Trigeminal Neuralgia After Gum Injury: Causes and Symptoms

Q: Trigeminal Neuralgia After Gum Injury: Causes and Symptoms

Hello： The branches of the trigeminal nerve are distributed from top to bottom in the forehead, cheeks, and chin. <br>During tooth extraction, the dentist anesthetizes the terminal branches of the trigeminal nerve. <br>Trigeminal neuralgia frequently occurs in the areas supplied

After the gum hole occurred, it was originally painful in the area of the hole, but now the pain has spread to the trigeminal nerve?

Yesterday, I may have injured my gums while using a water flosser, resulting in a hole.
Initially, only the area around the hole was painful.
Now, that area has developed into an ulcer with a white membrane as it heals, but the pain has shifted from the original hole to the trigeminal nerve, causing pain in the area around my left ear.
Swallowing also causes pain, and pressing near the painful area on the left side (the same side as the hole) can trigger discomfort.
Is this pain due to inflammation in the hole affecting the trigeminal nerve? Previously, when I had a gum hole, I experienced similar trigeminal nerve pain, which disappeared once the gum healed.
This time, however, the hole is less painful, but the pain has moved to the area behind my ear.
Certain movements, like moving my eyes or the muscles between my eyebrows, occasionally trigger sharp pain, but it doesn't hurt continuously unless I make specific movements.
I suspect this is related to the gum hole because the trigeminal nerve pain started after the hole developed, specifically in the left lower gum near the back molars.
Additionally, after a previous root canal treatment where I received a lot of anesthetic, I also experienced trigeminal nerve pain.
When I asked my dentist, they suggested it might be a side effect of the anesthesia, as the trigeminal nerve is connected to the teeth and gums.
I want to know if injury or inflammation in the area around the teeth and gums can lead to trigeminal nerve pain, potentially affecting areas like the forehead and near the ear.
In the past, I had trigeminal nerve pain due to this, but it resolved on its own.

Mr. Chen, 30~39 year old female. Ask Date: 2017/05/31

Dr. Jiang Junyi reply Neurology

Hello: The branches of the trigeminal nerve are distributed from top to bottom in the forehead, cheeks, and chin.
During tooth extraction, the dentist anesthetizes the terminal branches of the trigeminal nerve.
Trigeminal neuralgia frequently occurs in the areas supplied by its lower two branches, with a lower incidence in the region of the first branch.
A distinctive phenomenon of trigeminal neuralgia is that it can be triggered under certain circumstances, such as touching the skin on the face, eating, yawning, brushing teeth, or exposure to cold air.
This pain is extremely distressing, and some patients may avoid washing their face or eating during an episode.
The most common cause of trigeminal neuralgia, according to statistics, is compression of the nerve root by an aberrant blood vessel, which is more prevalent in middle-aged women.
Other causes of trigeminal neuralgia include tumors, vascular malformations, aneurysms, and multiple sclerosis.
The medications used to treat trigeminal neuralgia have significantly alleviated symptoms for many patients since the development of certain anticonvulsants.
Additionally, some individuals may experience head and neck discomfort due to cervical myofascial pain caused by anxiety during dental procedures.
It is recommended that you consult a neurologist or a rehabilitation physician for evaluation and treatment.
Wishing you good health, peace, and happiness.

Reply Date: 2017/05/31

More Info

Trigeminal neuralgia (TN) is a condition characterized by sudden, severe facial pain that can be triggered by various stimuli, including touch, chewing, or even speaking. It is often described as one of the most painful conditions known, and it can significantly impact a person's quality of life. In your case, the pain seems to have developed following an injury to your gums, which raises important questions about the relationship between dental issues and trigeminal neuralgia.

The trigeminal nerve, which is responsible for sensation in the face and motor functions such as biting and chewing, has three major branches: the ophthalmic, maxillary, and mandibular nerves. When there is an injury or inflammation in the areas supplied by these branches, such as your gums or teeth, it can lead to irritation of the trigeminal nerve. This irritation can manifest as pain that radiates to other areas, including the ear and even the forehead, as you've described.

In your situation, the initial injury to the gums likely caused localized inflammation. As the inflammation progressed, it may have affected the trigeminal nerve, leading to the pain you are experiencing in the ear and surrounding areas. The fact that the pain has shifted from the gum area to the ear suggests that the nerve may be sensitized due to the inflammatory process. This phenomenon is not uncommon; dental procedures and injuries can indeed lead to secondary trigeminal neuralgia.

The symptoms you are experiencing, such as pain upon certain movements or pressure in the affected area, are indicative of nerve involvement. The pain may also be exacerbated by muscle tension or movements that engage the facial muscles, which can further irritate the nerve pathways. It's important to note that while the initial pain from the gum injury may subside as healing occurs, the trigeminal nerve can remain sensitive for some time, leading to ongoing discomfort.

In terms of treatment, addressing the underlying inflammation is crucial. Here are some recommendations:
1. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen may help alleviate pain. If the pain is severe, your dentist or doctor may prescribe stronger medications, including anticonvulsants like carbamazepine or gabapentin, which are commonly used to treat trigeminal neuralgia.

2. Dental Care: Since the pain originated from a dental issue, it is essential to consult with a dentist. They can assess the gum area for any signs of infection or other complications that may require treatment.

3. Warm Compresses: Applying a warm compress to the affected area may help soothe pain and reduce inflammation.

4. Avoiding Triggers: Identifying and avoiding activities that trigger the pain can be beneficial. This might include avoiding certain foods, extreme temperatures, or specific facial movements.

5. Follow-Up: If the pain persists or worsens, it is important to follow up with a healthcare provider. They may consider further evaluation, including imaging studies, to rule out other potential causes of the pain.

In summary, it is plausible that your gum injury has led to inflammation affecting the trigeminal nerve, resulting in the pain you are experiencing. With appropriate management and care, many individuals find relief from trigeminal neuralgia symptoms, and the condition can improve over time. However, ongoing communication with your healthcare providers is essential to ensure that you receive the best possible care and treatment for your symptoms.

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