Case Study: Regina, Female, Age 45
In this case study, I discuss the connection between PCOS (Polycystic Ovary Syndrome), Toothache, and Facial Pain.
For over two years Regina had suffered with toothache pains, which persisted despite several root canal procedures and ultimately the extraction of several teeth. Even with these efforts and consultations with a number of dentists and dental specialists, she continued to suffer.
Evaluations by an internist and a neurologist led to further upset as she was told that “there is nothing wrong” and that she should return to her dentist.
Regina did not know where to turn.
Like many other patients that I see, Regina did in fact have tooth pain but the origin was not in her teeth. Her pain was due to a type of neuropathy (damage to the nervous system) that was likely related to a medical condition called PCOS and it’s association with Type 2 Diabetes.
PCOS, the common abbreviation for Polycystic Ovary Syndrome, is a condition in which a woman has an imbalance of female sex hormones. This may lead to menstrual cycle changes, trouble getting pregnant, and other health issues. Most important, however, the disorder shares a key factor with Type 2 Diabetes; namely the imbalance of blood glucose and insulin called Insulin Resistance.
Simply stated, Insulin Resistance is a malfunction of the body’s blood sugar control system (insulin system) is frequent in women with PCOS, who often have elevated blood insulin levels. Researchers believe that these abnormalities may be related to the development of PCOS.
In individuals where diabetes is not well controlled there are often constant high levels of blood sugar. Over time this can cause damage to both blood vessels and nerves throughout the body, including these structures in the face. The nerves can become physically damaged or inflamed causing pain, numbness and weakness.
According to the National Diabetes Information Clearinghouse, when this affects the nerves of the face, it is called a Focal Neuropathy. In fact, Diabetes is the biggest risk factor for neuropathy today!
How Was Regina Helped?
With the knowledge that Regina’s tooth pains were unrelated to her teeth but rather to her underlying PCOS and Diabetes, the focus of her treatment completely changed. All dental efforts (which had previously done nothing but make her pain worse or spread to adjacent teeth) were suspended and she was put into the hands of a group of medical specialists, of which I was one, who focused on her blood glucose levels and her weight gain, which had made her anxious and constantly upset.
I prescribed medications to diminish Regina’s nerve excitability and taught her strategies to ease jaw muscle tension, spasm and pain, which had developed secondary to her tooth pain suffering, which had persisted without answers. An oral appliance was also prescribed while sleeping as her variable blood glucose levels has impacted the quality of her sleep and led to increased levels of night clenching. My interventions helped ease her suffering considerably while her other physicians addressed the blood sugar issues.
For the most part Regina is pain-free except the when her blood glucose levels fluctuate excessively during times of high stress or sleep deprivation. When she does come to my office once in a while complaining of tooth pain and sensitivity in teeth that are structurally sound, I provide reassurance that her pain is real, but just not in the teeth.
This validation and getting Regina back on track with regard to sleep, stress, glucose levels, and weight remain critical to her long-term comfort.
Live or work in New York City or on Long Island? You can schedule a consultation with me here or call 212-265-0110
Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.
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