Unexplained Tooth Pain: Could It Be Trigeminal Neuralgia?

Toothache with no identifiable cause?

Hello Doctor: About one or two months ago, I started experiencing unexplained sharp pain in my teeth (specifically in the lower right back teeth), and sometimes I even wake up in the middle of the night due to the pain.
I went to see a dentist who took X-rays but found no issues, and another dentist confirmed the same.
Today, I went to Chang Gung Memorial Hospital where they performed a vitality test, and the doctor also said my teeth appeared to be fine, but I am still in significant pain.
Could this possibly be what you referred to as trigeminal neuralgia? What causes it? Should I consider seeing a neurologist for further evaluation?

Cynthia, 20~29 year old female. Ask Date: 2009/08/01

Dr. Lin Zijing reply Neurology

The pain sensation in the teeth is a branch of the trigeminal nerve.
Typical trigeminal neuralgia is characterized by sudden, severe unilateral facial pain that feels like a knife or electric shock, which then abruptly disappears, only to recur shortly thereafter.
Most individuals have trigger points, and the pain can easily occur during chewing, consuming cold foods, brushing teeth, or during times of stress.
Typical trigeminal neuralgia does not accompany other neurological deficits such as facial numbness, tenderness, swallowing difficulties, or ear pain.

Differential diagnosis includes:
1.
Dental pain: Pain localized to the teeth without facial pain.
2.
Temporomandibular joint (TMJ) inflammation: Pain triggered by actions such as opening the mouth, laughing, or eating hard foods.
3.
Idiopathic facial pain and atypical trigeminal neuralgia: Pain within the distribution of the trigeminal nerve, but symptoms do not resemble typical trigeminal neuralgia.
In terms of treatment, the use of carbamazepine (Tegretol) is effective, and if it provides relief, a diagnosis of trigeminal neuralgia can be made.
It is recommended that you consult a neurologist for evaluation and treatment.

Reply Date: 2009/08/01

More Info

Unexplained tooth pain can indeed be a perplexing issue, especially when dental examinations and X-rays do not reveal any underlying problems. Your symptoms, particularly the sharp, sudden pain that can wake you from sleep, raise the possibility of trigeminal neuralgia (TN), a condition characterized by intense, shooting pain along the distribution of the trigeminal nerve, which supplies sensation to the face, including the teeth.

Trigeminal neuralgia is often triggered by minor stimuli, such as light touch, chewing, or even exposure to wind. The pain is typically unilateral and can be described as electric shock-like, making it distinct from other types of dental pain. In your case, the fact that multiple dental evaluations have shown no issues suggests that the pain may not be originating from the teeth themselves but rather from the trigeminal nerve.

The exact cause of trigeminal neuralgia is not always clear, but it is often associated with vascular compression of the trigeminal nerve at its root entry zone in the brainstem. This compression can lead to demyelination of the nerve, resulting in abnormal pain signaling. Other potential causes include multiple sclerosis, tumors, or other structural abnormalities, but these are less common.

Given your situation, it would be prudent to consult a neurologist for further evaluation. They may recommend imaging studies, such as an MRI, to rule out any structural causes of your pain, including vascular compression or lesions affecting the trigeminal nerve. Additionally, a neurologist can provide you with appropriate treatment options, which may include medications such as carbamazepine or oxcarbazepine, which are commonly used to manage trigeminal neuralgia.

In the meantime, it is essential to manage your pain effectively. Over-the-counter pain relievers may provide temporary relief, but if your pain is severe or persistent, prescription medications may be necessary. Avoiding known triggers, such as certain foods or activities that exacerbate the pain, can also be helpful.

In summary, while your dental evaluations have not shown any issues, the nature of your pain suggests that it could be related to trigeminal neuralgia. Consulting a neurologist for further assessment and management would be a wise next step. They can help determine the underlying cause of your symptoms and develop a treatment plan tailored to your needs. Remember, effective communication with your healthcare providers is crucial in managing unexplained pain, so do not hesitate to express your concerns and seek further evaluations as needed.

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