When I woke up with a sore jaw and a wobbly crown promptly fell off a back tooth, I assumed the two were connected – or rather, suddenly disconnected. By the next day when the pain was worse and a lump had appeared on my cheek, I was pleased to get an appointment with my dentist.
My dentist is a bit of a psychotherapist and I always feel better for seeing him, whatever he does to my teeth. This time, he glued the crown back and reassured me that the lump and pain were not caused by the crown but linked to stress. Was I working too hard? Worrying too much? He could see evidence of tooth-grinding, a sure sign that I was trying too hard to be the perfect human, and the pain I was suffering was tension in the muscles that hold my jaw together. He recommended painkillers, hot compresses, the passage of time and I’m sure he also said something about taking a month off in the Med and never again doing housework.
All good, but I had a hunch that shivery feverishness might not be attributable to a bit of jaw clenching, and rang my GP. One of the joys that still surprises me after seven years living in the country is that whereas in London I had to plan a really long time ahead to be ill, here I can usually speak to my GP the day malaise strikes. He sounded less than convinced by the dentist’s diagnosis (tho’ far too polite to say so) and asked me to come in, promptly diagnosing parotitis (blockage and infection of a salivary gland) and sending me away with a reassuring sackload of antibiotics and an instruction to eat citrus fruit to break down the blockage. Adding hot compresses to an already inflamed cheek would, he said, be a mistake.
As this particular pain is not compatible with sleep (fine lying on one side, less good when you roll over) I spent most of last night thinking about evidence-based medicine. If the dentist is right (and he was very sure), I am now contributing at personal and global levels to the devastating problems caused by antibiotic overuse, if the GP is right, I would most likely have got iller with each passing day, deprived of the antibiotics that I sorely need.
Ten midnight minutes with Google and I’m none the wiser about what the pain might be (both explanations seem plausible) but, intriguingly, there’s an almost equal split between suggestions (I hesitate to call it evidence) that citrus cures trouble in salivary glands, or causes it. As so often, I’m left wondering who really knows or cares, and perhaps more importantly, who will take the trouble to find out?
We see time and again from our work with the James Lind Alliance (I wrote about this a couple of weeks ago – https://oxfordbrc.nihr.ac.uk/blog/taking-work-home/) that patients want more research into often quite mundane things, whereas the drivers of innovation and wealth-creation too often get the upper hand in setting the research agenda. It won’t make anyone’s fortune to find out if citrus cures sore jaws (except possibly the makers of a sour fruit sweet lauded in one article) and it’s unlikely to get them a paper in Nature, but if I ever get this again, I’d love to know whether eating a few extra oranges is a bad idea, an important part of a cure, or really just a pleasant way to stave off scurvy.