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Suggest Treatment For Severe Pain In Jaws

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Posted on Tue, 7 Mar 2017
Question: My adult step-daughter had all her teeth removed during the seventh grade. She had experienced early age tooth decay as well as infections. Her Dr's decided it was the best decision based on her conditions to remove all her teeth. She obviously went through tons of bullying, kids being horrible making fun of her, etc. She finally was able to handle her top dentures. Soon after she received her top teeth, she had bottom titanium implants installed so she could receive her bottom plate. This never happened as she started experiencing major gum pain, similar to when she had her original bottom teeth. At the age of 18, we had her implants removed (as per the organ surgeon's opinion - apparently the implants were causing her pain). OK, lets jump forward a year and half later... she has started experiencing major pain in her lower jaw. We've been back to and forth to dentist in addition to her oral surgeon - he recommended seeing a neurologist. She was seen by a neurologist, last Thursday, who basically looked at us like we were idiots due to the fact she didn't have any teeth. Long story short, I begged her to put her on some type of nerve pain medication. At this point she's been in major pain for over a week. The neurologist ordered an MRI and prescribed her 300 mg of gabapentin 3 times per day. She's still in so much pain after almost 4 days of being on gabapentin. We're giving her TENS muscle therapy in addition to Motrin on top of warm baths, ice packs, heating pads. I'm praying the MRI pre cert comes in tomorrow and the neurologist believes her. Any thoughts?

Also, her oral surgeon advised us that she had major bone deter due to not having bottom teeth. He also stated she was having muscle spasms due to her jaw not knowing where to place itself during rest/sleep. Her pain is extreme especially when she wakes up. We cannot seem to get her any relief. I gave her a Xanax from a friend but this is temporary fix. Please help.
doctor
Answered by Dr. Mahesh Kumar T S (56 minutes later)
Brief Answer:
Temporomandibular joint disorder, neuralgia, medication

Detailed Answer:
Thanks for your query. I have gone through your query.
As far as the pain in the jaw is concerned, I have the following possibilities.
It can be a myofacial pain secondary to temporomandibular joint disc disorder. This occurs when you have missing teeth which are not replaced for long time or due to abnormal positioning of artificial teeth leading excessive forces over the temporomandibular joint. Nothing to be panic, consult an oral physician and get it evaluated. You need to get a radiograph like orthopantomograph and MRI of the joint to confirm the diagnosis. If it is a joint disorder then we can treat her with a course of piroxicam followed by replacing her missing teeth. Do not take hard food. Give hot fomentation over the joints.
The other possible cause can be a trigeminal neuralgia. This occurs secondary to any nerve injury during teeth removal or implant placement. This can be treated with nerve regenerating drugs like vitamin B6 and B12(neurobion) and carbmzepine. These medicines has to be taken after consulting the physician. In this condition the pain will be like shock like which lasts for only few seconds. That is the charecteristic feature. where as in joint disorder the pain will be there throughout the day.
I hope I have answered your query. If you have any queries reply me back. Upload the reports of the radiograph and MRI so that I can give you better diagnosis and treatment plan. Take care.
Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Mahesh Kumar T S

Dentist, Oral and Maxillofacial Surgery

Practicing since :2007

Answered : 3377 Questions

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Suggest Treatment For Severe Pain In Jaws

Brief Answer: Temporomandibular joint disorder, neuralgia, medication Detailed Answer: Thanks for your query. I have gone through your query. As far as the pain in the jaw is concerned, I have the following possibilities. It can be a myofacial pain secondary to temporomandibular joint disc disorder. This occurs when you have missing teeth which are not replaced for long time or due to abnormal positioning of artificial teeth leading excessive forces over the temporomandibular joint. Nothing to be panic, consult an oral physician and get it evaluated. You need to get a radiograph like orthopantomograph and MRI of the joint to confirm the diagnosis. If it is a joint disorder then we can treat her with a course of piroxicam followed by replacing her missing teeth. Do not take hard food. Give hot fomentation over the joints. The other possible cause can be a trigeminal neuralgia. This occurs secondary to any nerve injury during teeth removal or implant placement. This can be treated with nerve regenerating drugs like vitamin B6 and B12(neurobion) and carbmzepine. These medicines has to be taken after consulting the physician. In this condition the pain will be like shock like which lasts for only few seconds. That is the charecteristic feature. where as in joint disorder the pain will be there throughout the day. I hope I have answered your query. If you have any queries reply me back. Upload the reports of the radiograph and MRI so that I can give you better diagnosis and treatment plan. Take care.