Could This Be Trigeminal Neuralgia? Dental Pain Symptoms

Is this trigeminal neuralgia?

Hello, doctor.
After I had a tooth extraction, I experienced severe pain in the area of the upper left first and second premolars, with the pain radiating from the zygomatic bone to the ear.
I went to the dentist for an examination, and everything appeared normal.
Currently, I am undergoing orthodontic treatment.
Last night, after eating and drinking water, I suddenly felt a gradually intensifying severe pain in my upper right canine, which lasted for a few seconds and then subsided.
However, every time I drink water, the pain returns, radiating to the area near my nostrils.
After a while, the pain goes away, but it recurs when I brush my teeth and rinse my mouth before bed, continuing until the next day.
The pain occurs whenever I come into contact with water, or if I make significant movements with my mouth or feel a slight breeze.
I took the pain medication prescribed by my dentist, but it had no effect! The pain is still very intense.
Could this be trigeminal neuralgia, or is there an issue with my teeth?

A-Meng, 20~29 year old female. Ask Date: 2017/03/13

Dr. Jiang Junyi reply Neurology

Hello, your symptoms are caused by trigeminal nerve instability, which is commonly seen in women around the age of 50.
Since this occurred after your dental treatment, it is generally advisable to wait for the inflammatory phase to subside (approximately 2-3 weeks) before further evaluation.
The primary cause of trigeminal neuralgia is often due to compression of the trigeminal nerve by vascular structures as it exits the brainstem.
Other causes, such as vestibular schwannoma, meningioma, multiple sclerosis, and herpes zoster, can also lead to trigeminal nerve dysfunction, amplifying normal sensory signals like touch and temperature into pain signals.
Unlike pain caused by other tissue injuries, anti-inflammatory and analgesic medications have limited effectiveness for trigeminal neuralgia.
The mainstay of treatment for trigeminal neuralgia is anticonvulsant medications.
If there is a poor response to medication, options such as microvascular decompression of the trigeminal nerve root, nerve block procedures, and gamma knife surgery may be considered.
It is recommended that you consult a neurologist for discussion and treatment.
Wishing you good health and peace.

Reply Date: 2017/03/13

More Info

Trigeminal neuralgia (TN) is a condition characterized by sudden, severe facial pain that can be triggered by everyday activities such as eating, drinking, or even touching the face. Your symptoms, particularly the sharp, intense pain radiating from the upper teeth to the cheek and ear, along with the pain being triggered by drinking water or brushing your teeth, could indeed suggest the possibility of trigeminal neuralgia. However, it is essential to consider other potential causes of your pain as well.

In your case, the history of dental procedures, including tooth extraction and orthodontic treatment, raises the possibility of nerve irritation or inflammation. After dental work, it is not uncommon for patients to experience temporary pain or discomfort as the tissues heal. However, if the pain persists or intensifies, it may indicate an underlying issue, such as nerve damage or inflammation of the trigeminal nerve.

Trigeminal neuralgia is often described as a "lightning bolt" of pain that can last from a few seconds to a couple of minutes. The pain is typically unilateral, meaning it affects one side of the face. The fact that your pain is triggered by specific actions, such as drinking water or brushing your teeth, aligns with the typical presentation of TN. Additionally, the pain radiating to the nasal area could also be consistent with trigeminal nerve involvement, as this nerve supplies sensation to the face.

However, it is crucial to rule out other dental issues that could be causing your symptoms. Conditions such as dental abscesses, pulpitis (inflammation of the dental pulp), or even referred pain from other dental problems can mimic the symptoms of trigeminal neuralgia. Since you mentioned that dental examinations did not reveal any issues, it may be beneficial to seek a second opinion or further diagnostic imaging, such as an MRI, to assess the trigeminal nerve and rule out any structural abnormalities or lesions.

Pain management for trigeminal neuralgia typically involves medications such as carbamazepine or oxcarbazepine, which are anticonvulsants that can help stabilize nerve activity. If medication does not provide relief, other treatment options may include nerve blocks or surgical interventions, such as microvascular decompression, which aims to relieve pressure on the trigeminal nerve.

In conclusion, while your symptoms could potentially indicate trigeminal neuralgia, it is essential to conduct a thorough evaluation to rule out other dental or neurological issues. Consulting with a neurologist or a specialist in facial pain can provide further insights and help determine the most appropriate course of action for your situation. It is crucial to address these symptoms promptly to ensure effective management and relief from pain.

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