Q: I have been experiencing shooting pain on the right side of my mouth for several months. My dentist has examined the area and taken X-rays, but can't find any problems. I got a second opinion, with the same results. Do you have any suggestions?
A: In most cases, pain in the oral cavity (mouth) is related to disease of the teeth or gums -- namely cavities or periodontal gum disease. Less frequently, strain of the TMJ (jawjoint), and infection of the maxillary sinus can cause pain that radiates to the teeth or ear.
If two dentists have ruled out these possibilities, we must look at some of the more rare disorders that can cause your symptoms. Your symptoms lead me to suspect a relatively uncommon disorder known as Trigeminal Neuralgia or Tic Doloureux. The trigeminal nerve supplies both sensory (feeling) to the forehead, eye, cheek and jaws, as well as motor (movement) to the mouth. Trigeminal Neuralgia is usually a benign but debilitating disorder where electric shock-like pain is triggered by laughing, chewing, brushing your teeth or even touching the face. Rarely, multiple sclerosis or certain brain tumors may cause it. A MRI can help rule out these more serious disorders.
The diagnosis can be elusive to dentists or physicians unfamiliar with this disorder. I consulted with a patient during my hospital residency with trigeminal neuralgia that had had every tooth on the right side of her mouth extracted due to numerous doctors' unfamiliarity with trigeminal neuralgia. I recommend you see a specialist in facial pain (preferably with a background in oral surgery) or a neurologist. Treatment usually involves taking anti-convulsant drugs such as Tegretol®, or in some cases surgery-involving decompression of the nerve may be required.
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