Toothache pain can fool your doctor

As published in the Buck’s County Courier Times

It’s an unfortunate fact that most of us know all too well the pain that an infected tooth can cause. In most cases, the pain is easy for the patient and dentist to localize. The patient will just point to the tooth and say, this is the one, and more often than not, the patient is right. There are other times that an infected tooth is hard for the patient and dentist to find, and the symptoms are vague, nonspecific, and confusing, especially for other doctors who may become involved with the patient’s care.

One of the unusual things about dental pain is that it can travel. Pain from an infected back molar can travel to a tooth or teeth adjacent to it, and on the jaw above or below (on the same side of the mouth). Toothache pain can also travel to the ear or sinus, and cause headaches to the side of the head with the infected tooth. To add to the confusion, the type of pain can be sustained or intermittent, sharp and localized or dull and diffuse. Pain can be made worse by hot or cold foods or beverages and by biting down.

The dark circle around the roots of the last tooth on the lower right of this image represents a dental infection which was incorrectly diagnosed as Trigeminal Neuralgia

The dark circle around the roots of the last tooth on the lower right of this image represents a dental infection which was incorrectly diagnosed as Trigeminal Neuralgia

Because the pain from an infected tooth can often mimic other problems, a patient may seek the help of their family doctor or even a medical specialist. This situation recently occurred at my office. A patient of mine told me she was being treated for the last year for trigeminal neuralgia, a relatively rare condition that causes electric shock-like pain that is triggered by laughing, chewing, brushing your teeth, or even touching the face. She was given the drug Tegretol by her ear nose and throat physician (ENT), but was experiencing bad side effects so the dose had to be reduced. Common side effects of this drug include dizziness, drowsiness, nausea, vomiting, feeling unsteady, dry mouth, swollen tongue or loss of balance or coordination. She also still had pain in her jaw when I saw her for her check-up appointment.

After she explained to me all of her symptoms, I did a simple test on her. I gently stroked the side of her cheek where she supposedly had trigeminal neuralgia. Instead of pain, she had a completely normal response. Then I took a panoramic x-ray of her jaw and revealed what I had come to suspect. She had a badly infected tooth on the lower right second molar. A root canal or extraction of her tooth would quickly solve the problem, not a yearlong course of an anti-convulsant medication. The lesson is simple; your dentist should be the first doctor to evaluate any pain that you have in the teeth, gums, or jaw, even when the pain is radiating to the ear, sinus or other parts of the face and head.

Dr. Jerry Gordon can be reached at (215) 639-0571.  Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket).   E-mail: drjdmd@comcast.net