Trigeminal Neuralgia
Ronald Brisman, M.D.

Trigeminal neuralgia and dental considerations

 What are some dental considerations for patients with trigeminal neuralgia (TN)?

Pain in the teeth and peridental structures is most commonly caused by dental disease. Trigeminal neuralgia is an uncommon condition that may also cause pain in the teeth or surrounding tissues. Patients with TN often undergo many dental procedures, and these sometimes are unnecessary. It is appropriate for patients with pain in the teeth and/or surrounding tissues to see a dentist for an evaluation. If obvious dental pathology is identified, it is reasonable for this to be treated by the dentist. However, if the dentist finds no clear pathology, great caution should be undertaken before doing any significant dental procedures such as root canals or tooth extractions since tooth or peridental pain may be caused by TN and not dental disease.

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 How do you distinguish tooth pain from that of trigeminal neuralgia (TN)?

Dental pain is usually provoked by direct percussion to a tooth or application of cold and is diagnosed by examination of the teeth and peridental structures. Trigeminal neuralgia is often triggered by light touch about the face and may be provoked by wind, shaving, talking, eating or brushing the teeth. Carbamazepine (Tegretol) or oxcarbazepine (Trileptal) will eliminate the pain of TN but not dental pain. The relief of TN pain from carbamazepine or oxcarbazepine is usually very rapid and may occur within 45 to 60 minutes.

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 What can be learned from the results of a local anesthetic block?

A local anesthetic such as given by the dentist will usually relieve the pain of trigeminal neuralgia (TN) and relief may last for several hours or as long as the anesthetic effect (numbness) from the local injection persists. Pains that are not TN can also be relieved temporarily by such a local block.  If a local anesthetic injection causes temporary numbness without relief of pain, it should raise doubt about the diagnosis of TN. Because local blocks may relieve other kinds of pain, they are not diagnostic of TN. Such blocks are usually not necessary for the diagnosis of trigeminal neuralgia because pain relief following carbamazepine or oxcarbazepine is a more reliable guide that one is dealing with TN.

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 Do dental procedures cause trigeminal neuralgia?

Dental procedures do not cause trigeminal neuralgia (TN). The development of TN in association with dental procedures usually occurs because patients with trigeminal neuralgia often go to a dentist when they have tooth or peridental pains, which often are caused initially by TN and not the dental maneuvers.

Dr. Ronald Brisman recently testified successfully as an expert witness on behalf of a dentist who was accused of causing the patient’s trigeminal neuralgia. Dr. Brisman testified that the dental work (root canal treatment) was not causally related to the patient’s trigeminal neuralgia. The jury agreed and came back with a verdict that was favorable to the defendant (dentist).

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 What kind of dental care should patients with trigeminal neuralgia (TN) have?

Patients with TN require even more than usual attention to regular oral hygiene such as cleaning, brushing and flossing. When they have trigeminal neuralgia pain they are reluctant to brush or floss, but they still require good oral hygiene to be sure that they clean the teeth and peridental areas properly. They certainly need regular dental care, but not to treat their trigeminal neuralgia pain, which is causally unrelated to dental issues. If a patient knows she has trigeminal neuralgia, she should inform the dentist. Although dental maneuvers are not likely to precipitate TN pain in patients who are in remission, there is always a chance that the TN may return. Nevertheless, patients with trigeminal neuralgia should pursue a normal course of dental management for their dental issues, which are unrelated to trigeminal neuralgia.
 
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