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Mouth Diseases

Intense Pulsing Pain from Roof of My Mouth

07/08/2010

Question:

I have been in intense pain since Sunday night,it is now Tuesday. The roof of my mouth feels swollen and is tender to the touch, especially about a 1/4 of an inch behind my front teeth. It is a horrible throbbing pain, that shoots up almost through my nose. It feels like someone is pulling out my teeth. I am desperate for answers.

I have been to the ER, my primary care doctor, 2 dentists, an Endodonitist and an Oral/Facial Surgeon. No on seems to know what the problem is. They have decided that it is not an absessed tooth, thrush, a cavity, cancer or gum disease. They put me on very strong antibiotics thinking it might be an infection of some kind. I was reading on this website about Mucocule, but I couldn`t tell from the website how painful Mucocule would be or not. As of about an hour ago I do feel almost a bubble like inflamation on the roof of my mouth that I do not remember having since this started. I was wondering if you thought it might be that or if you might have some other ideas. Thank you so much!

Answer:

It seems that you have had an extensive evaluation, what type of imaging have they done? Did they do a CAT scan or MRI?

The location of the origin of pain may be the incisive foramen/canal.
Cysts can occur in this area (Nasopalatine Duct Cyst and Median Palatal Cyst) and these can become enlarged, fluid filled and contains blood vessels, lymphatics and nerves. Treatment for both is enucleating the cyst and removing the lining of the lesion.

Another possibility of what you are describing could be related to trauma and irritation of the nerves in the area of concern. I would consider the possibility of an over simplification description referred to as atypical odontalgia. This is a “garbage can” diagnosis to describe pain in the mouth and teeth of unknown origin. Radiographically, clinically, and the cause of the symptoms is not readily identifiable. Antibiotics may or may not work, dental procedures do not relieve the pain or if they do it is only temporary, and a lot of root canals and extractions are done needlessly. The cause can be some trauma to the nerve supply in the area of pain, and the pain fibers then respond by constantly sending out pain impulses.

Treatment and diagnosis can be complicated and take years for remission. Currently, treatments include the use of tri cyclic antidepressant, topical capsaicin, and other neuro modulating drugs like neurontin. This is only started after infection and or other forms of pathology are ruled out. (OSCC, Cysts, vascular pathology, etc) Best wishes.

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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