Synergy TMJ Pain

Facial Pain

(Other Types of Neuralgias)


Atypical Odontalgia
This is one of the most common and frustrating conditions presented to dentists. This is basically a toothache of unknown origin or “phantom tooth pain’. Patients usually present with a chief complaint that their tooth hurts or has a strange sensation and naturally dentists start focusing on a “dental problem” rather than a “neuropathic pain problem”. Unfortunately, this can lead to unnecessary dental procedures because the pain is not a “tooth problem”, but rather a peripheral or central nerve problem. Consequently, dental procedures like root canals and extractions are performed, then sadly the pain persists. This leads to wondering why treatment failed, then more procedures are done thinking that “another tooth’ is the problem and the cycle continues. Orofacial Pain specialists can help diagnose these conditions and determine whether it is a “tooth” related problem, or a “neuropathic” Pain problem. Treatment includes:
  • Topical Anesthetics
  • Medications (antidepressants, anticonvulsants)
  • Capsaicin ointments
Glossopharyngeal Neuralgia
Glossopharyngeal Pain is pain that is localized to the ear and tonsillar area in the back of the throat and is exacerbated by yawning and swallowing food. As a result of this pain, patients tend to refrain from eating which leads to undernourishment. To diagnose this type of pain, a clinician will see if topical anesthetic on the back of the throat alleviates the pain. Treatment includes:
  • Medications (Carbamazepine, Oxcarbazepine, Topiramate, Gabapentin)
  • Rhizotomy
  • Gamma Knife Procedures
  • Microvascular Decompression


CRPS is a type of neuralgia that can present in the head and neck region but is most common in the limbs and extremities. There are two types of CRPS; Type | which is associated with tissue damage and Type Il which is associated with nerve damage. Patients describe this type of neuralgia as a constant burning, tingling, cold pain, with redness, swelling and stiffness of the tissues. Treatment Includes:
  • A concerted effort by neurologists, anesthesiologists, and orthopedists, to treat the myriad of complications that exist with this syndrome.
Medications, surgical procedures and infusion therapy with Ketamine seem very promising for CRPS.


Burning Mouth/Tongue Syndrome
With this condition, patients will have a chief complaint of a “Burning tongue, lips, and/or qums”. There are so many etiologies that can cause burning mouth syndrome that it is often difficult to manage. Fungal infections, dry mouth, as well as neuropathic disorders can all be reasons why this condition occurs. Depending on the etiology, antifungal drugs, topical anesthetics, anticonvulsants, benzodiazepines and saliva stimulants can be used to treat burning mouth syndrome.
Mandibular Paresthesia (Lower Lip Numbness)
Occasionally following a dental procedure, the area where the dental work was performed, stays numb after the dental anesthetic has worn off. This condition is known as “Paresthesia” and occurs most often in the lower jaw or mandible. Most patients are alarmed by this phenomenon as they have acontinuing sensation of numbness, tingling, pins and needles, and sometimes pain. This condition can be the result of an iatrogenic dental procedure where the main nerve of the jaw is damaged either by the dental injection, the procedure itself, or both. Paresthesia can also be the result invading tumors (benign or malignant), infections, and various neurologic disorders. When it is the result of a dental procedure, the good news is that it is usually temporary. It can last for a few days, up to several months. It is important to notify your treating dentist or an orofacial pain specialist, to determine what type of procedure caused the paresthesia…was it a root canal procedure? Is the root canal filling material pushing on the nerve? Was it due to an extraction and the nerve was damaged during the procedure? Was it caused during the dental injection? Once it is determined how the paresthesia occurred, treatment should be initiated to calm the nerve down. Case studies have shown favorable results when paresthesia is treated with corticosteroids and pregabalin (Lyrica). If this course of treatment does not work, refferal to a neurologist,a neurosurgeon, and/or and oral and maxillofacial surgeon is in order, where surgical intervention to repair of the nerve might be attempted.

Appointments & Consultations

Occlusal Dysesthesia
A condition where patients describe a feeling in the gums and teeth as a “fullness, tingling, pins and needles, electrical shock, buming, or itching” sensation in a tooth or the surrounding gum tissues. Unfortunately, as with atypical odontalgia, this condition can lead to unnecessary dental procedures trying to solve the problem. Recognizing that this is possibly a neuropathic pain problem is key in this situation. Topical anesthetics in bleaching trays and anticonvulsant drugs are commonly used to treat this problem.
Post Herpetic Neuralgia
This condition occurs “after” an acute herpes zoster (shingles) infection and rarely occurs before the age of 40. The incidence of PHN is about 10% in individuals age 40 and increases to about 75% by age 90. It is a chronic, superficial burning pain in the area where the shingles infection occurred. If this pain persists for more than a year, it most likely won’t respond to most therapies. Management of PHN pain can be very challenging. It is commonly treated with anticonvulsants (like Gabapentin and Pregabalin), narcotics, capsaicin creams, and most recently, Botox injections. The best way to avoid shingles is to get the “shingles Vaccine” around the age of 60 years old.