Jaw Pain: Is It Trigeminal Neuralgia?

Pain in the occlusion of the lower right molars?

Hello doctor, recently I have started experiencing pain when biting down on my lower right molars.
This issue began around early November, and I visited my family dentist at that time.
The dentist said that there were no visible cavities on the teeth, but I felt pain when biting down.
However, other movements such as opening my mouth or moving my jaw side to side did not cause pain.
Initially, the pain was mild and vague, but it gradually intensified over the course of a day or two.
The pain comes in waves and becomes more pronounced when I lie down at night, making it difficult to sleep.
After about a week, the pain subsided, but now it has returned for the second time.
Could this possibly be a case of trigeminal neuralgia? If I see a doctor, which specialty should I consult first, and what tests or treatments should I expect?

Ahe, 30~39 year old female. Ask Date: 2017/12/30

Dr. Huang Tingfang reply Dentistry

Dear Mr.
A-Ho,
Hello! (Pain in the lower right molar during occlusion) The biggest concern is a possible tooth fracture, which may not be visibly apparent in the early stages.
A thorough examination is necessary, and if needed, root canal treatment may be required.
Please communicate closely with your dentist.
Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2017/12/30

More Info

Jaw pain, particularly in the context of your symptoms, can indeed be indicative of trigeminal neuralgia (TN), a condition characterized by sudden, severe facial pain that can be triggered by everyday activities such as chewing, speaking, or even touching the face. However, it is essential to consider other potential causes of your jaw pain, especially since your initial dental examination did not reveal any cavities or other dental issues.

Trigeminal neuralgia is often described as a sharp, shooting pain that can occur in episodes, and it typically affects one side of the face. The pain is usually localized to areas innervated by the trigeminal nerve, which includes the jaw, cheeks, and forehead. In your case, the pain in your right lower jaw, especially when biting down, could suggest involvement of the mandibular branch of the trigeminal nerve. The fact that the pain worsens at night and disrupts your sleep is also a common characteristic of trigeminal neuralgia.

However, it is crucial to rule out other potential causes of your symptoms. For instance, temporomandibular joint (TMJ) disorders can also lead to pain in the jaw area, particularly when chewing or during certain jaw movements. TMJ disorders can result from various factors, including teeth grinding, jaw misalignment, or arthritis. Additionally, dental issues such as gum disease or issues with the roots of the teeth can also cause similar pain.

Given your symptoms, the first step would be to consult with a healthcare professional. I recommend starting with a visit to a dentist who specializes in TMJ disorders or orofacial pain. They can perform a thorough examination, including checking for any signs of TMJ dysfunction, muscle tension, or other dental issues that may not have been apparent in your previous visit. They may also recommend imaging studies, such as X-rays or an MRI, to assess the condition of your jaw joint and surrounding structures.

If your dentist suspects trigeminal neuralgia or if your symptoms persist despite dental evaluation, a referral to a neurologist would be appropriate. The neurologist can conduct a comprehensive assessment, which may include a detailed medical history, neurological examination, and possibly imaging studies to rule out other neurological conditions. They may also discuss treatment options, which can include medications such as carbamazepine or gabapentin, which are commonly used to manage trigeminal neuralgia.

In summary, while your symptoms could suggest trigeminal neuralgia, it is essential to undergo a thorough evaluation to rule out other potential causes of your jaw pain. Starting with a dentist specializing in TMJ disorders is a prudent first step, followed by a consultation with a neurologist if necessary. Early diagnosis and appropriate management can significantly improve your quality of life and alleviate the pain you are experiencing.

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