Our brain contains thousands of nerves and multiple neural pathways, and sometimes those nerves can encounter abnormalities or injuries that result in chronic conditions. One such condition is trigeminal neuralgia, a painful disorder affecting the trigeminal nerve, which runs through the face and upper jaw area. Since its trademark spasms can be triggered by touching the face, some people first notice the symptoms when brushing their teeth and may mistake it for a dental problem. This condition, however, is considered a neurological issue as opposed to an oral health issue. While there is no cure, pain management methods are available.
What Is Trigeminal Neuralgia?
Neuralgia of the trigeminal nerve creates few to frequent attacks of shooting facial pain that may feel like a burn or an electrical shock. An attack can last for a few seconds or up to two minutes and can affect a person for an hour or more at a time.
A person with facial neuralgia may find daily life difficult. As the condition worsens, eating and speaking can be affected, and even simple facial contact like shaving, flossing, or putting on makeup can trigger a wave of pain. The constant worry about the next episode may lead to depression and other mental health stressors, which are just as necessary to manage as the neuralgia itself.
The condition occurs when a blood vessel or tumor presses on the trigeminal nerve. This contact, in turn, puts pressure on the nerve and damages its protective coating. When or why it can come about, that can be due to injury to the nerve from sinus surgery, oral surgery, head trauma, a stroke, or a complication of multiple sclerosis. According to the Mayo Clinic, this kind of neuralgia can affect people of any age but is most common in adults 50 or older and more often affects women.
Besides mimicking the teeth or gum pain of a dental problem, this condition might surface as pain in the lips, nose, eyes, or forehead. If you are experiencing tooth sensitivity or tooth pain and think it might be trigeminal neuralgia, talk to your dental professional, as these could be signs of something else if you're not experiencing any other symptoms of this condition.
A thorough medical exam and history are required to diagnose trigeminal neuralgia. Once you talk with your dentist and doctor about the problem, they will refer you to a neurologist, who may order an MRI of the head or other imaging to confirm the problem and start creating a treatment plan.
While there is no cure or a treatment that will be effective for every individual, there are pain relief methods your doctor or neurologist may recommend. Nonsurgical treatment is usually the first approach a doctor will take to manage the condition.
Since neuralgia is neuropathic (originating directly from the nerve), the pain associated with it does not respond to ordinary pain relievers or opioids. Anticonvulsants, such as carbamazepine (usually used to reduce seizures), can often minimize pain and attacks. A neurologist may also prescribe a muscle relaxant or other medication to help control facial "shocks."
Surgeons recommend invasive procedures only after available drug options have been shown not to help a person manage the condition. Surgeons might turn to a minimally-invasive procedure called microvascular decompression, in which a surgeon makes a minor incision behind the ear and places a “pillow” between the nerve and blood vessel that’s putting pressure on it. This procedure has been successful with patients, with over 75% experiencing complete pain relief after a year of surgery.
It may seem strange, but some of the primary invasive surgeries for treating this condition involve damaging the nerve to relieve pain. One of these procedures is called brain stereotactic radiosurgery (Gamma knife), which uses radiation to target the nerve and “damage it,” which relieves pain. Another type of nerve-damaging surgery is called a rhizotomy, where a surgeon damages the nerve fibers to help ease pain through an injection, balloon compression, or thermal lesioning.
The use of Botox, derived from the botulinum toxin, is being investigated as an additional non-surgical option due to its potential to freeze muscles of the face. Research with Botox as a treatment is still ongoing, but a small study published in the journal Medicine shows promising results.
If you have been diagnosed with trigeminal neuralgia, talk to your neurologist about the best options for managing your symptoms. You may also decide to meet with a counselor to address the mental health concerns associated with the condition. No matter your age or stage in life, your treatment team can help you on your way to recovery, so you won’t have to fear any pain when showing off your bright, beautiful smile.
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.