Chronic Trigeminal Neuropathy

Introduction

Chronic trigeminal neuropathy is a continuous pain sensation in the tooth, gum, or other adjacent regions. This condition is also referred to as idiopathic neuropathic pain, peripheral painful trigeminal traumatic neuropathy, or atypical facial pain. When the pain is focused in the tooth area, it is named as atypical odontalgia. When the pain persists after the tooth is extracted, it is described as phantom toothache.

Cause

Neuronal hyperexcitability is the key to the development of chronic pain. Acute injury or inflammation can lead to irreversible changes in the periphery and/or central nerve. This is called peripheral and central sensitization. Peripheral sensitization can be completely blocked with a local anesthetic and is more focal. Central sensitization does not fully respond to anesthetic blocks and can feel more widespread.

Symptoms

The extent of pain experience varies in each individual. This depends on the underlying disease, environmental, psychological, and genetic factors. Patients with this condition can have:

  • Prominent pain without sensory deficits
  • No significant pain with sensory deficits
  • Both Pain and sensory deficits

Pain felt can be:

  • Burning, tingling
  • Dull, aching
  • Pulsating or electric shock like pain

Diagnosis

Diagnosis of chronic trigeminal neuropathy is made by ruling out all other possible local or systemic causes such as: dental, oral, facial, sinus, musculoskeletal or intracranial conditions. Additional assessments by ENT and/or neurologist may be required. Diagnostic tests that can be performed include:

  • Comprehensive head and neck exams
  • Dental pulp test
  • Anesthetics challenge test
  • Intra-oral x-rays
  • MRI of brain, head and neck structures

Treatment

Treatment of chronic trigeminal neuropathy depends on the severity of the condition, and may include:

  • Medications such as analgesics, topical anesthetics, anticonvulsants, antidepressants
  • TENs stimulation units
  • Neurosensory gingival stents
  • Botox injection

References

  1. Orofacial Pain: guidelines for assessment, diagnosis, and management. American Academy of orofacial pain. Fifth edition. Reny De Leeuw, DDS, PhD, MPH and Gary D. Klasser, DMD
  2. Bell’s oral and facial pain. 7th edition. Jeffrey P. Okeson, DMD
  3. American Association of Dental Sleep Medicine


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