Challenges in the Management of a Known Trigeminal Neuralgia Patient Presenting for A Fixed Dental Restoration-A Case Report

Abstract

Background: Although many studies approved the use of local anesthetics in controlling Dental Procedural Pain (DPP), patient with Trigeminal Neuralgia (TN) may continue to suffer DPP in spite of being in pain remission phase for TN. This report provided information on the challenges encountered in controlling DPP with Local Anaesthesia (LA) while carrying out a fixed prosthodontic procedure in a known classical TN patient. Case Presentation: Patient had been under the care of oral medicine specialist for 9-years with history of pain remission over the last two years and had since been on routine 200mg/day carbamazepine (CBZ). Examination showed tooth 37 was clinically healthy; tooth 35 and tooth 36 were missing; and tooth 34 was mesiolingually rotated, all with negative pulp test. A diagnosis of Kennedy’s class III lower edentulous space in a classic TN patient was made. Consecutive injection of three to five doses of LA (1.8ml lidocaine with 1:100,000 epinephrine) failed to control DPP during crown preparation procedure for fixed prosthodontics. This resulted in the postponement of the procedures for three different appointment visits in this case report. Upward review of CBZ dosage from 200mg/day to 800mg/day 72 hours prior to a dental procedure under LA produced a satisfactory DPP control. Combination of CBZ with Baclofen resulted in abolition of post procedural pain which rebounded patient to the pain remission phase. Conclusion: Team management approach involving the oral medicine specialist right from the pre-procedural assessment stage is hereby advocated.