let us know if we can help you again in the future.

Dr. Galamaga
Above answer was peer-reviewed by
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