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Trigeminal Neuralgia Joanna M Zakrzewska Dental Update 2024 46:8, 707-709.
Authors
Joanna MZakrzewska
MD, FDS RCS, FFD RCSI, FFP MRCA, FHEA
Professor of Pain in Relation to Oral Medicine, Clinical and Diagnostic Oral Sciences Dental Institute, Barts and the London Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
Trigeminal neuralgia is one of the most severe facial pains that patients can experience. This unpredictable, episodic pain, mostly unilateral in the distribution of the trigeminal nerve, results in recurrent shooting pain lasting for seconds to minutes. It is light touch provoked and therefore prevents patients from eating and touching their face, and so has a significant impact on quality of life. Patients often consult a dentist because it usually presents like dental pain. Dentists need to avoid irreversible dental treatment. Response to carbamazepine is good but tolerability is poor. Surgical options are available and are generally successful. Patients can gain further information from a patient support group, such as Trigeminal Neuralgia Association UK.
CPD/Clinical Relevance: Although rare, trigeminal neuralgia patients often present to dentists who therefore need to recognize it as a non-dental cause of pain in order to avoid irreversible dental treatment.
Article
Trigeminal neuralgia (TN) is described as a: ‘sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the trigeminal nerve’, which is triggered by light touch activities.1
Trigeminal neuralgia is considered to be a rare disease and the estimated prevalence from an old study in the USA put it at 4.1/10,000.2 More recent studies in the UK3 and Holland,4 using data from primary care records, suggests a higher incidence of 8 to 12.6 per 100,000 per annum. In a study in Germany, where all the diagnoses were validated by specialists, a lifetime prevalence of 0.3% (95% CI 0.1–0. 5%) was estimated.5 Up to 90% of patients develop TN after age 50, with the peak between 60–70 years, and there is a slight predominance in women. It can occur in young people and even children. The disease most frequently linked with TN is multiple sclerosis (in around 5–10% of cases). In this group, it occurs in a younger age group and there is an increased frequency of bilateral pain. Tumours account for a very small number of cases. Hypertension is a risk factor and strokes more likely.6,7 Data from a population-based study in Taiwan highlights increased risk of depression, anxiety and sleep disorder after diagnosis of TN.8 There are reports of familial links.
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