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Dental and Oral Health (Adults)

Lingual Nerve Damage

12/12/2011

Question:

I suffered lingual nerve damage during a dental procedure about ten years ago. I am looking for help in finding a physician who specializes in this condition. I saw a local neurologist, who ran a batter of tests and determined no other neurological cause, so he concured that it happened during a recent dental procedure. BUT... he game me the bad news: "We don`t know enough about the brain and nervous system, so no fix." We tried anti-seizure medications, but not much change, just side affects. The pain is getting worse over time. Perhaps if I can find a physician who specializes in facial nerve pain, he or she may be able to offered more options. Thank you for any assistance you can provide.

Answer:

I am sorry to hear about your problem. Your neurologist is correct that complete resolution may not be possible.

As an Oral Medicine trained dentist, I would have referred you also to either a ‚ÄúPain Specialist" (usually an Anesthesiologist with specialty training in chronic pain disorders) or to either a neurologist or neurosurgeon. For acute injury, NSAIDs and steroids have been utilized, but your situation is ten years post-injury and this would not have much impact. Most pharmacologic interventions are with drugs like tricyclic antidepressants, anticonvulsant medications like tegretol, lamotrigine, gabapentin, anti-spasmodics like baclofen, and clonazepam.  Recently research has also focused on another class of medications that may be useful in the treatment of nerve injury: calcitonin gene-related peptide (CGRP)  agonists, but this is still in progress. Drug interventions require trial and error, and response varies with patient and severity of the lesion.

Also there have been microsurgical surgical interventions for treatment of post traumatic neuralgias.

I do not know where you are writing from; two dental pain specialists close to Ohio- Dr. Ronald Dubner, DDS, PhD, at the University of Maryland and Dr. Jeff Okeson DMD, at the University of Kentucky - come to mind.  They have international reputations in the area of diagnosis and management of orofacial pain disorders.

Otherwise, I would also seek out a consultation from a chronic pain specialist at any of the large university Medical Centers near you. Most have specialty clinics that deal with post-operative pain disorders and can closely monitor the pharmacologic interventions and provide the necessary support required for these injuries.

I hope this helps.

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Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University