Case Study: Richard Presents Muscle Pain, Jaw Ache
Richard was 62 years old when he came to me for an allergy consultation. He was taking prednisone (a powerful steroid drug) and I assumed this was to treat his severe allergic rhinitis (hayfever), but Richard explained that he was taking prednisone for a severe and chronically painful condition in his muscles that he had experienced over the previous three years. It soon became apparent to me that he was suffering with Polymyalgia Rheumatica, a severe inflammatory condition of the muscles, the cause of which is unknown. If the diagnosis is missed and treatment with steroid drugs is not implemented, people can develop irreversible blindness. For the first one and a half years Richard had used prednisone daily, shifting thereafter to shorter courses on a monthly basis. He told me that he did not like taking this powerful drug but his doctor had told him that there was no other treatment available.
When I asked Richard the key question about whether or not he had undergone dental work, he stated that he had a root canal procedure performed on one of his left lower molars six months prior to onset of his severe muscle pain. When he developed extreme pain in the left lower jaw laterally, he ordered his dentist to remove the tooth with the root canal, but the pain persisted and gradually became worse. Taking prednisone did not help, and Richard supplemented it with over-the-counter pain medications.
Richard’s other medical conditions included osteoarthritis and high cholesterol for which he was not on medication. He appeared older than his actual age and his blood pressure was somewhat elevated. He had tenderness along his left lower mandible as in well as the associated glands in the left upper neck region. The membranes in his nasal passages were chronically swollen, and his knees showed signs of chronic osteoarthritis.
Richard’s multiple investigations were normal except for an elevated sedimentation rate (this is a blood test for the presence of inflammation in the body). The test result was 24 mm/hr (with normal being 0-20). His cholesterol and triglycerides were somewhat elevated, and his chest x-ray was normal. An x-ray of his jawbone revealed an absence of all molars in the left lower jaw and no signs of bone necrosis. Richard attended my Clinic one month before we received our Cavitat 4000 ultrasound unit and so we were not able to perform a Cavitat scan on him, but I told Richard that he was probably suffering from NICO, and I referred him to a dentist skilled in dealing with these lesions.