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Permanent Nerve Damage from Dental Injection - need advice for pain relief

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Posted 6/11/2013 7:42 PM (GMT -5)
Howdy -

Have visited this site several times, looking for ideas of how to help my husband, but too shy to actually post anything myself. Finally, my desperation has overcome my fear of joining and - TA DAH - here I am posting!

My husband, otherwise healthy and strong, was injured in April 2011 during what should have been a routine tooth extraction. The oral surgeon had a hygienist do the anesthetic injection of Septocaine (aka Articaine), which is legal in our state, though very "unusual" according to all 4 of the other oral surgeons we've seen since his injury. We've traveled to CA and TX, and all have agreed that the injection was likely into his nerve and caused damage/demyelination to a number of the smaller nerves within the larger nerve pathways. Since many nerves over a large area were damaged, we have been told by multiple specialists that there is no surgical solution, only pain meds and cognitive/behavioral therapy, possibly gamma knife.

Has anyone else experienced this type of injury and willing to share what has worked and what hasn't in terms of pain management?

Here is what he has tried:
- Opioids: ineffective on pain, though had some mood improving effects short-term
- Prednisone: ineffective
- Gabapentin (Neurontin): ineffective, huge side effects
- Nortriptyline (Pamelor): mildly effective (avg pain from 8 to 6), but not worth side effects (zombie-like, dry mouth, trouble peeing, etc)
- Capsaicin (intraoral): ineffective
- Lidocaine patches
- Lyrica: taking currently (for about a month) and it's mildly effective (avg pain from 8 to 6), only side effect is NO libido (none!)

Pain dr is good, but doesn't understand the nerve/injection specifics and oral surgeons don't have expertise in pain management, so we find ourselves "between disciplines".

My questions for the forum here (and thank you in advance for reading!):
- Has anyone on Lyrica had a lack of libido and then have it return? (i.e. any chance his body will adjust)
- I've read about Naltrexone, Savella, and Cymbalta. Are these worth trying to see if the pain management dr will prescribe?
- Anyone tried gamma knife for facial pain?

He has all motor and almost all sensory ability, but his pain is severe and non-stop. His pain is so overwhelming and all-consuming... it's changed everything about his life, and in turn mine. I am at my wit's end trying to help, but he's so depressed from the pain and distrustful or doctors that each visit is a struggle. He's leery of trying a bunch of medications, but at the same time wants and needs relief, so I am hoping to streamline our efforts.

I welcome any ideas/suggestions!
Posted 6/11/2013 9:31 PM (GMT -5)
Hello Oregon

I wanted to pop in and welcome you. Glad you found your way here and decided to post but sorry to read of your husbands facial pain. Certainly sounds awful. Myself I have had one big continuous headache for thirteen yrs which has not repsoned to any meds or treatments.

I wanted to let you know of something you could research if his pain is on the trigeminal nerve. Look into a peripheral nerve stimulator. I am awaiting an occipital nerve stimulator surgery for my head pain.

 My leads will be placed on the occipital nerves but yours could be placed on the trigeminal nerves. The battery of the stimulator is placed in the chest much like a pacemaker and the wires from the battery in the chest are threaded under the skin and to the back of the head; in my case they will be placed on the left and right greater occipital nerves.

 There are several contact areas on the leads(wires) which make contact with the nerve and one feels a gentle stimulation instead of the pain; the stimulation reaches the brain before the constant that one has, much like tricking the brain. But google the stim and you will get lots of info. A neurosurgeon does this type of surgery.

Also has your husband seen a neurologist for his pain? they may be able to help?

Sometimes a combo of meds can help, ie pain med plus a nerve pain med? Cymbalta, lyrica and gabapentin are nerve pain meds. Has he tried ice packs? nerve blocks? just a few ideas that are going thru my head right now for him to try.

Also if you are interested in the stimulator surgery I can suggest a facebook group of individuals who have had the surgery or are looking into it and they can offer you or your hubby a lot of info and support and perhaps doctors who are in your area as well that do this surgery. Let me know if you are interested in this.

Hope you will keep posting with us and keep us posted on how your hubby is doing. Perhaps he will consider joining us here as well. The members here are very supportive, non judgemental and also have a wealth of knowledge on chronic pain.

Take care

Suzane

Posted 6/12/2013 12:56 PM (GMT -5)
Hi Suzanne,

Thanks so much for your welcome, support, and ideas!

Doctors so far didn't think the PNS would help, though it's worth asking about again. I certainly hope that it helps you and that you don't have to wait too much longer for it.

To your specific Qs, although cold helps temporarily by distracting the nerves (similar mechanism to the PNS, perhaps?!), ice has a delayed pain bounce-back effect, so we don't ice. Nerve blocks are off the table - both he and his doctors aren't willing to risk further nerve damage with more injections, although Botox in the surrounding area may be an option.

I think you're right about the med combo, just have to convince him to keep trying stuff... exhausting and frustrating, but I suppose everyone here knows that already. cry
Posted 6/13/2013 12:38 AM (GMT -5)
Where exactly is the pain and what does it feel like now? Did he feel an electric shock during the injection or the extraction? I notice you mention chemical caustic damage to the nerve! gamma knife is radioactive further damage to the nerve......... STAY away from it! Most in this condition would learn to live with any drug side effect if it just lowers the pain factor 1%
Posted 6/13/2013 3:46 AM (GMT -5)
Oregonsunray,

Welcome to the CP forum.... and please don't be shy! I'm glad you posted and reached out for support and help.... I'm really sorry, though, for the terrible pain your husband is having.... I'm sure it's very stressful for you both :(

I hope others will be along to give you some good advice, on top of what you've already received here.... I wish I had more ideas to help you -- other than just encouraging your husband to keep trying things.

I. too, would push him to consider Botox. I recently had it for my migraine headaches..... and that stuff is powerful! It definitely makes you unable to feel certain areas!

--Tina
Posted 6/13/2013 11:05 AM (GMT -5)
Thanks for asking!

Pain epicenter is the now-empty socket of tooth 31 and the entire right side of his tongue, along with nerve pain along jaw (v1) and cheek (v2) and up past the temple (v3). He felt pain during the injection, but no electrical shock, and no pain during the extraction since by that time he was numb from the anesthetic. After and ever-since the anesthetic wore off, his pain has had a constant burning/clamped intensity, no electrical shocks.

Interesting about gamma knife... I will keep this in mind.

nerve damaged said...
Where exactly is the pain and what does it feel like now? Did he feel an electric shock during the injection or the extraction? I notice you mention chemical caustic damage to the nerve! gamma knife is radioactive further damage to the nerve......... STAY away from it! Most in this condition would learn to live with any drug side effect if it just lowers the pain factor 1%

Posted 6/14/2013 12:06 AM (GMT -5)

V3 is lower jaw lingual nerve which gives sensation to the tongue,  back jaw and inner cheek. v2 and v1 could never be affected due to a injection or extraction in the v3 region, it is impossible. which part burns and which part is clamped? I had burning tongue with shocking and a clamped jaw pressure.

oregonsunray said...
Thanks for asking!

Pain epicenter is the now-empty socket of tooth 31 and the entire right side of his tongue, along with nerve pain along jaw (v1) and cheek (v2) and up past the temple (v3). He felt pain during the injection, but no electrical shock, and no pain during the extraction since by that time he was numb from the anesthetic. After and ever-since the anesthetic wore off, his pain has had a constant burning/clamped intensity, no electrical shocks.

Interesting about gamma knife... I will keep this in mind.

nerve damaged said...
Where exactly is the pain and what does it feel like now? Did he feel an electric shock during the injection or the extraction? I notice you mention chemical caustic damage to the nerve! gamma knife is radioactive further damage to the nerve......... STAY away from it! Most in this condition would learn to live with any drug side effect if it just lowers the pain factor 1%

Posted 6/14/2013 11:41 AM (GMT -5)
You "had"? It's improved or managed by medication?

They think the injection went into the lingual nerve directly, caused chemical damage to a large area within and around, resulting in full trigeminal involvement. Or she managed to hit multiple nerves with her injection. Regardless, it's not impossible because it happened! He didn't have this pain before the injection(s), has had it ever since, and numerous doctors have concurred that's what caused his (central lesion, MS, etc - all ruled out).

His tongue is burning/clamped feeling (like it's clamped and being lit on fire at the same time), his jaw feels like it's being stabbed behind the socket where the lingual nerve is near the gum surface (where she injected him), and the cheek/temple is a burning nerve pain. No shocks, just constant pain.

nerve damaged said...
V3 is lower jaw lingual nerve which gives sensation to the tongue, back jaw and inner cheek. v2 and v1 could never be affected due to a injection or extraction in the v3 region, it is impossible. which part burns and which part is clamped? I had burning tongue with shocking and a clamped jaw pressure.oregonsunray said...

Posted 6/14/2013 5:57 PM (GMT -5)
if you look at the tri nerve anatomy
http://www.medicalook.com/systems_images/Trigeminal_nerve.gif
you can see the inferior alveolar nerve travels under the lower teeth in the jaw bone.. v3 mandibular... what is half missing in the diagram is the lingual nerve going to the tongue but that short black line is pointed in the right direction of the tongue. the IAN gives sensation to the front lower teeth and the lower lip and chin. the only other nerve in the lower jaw is chorda tympaini which is the nerve that supplies taste. If the nerve was struck by a direct needle hit he would be numb on top burning and shocking and you don't mention numbness? damage to v3 can never affect v2 or v1 as you can see how the nerve runs.. damage to v2 could only happen if upper jaw work was performed on the same day.. you could never have lower v3 damage when upper jaw is worked on! it is impossible because the v3 is only in the lower jaw no where near v2 or 1.. was bone removed with the extraction?
Yes I said had.. I have numb and no taste on top of it all. Mine began in 2001 and 7 months later in 2002 I had my lingual nerve surgically explored... the damage was found extending up to the first molar after 3rd molar extraction #32.. the nerve is located in the bone so they had to saw my jawbone open and lift the teeth out the way to locate the nerve down under.... more times than not people with just burning do get better. no i did not wake up after nerve surgery cured.. it took about 5 to 6 years before the electrical shocks and burning tamed down and i was able to get off all meds. i still have a numb tongue though and my jaw is still under pressure, but i have adjusted better without that constant burning and shocking in my tongue. In the beginning the back of my tongue felt stretched out all the time and that was one and only thing that was relieved in the first month after surgery. Has he been checked for jaw fracture and jaw joint issues?
Posted 6/14/2013 6:19 PM (GMT -5)
After many diagnoses that this was caused by the injection, I really don't think jaw fracture or joint issues have anything to do with this. Plus, he's had an MRI, CAT scan, and xrays - all negative. I wish it was as simple as a mechanical issue, which may be much easier to treat.

Yes, I had my #s backwards for V1-V3, but the locations and type of pain I described are unchanged. The tooth being extracted was his lower right molar, next to where wisdom tooth was (#31 I think). They think the injection went right into the lingual nerve. Seems logical to me that burning liquid injected into V3 could (and seemingly DID) affect the trigeminal hub, therefore V2 and V1 too. Especially if the needle was placed too far back, which is what we think.

Correct, he's not numb, his nerve was not cut or compressed, and has almost all his taste sensation. According to drs, direct needle hit does not always mean numbness...

I'm sorry for your continued numbness, but that's wonderful the pain has ebbed so significantly and that you were a candidate for surgery. How did your damage occur - was it by an instrument?

In his case, since the damage is not localized, drs think surgery would likely do more harm than good and have said it's not an option, period. (multiple oral surgeons have concurred on this).

Post Edited (oregonsunray) : 6/14/2013 5:26:52 PM (GMT-6)

Posted 6/14/2013 11:43 PM (GMT -5)
Just like the rest of the nerve damaged people in the world. I don't know what exactly caused my damage. The anesthetic injection was killer shocking and the extraction was worse.

The Dentist said it wasn't any thing he did wrong! and the Oral Surgeon said I should have never let a general dentist near my wisdom tooth in the first place! Live and Learn I guess!

I never had any actual pain at the extraction site once it healed but my damage is still localized at that location of the nerve. I had hearing/sound issues to, from the wind to the just the tick of the clock would send my tongue into a electric frying pan mode.

OS said it was hyper-aesthesia - dysesthesia of the lingual nerve. neurologist called it anesthesia dolorosa of the trigeminal nerve.

I have been damaged long enough to know that attempted repair of these injuries are rarer than the injury itself.

I have only met about less than a dozen other people online since 2001 who have undergone what I had done. but I have seen way way more who did get better by just doing nothing but taking drugs to help lower the level until it healed. nerve injury can heal as long as you don't go around damaging it more than it already is. Does he find himself clenching his jaw a lot on that side?
Posted 6/17/2013 12:31 PM (GMT -5)
I appreciate you talking to me about this. You're the only person with a similar injury that I have met.

How did you finally find someone who would operate? Was it an OS or a neurosurgeon? I feel like that door was fully closed on us, but hearing your story makes me wonder if we need to try to pry it open again...

My husband's injury was in the OS office, but OS had hygienist do the injection, which is legal in OR, just very unusual according to all the other OSs we saw, who said they always do their own. As you may know, Septocaine in particular has to be handled with care (infiltration, not block, etc).

He tries really hard not to clench or squint, but I know from massaging him that his neck and shoulder are very tense. He's taking the 600mg/day max of Lyrica and it just barely takes the edge off. Side effects seem manageable at least, much better than Neurontin and Pamelor.

Damage doesn't seem to be healing at all and they don't expect it to improve on its own after 2+ yrs of very little improvement. In fact, the only improvement seemed to be in the first few months, then plateaued.

The lack of accountability for these injuries is so infuriating and shameful. That they don't even know how to diagnose the injuries they cause, let alone treat them, is truly beyond belief. mad
Posted 6/17/2013 12:42 PM (GMT -5)
aAll ican offer is anecdoTal info from my mother's long term trouble with trigeminal syndrome. She was RXed 2mmg of Elevil over a period of two years and it slowly went away, best of luck . . . Q
Posted 6/17/2013 12:44 PM (GMT -5)
Thanks Quincy17, much appreciated. Best wishes to you as well.
Posted 6/17/2013 4:38 PM (GMT -5)
Sorry about all the misprints in that last post, iPads are great but not for typing. I've tried Lyrica for neuralgia in my feet and it seemed like an expensive Gabapentin. Amitriptyline, or Elavil, are old school CP meds given in way small doses, give it a try if you can . . . Q
Posted 6/18/2013 1:13 AM (GMT -5)
I have had many injections always injected by the dentist/OS only. I have always heard 4% Septo has higher risk of nerve damage with mandibular blocks and dentists were being encouraged by insurance companies to list that "risk" in the consent form. Mine was 2% lido. and over 10 years ago consent forms only listed procedure risks of nerve damage. but nerve damage was actually listed as one short, tiny print, paragraph... paraesthesia of the lip or tongue may occur. Did he sign one?

I never had any relief from any of it in the first 6 months and I had 3 OS's monitoring my mouth the entire time. At 7 months the OS decided he needed to see what was causing it and it was only after the jaw was opened did I find out it was the lingual nerve involved.

My condition was monitored by the same OS for the first 3 years. He was the only one who could prescribe narcotic med and that along with Xanax, Zoloft, Neurontin plus I forget what else helped me get through the worst of it.
Posted 6/18/2013 2:58 AM (GMT -5)
glad to hear you are through the worst of it and hope that you keep on getting better. . .Q
Posted 6/18/2013 4:34 PM (GMT -5)
quincy17 -
No worries about typos, I could tell what you were saying just fine :-)
He didn't get any relief from Gapapentin and felt like a zombie. Nortriptyline did more than Gabapentin, but still made him feel like a zombie. Lyrica doesn't have too much side effects, but isn't as effective as we'd hoped. Now I wonder if combining it with a low-dose Elavil (or similar) could help, but he's resistant to trying a bunch of stuff that could make him feel worse and "probably won't work anyway" after being disappointed so many times. Good food for thought!

nervedamaged-
The Septo was supposed to be infiltration, but it sounds like she goofed and placed the shot back where a block would go. Lido was also used. I believe there was informed consent, but the attorneys we contacted didn't even consider that, they were all about finding another OS who would say the hygienist/OS were negligent. Like any OS would have any motivation to stick their own neck out like that! All OSs we talked to agreed it was unusual and that it could have been done right or wrong and still had this outcome. They each also said they're not in a position to judge if it was negligent. Doesn't help that the OS where this happened is well known, both in the field and in the courtroom. Of course, if we'd known then what we know now, he'd have never let that hygienist inject him and would have asked for Lido only. Although, talking to you, that may still not have been enough to prevent the injury. I am still just shocked there's no accountability or known treatments...
Posted 6/19/2013 1:30 AM (GMT -5)
In reality my OS did stick his neck out since he was the one who opened my jaw took check out the nerve. but he would not testify under oath because he only did work for the other side! so naturally my written post op report is not accurate.............

Since he has been to Calf. and Texas I would suspect he has seen some pretty decent OS's?? There is accountability in some cases or dental malpractice lawyers wouldn't exist, but its hard to prove.... I can just imagine what his OS is well known for in the court?? Have you checked his record at the state dental board lately?
Posted 6/19/2013 11:08 AM (GMT -5)
Yes, CA and TX OS are considered among the top, if not the top, in their field. Both are well published as well, specifically in discussing nerve injuries. And, yes, the OS where this happened is well known for defending other physicians in court and also for donating to the college that supplies most of the area's new OSs! His record is peachy because he's made himself "untouchable". One can only guess how many others he's injured. Sorry if I sound bitter, I am just so frustrated and stressed seeing my husband in so much pain, with so little hope, and outlook so grim.
Posted 9/26/2013 3:49 PM (GMT -5)
cinbad52OH

I have similar jaw pain.  My nerve was damaged when I had wisdom teeth extracted.  Both an upper/which was ouside the gum line and a lower impacted one.  Because I was in my 50's they said there was a possibility that I could have a problem.  Then after several xrays were taken and the teeth were extracted the OS didn't think I would have a problem.  A couple days after the surgery I noticed my lower right  gum line, some of my tongue and my chin on the left side was feeling a numbness, tingly sensation.  It is going on 4 years now and my pain has not subsided.  I saw a neurologist who put me on several different medications.  I am very sensitive to medications so I haven't found one to work for me yet!  I did go to an acupuncturist who I think came the closest to easing my pain some but it is very expensive and my insurance would not cover it.  If it was just numbness I think I could live with it.  But this is very hypersensitive to wind, cold, touch, eating, kissing, talking...you name it and it bothers me very much.  The pain is like an electric shock, burning sensation, sometimes throbbing like a toothache and there is no way I can just live with it...I've been trying for almost 4 years now......I am pleading for someone to be able to help find me answers.  I've been to my dentist, the OS, family doctor, neurologist and acupuncturist all to no avail.  If anyone out there has any suggestions I look forward to hearing them.

Posted 9/26/2013 5:49 PM (GMT -5)
Hi Cinbad, I'm very sorry for your injury and pain. I wish I had some answers. Oh how I wish I did!!! There is a blog about Lingual Nerve Damage http://lingualnerveinjury.blogspot.com/ and a facebook group https://www.facebook.com/groups/260466177345212/ that I'd recommend for support, suggestions, etc. The blog is open to anyone to read, but you have to request to join the FB group - it's worth it. People have had varying degrees of injuries and varying degrees of success treating them, so you can very likely find out about some new ideas or at least join a group of great people who can probably best understand what you're going through. Hope to see you around there!
Posted 4/1/2014 9:09 PM (GMT -5)
Hi Oregonsunray,

I am just now seeing your post but I would like to know how your husband is doing now. I was injured w/ 4% Septocaine on 11-1-13 and I am looking for some hope of healing and recovery.

Thanks.
Posted 4/3/2014 8:12 PM (GMT -5)
Hi Gimmeabreak,
I'm so sorry you were injured this way. I'm also sorry to say that my husband's pain is still unmanaged. The good news is that many people with dental nerve damage do recover, sometimes it just takes a while. There are many medications that may help - have you seen a neurologist or pain management dr yet? Have you seen a few oral surgeons to be sure there isn't a surgical solution? I belong to a facebook group as well, see post above to Cinbad, you may find it useful. No two injuries are exactly the same, so it's very difficult to predict how yours may evolve. There is hope for sure though, as recently as this occurred, especially if you're noticing any improvement at all...? I wish you all the best and look forward to hearing more from you
Posted 2/19/2015 2:34 PM (GMT -5)
I just wanted to post on here because I know how helpful it was for me to read about other people's lingual nerve damage experiences after my own. In 2008 at the age of 21 I had my wisdom teeth removed, and after waking from the anesthesia (and after the numbing medication wore off) I realized that I had lost all feeling and taste on the left side of my tongue. I struggled to talk and eat and was heartbroken at the thought that it may never improve. After a couple years I was talking normally and had much less trouble eating. I thought maybe it was coming back but I soon realized that I was just getting used to it. This wasn't so horrible, but it wasn't the greatest either and after about four years I just accepted my situation was what it was. It is now 2015, 7 years since my nerve damage. I was talking to my husband last week and I felt a strange new sensation on my tongue. My feeling and taste were coming back!! Even today moving it around on the roof of my mouth and drinking bitter coffee it is undeniable! I am shocked and elated. I would have never guessed that something could heal after 7 long years of no improvement. Just one day it starts to show. Amazing. I had to let people know that this is possible. Thanks :)
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