Intraoral Sensory Abnormalities Caused by Tooth Extraction in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy

Abstract

Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is considered to be an immunemediated, acquired disease of the peripheral nerves. CIDP patients infrequently develop neuropathy with various clinical forms, such as blink reflex and trigeminal neuropathy. However, to our knowledge, there is no information about intraoral somatosensory changes associated with CIDP. Here, we report the case of a patient with CIDP who exhibited somatosensory changes investigated by quantitative sensory testing (QST). Case Report: A 77-year-old Japanese man was referred to our institution with symptoms of intraoral pain and swollen gingiva. The patient had been diagnosed with CIDP 8 years earlier. The second premolar of the right mandible was diagnosed with apical periodontitis, and tooth extraction was performed to control his pain and inflammation. Following the tooth extraction, local inflammation and pain subsided, however, the patient reported spontaneous dysesthesia on the adjacent gingiva of the extracted tooth. Intraoral qualitative sensory testing of the gingiva showed gingival mechanical allodynia and cold hypoalgesia at the extraction site. We diagnosed the patient with painful post-traumatic trigeminal neuropathy related to tooth extraction. Conclusion: Because of the lack of evidence for peripheral, organic changes in the oral mucosa, the sensory changes may be best explained by peripheral disturbance, an association may exist between these reported somatosensory changes and CIDP.