Cause for jaw swelling remains elusive

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DEAR DR. GOTT: I am an active 90-year-old man with a large garden, yard, and a couple of fruit trees. Yes, I was raised on a farm.

In April 2009, I woke up one morning with a swelling in my left jaw and cheek. I went to my family doctor for an examination. He suggested I go to the local dentist for an X-ray, which I did. The dentist said it acted like temporomandibular joint (TMJ) disorder but he doubted it, so he gave me some Diflunisal. Later that week, I went for two chiropractic treatments, and in a week the swelling was gone.

I had no problem except for numbness in my back lower jaw. Then in April this year, the numbness moved forward on my jaw and to the side of my face again. I contacted an ENT specialist, who gave me a CT scan. He reported nothing wrong with my sinuses and said I was just going to have to live with it. The numbness increased and moved to under my nose. Seeking relief, I went for six acupuncture treatments that gave temporary relief.

I went to a TMJ sleep specialist, who took X-rays of my teeth and bite pattern. Naturally, the left side showed very little bite pressure. The numbness went up to my cheekbone and around my eye. With no definite conclusion, he suggested I consult a neurologist, who sent me for an MRI that was negative. He gave me a prescription for gabapentin, which does subdue the numb feeling.

My medications are metoprolol, Doxazosin and Lisinopril, vitamin D3, vitamin E, fish oil and flaxseed oil, plus a general group of vitamins a couple of times a week.

I know this letter is long, but any relief you can provide would certainly be appreciated.

DEAR READER: This is puzzling. My guess is the swelling might be caused by an allergy or infection, yet you have already seen every specialist that might zero in on your complaint. April appears to be your weak month, which makes me wonder if you are allergic to something that begins to sprout at that time, to sprays you use early in the season, or to fertilizer you inhale while preparing your crops.

I am also apprehensive regarding your use of over-the-counter medications. Herbs and supplements are not regulated the way prescription drugs are. You may be allergic to one specific ingredient in your “general group” without even knowing it. Did you switch brands, purchase from a different supplier or increase any dosing?

You don’t appear to exhibit the common signs of TMJ, so I think we can rule that out. Do you practice good dental hygiene and visit your dentist on a timely basis? X-rays should have ruled out possible abscesses.

Gather all your test results from your cadre of physicians and return to your primary care physician, who should review everything to determine what is missing in the big picture. Something (perhaps a very simple something) is being overlooked that might provide you the relief you need. Be sure to review all your medications with him or her. It may be that more than one doctor is involved with your care, and your primary care physician doesn’t have a complete listing. Cross-over reactions are possible.

A referral to another neurologist may be in order. Gabapentin works to block nerve signals and you have had positive results, which indicates a likely nerve problem. Perhaps you are experiencing an unusual case of trigeminal neuralgia, a nerve disorder characterized by sharp pains in parts of the face.

Readers who would like additional information can send for my Health Report “Allergies” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or postal money order to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing, or print out an order form from my website’s direct link:

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