Many patients report a long history of toothache with an equally long history of dental interventions that proved to be unsuccessful. The typical story starts with a tooth that needed a root canal treatment. The root canal was unsuccessful so it was retreated and eventually extracted. The adjacent tooth became painful and required a root canal with no relief of pain; it too was extracted. Continued dental procedures prove to be unsuccessful.
We now recognize this as neuropathic pain, a disorder of the trigeminal nerve. The nerve fires spontaneously; the threshold for activation is decreased and the receptor field expands. In clinical terms it means the area of pain becomes more responsive to slight stimulation and the adjacent teeth start to hurt.
Neuropathic pain is best treated with topical medications or oral medications. Both approaches try to shut down activity of the nerve to allow it to heal. Topical application utilizes combinations of various medications applied to the sore area in the mouth. The medication may be held in place with a neuroshield to prevent saliva and the tongue from displacing it.
Oral medications are primarily from a class of drugs known as anticonvulsant medications. These medications reduce nerve activity. For neuropathic pain the doses are usually much less than needed for a seizure. There are other categories of pain medications including antianxiety and antidepressant medicines that are very helpful.
Patience is needed with treatment since medication dosage may need to be slowly increased over time. Sometimes a combination of medications is needed. There is great variability in patients response to medication.