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Dr. Andrew Rynne
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Dr. Andrew Rynne

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How Can Tic Douloureux Be Treated?

Hello, I am a dentist and I believe one of my patients has developed a tic Doulouex. It is a mild case but it began right after having a root canal done on his lower second molar by a vey good specialist on the ipselatereral side. The trigger point is about where the trigeminal nerve exists the mandible on the surface of the skin. This is extremely rare to me so I don't know how to treat it or who to refer it to. Can you give me a suggestion?
Fri, 21 Apr 2017
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Dentist, Orthodontics 's  Response
Greetings from Healthcare magic members,

Dear Doctor,
I have understood your query.
It is very important to first confirm the diagnosis of trigerminal neuralgia as many other medical and dental conditions have similar presentation of pain. Improper diagnosis may lead to patient dis-satisfaction and withdrawal.

Once you come to definite diagnosis, then comes the treatment choices.
There are a number of medications that control the pain of trigerminal neuralgia.The most commonly prescribed first line drug used is carbamazapine (Tegretol) which is an anticonvulsant.

If its not effective then other choices of medications could be phenytoin (Dilantin), gabapentin (Neurontin), oxcarbazepine (Trileptal) topiramate (Topamax), lamotrigine (Lamictal) and valproic acid (Depakene).

Start with the lowest dose and then increase gradually until the symptoms of pain resolved.

In some patients, muscle relaxant such as baclofen (Lioresal) can be given in combination with an anticonvulsant for adequate management of pain. While in others, opioids drugs such as oxycodone, hydrocodone or morphine is prescribed for very short period of time depending on the severity of pain. However, all these drugs are not without adverse side effects so prompt use in advisable.
Handling these patient is bit difficult for general dentist, so if you have doubts, then you can refer your patient to either a neurologist or maxillofacial surgeon who have expertise in handling nerve disorders.

Hope this answer is helpful. If you have further questions please do not hesitate to ask me.
Best regards,
Dr. Khoja
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How Can Tic Douloureux Be Treated?

Greetings from Healthcare magic members, Dear Doctor, I have understood your query. It is very important to first confirm the diagnosis of trigerminal neuralgia as many other medical and dental conditions have similar presentation of pain. Improper diagnosis may lead to patient dis-satisfaction and withdrawal. Once you come to definite diagnosis, then comes the treatment choices. There are a number of medications that control the pain of trigerminal neuralgia.The most commonly prescribed first line drug used is carbamazapine (Tegretol) which is an anticonvulsant. If its not effective then other choices of medications could be phenytoin (Dilantin), gabapentin (Neurontin), oxcarbazepine (Trileptal) topiramate (Topamax), lamotrigine (Lamictal) and valproic acid (Depakene). Start with the lowest dose and then increase gradually until the symptoms of pain resolved. In some patients, muscle relaxant such as baclofen (Lioresal) can be given in combination with an anticonvulsant for adequate management of pain. While in others, opioids drugs such as oxycodone, hydrocodone or morphine is prescribed for very short period of time depending on the severity of pain. However, all these drugs are not without adverse side effects so prompt use in advisable. Handling these patient is bit difficult for general dentist, so if you have doubts, then you can refer your patient to either a neurologist or maxillofacial surgeon who have expertise in handling nerve disorders. Hope this answer is helpful. If you have further questions please do not hesitate to ask me. Best regards, Dr. Khoja