Unnecessary dental procedures as a consequence of trigeminal neuralgia.

Abstract

Trigeminal neuralgia (TN) is a disorder characterized by repetitive lancinating pain along one or more branches of the trigeminal nerve and is commonly triggered by chewing and manipulation of the gums. The second and third divisions are most commonly affected. Due to these symptoms, patients are likely to consult their local dentist when symptoms first develop and may receive further dental evaluation and treatment before they are referred to a neurologist or neurosurgeon. We sought to answer questions regarding evaluation and possible dental treatment as well as referral patterns in TN patients. Using a surgical database, we obtained data of patients undergoing an intervention for trigeminal neuralgia. Telephone interviews were conducted, focusing on initial evaluation and possible dental treatment, on referral patterns, and on present status. Secondly, a written questionnaire was mailed to local dentists. Eighty-two percutaneous rhizotomies and 33 microvascular decompressions were performed in 99 trigeminal neuralgia patients. Of 92 patients contacted, 51 were alive and willing to participate. Two thirds reported being pain-free. Forty-one patients (82%) initially consulted their dentist; of these, 27 patients received invasive dental treatment for the pain syndrome, including extractions, root canal treatments, and implants. Of 98 local dentists contacted, 51 responded, with three quarters feeling competent in evaluating trigeminal neuralgia. A high percentage of patients that are surgically treated for trigeminal neuralgia consult their dentist first and receive possibly unjustified dental treatment. Differential diagnoses include odontogenic pain syndromes as well as atypical orofacial pain. The present literature acknowledges difficulties in correctly diagnosing trigeminal neuralgia, but seems to underestimate the extent.