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TN: A Primer for the Oral Health Care Professional and Patients

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What is Trigeminal Neuralgia?

Trigeminal Neuralgia (TN) also known as tic douloureux, is an excruciating facial pain that tends to come and go in sudden shock-like attacks. For some, it will be relentless, lightning-like bolts of pain. Classic TN has distinct symptoms which clearly separate it from other forms of facial pain:

  • It is usually unilateral pain, only occurring bilaterally in 4% of patients with diagnosed TN
  • The pain comes in short, acute bursts, rather than in a dull, constant ache.
  • Pain is usually triggered by light touch or sensitivity to vibrations, like brushing one’s teeth, shaving, a light breeze, talking etc.
  • Pain has a tendency to come and go with periods of intense pain followed by complete pain-free periods of remission lasting from weeks to months or longer.
  • Most patients experience pain during the day. Generally, they are pain-free while asleep unless triggered by the touch of bed linens or changes in position.

How to Diagnose TN

  • Take an extensive medical history.
  • Do a thorough examination
  • Ask detailed questions about the pain.
  • Test the tooth with hot or cold. If it hurts, pulpitis is likely.
  • If uncertain about whether the pain is a dental problem, refer the patient to an oral medicine specialist, an orofacial pain specialist, or neurologist.

Note: There is no specific test available to confirm the diagnosis of TN.

Tell Your Patients The Importance Of…

  • Maintaining their dental care to prevent extensive dental treatment;
  • Oral hygiene when medication is at its peak level of effectiveness;
  • Using a soft toothbrush; and
  • Staying away from tartar control and bleaching products.

Medical Treatment

The first universally accepted treatment option is through medications. The most commonly prescribed medications to treat TN are :

  • Tegretol (carbamazepine)
  • Carbatrol (long-acting)
  • Neurontin (gabapentin)
  • Lyrica (pregabalin)
  • Liorsal (baclofen)
  • Dilantin (phenytoin)
  • Other anti-epileptic drugs

Analgesics, i.e. aspirin, Tylenol, etc., and narcotics are not effective in addressing the pain of TN as it is of lightning like intensity and the attacks are of brief duration.

Surgical Treatment

Surgical procedures are used for those patients who are unable to tolerate the medications, exhibit serious side effects, or if the medications do not control the problem. There are several modes of surgical intervention available. Each procedure has advantages and disadvantages. There is no one medical or surgical treatment that is effective in all patients.

How to Help

With TN, the nerve is highly sensitized. Below are some tips to help your TN patients.

  • Schedule routine visits when TN patients are in remission.
  • For someone who must have major work done, schedule shorter appointment time during the time period in which their medication is at its highest level of effect.
  • Discuss a short-term preoperative increase in the patient’s neuralgia-directed medication with the health care provider prescribing the medication.
  • If a patient is very nervous, suggest nitrous oxide gas or IV sedation to reduce emotional trauma.
  • Use pre-emptive anesthesia by providing a long-acting anesthetic block at the end of the procedure.
  • Inject the anesthetic at a site as far as possible from the trigger point for TN pain.
  • Utilize dry mouth products.
  • If tooth-brushing is intolerable, prescribe viscous lidocaine, a typical anesthetic as an anesthetic camouflage, or Peridex mouth rinse.
  • Refer your patient to FPA (The Facial Pain Association) for information, support and encouragement.

The Facial Pain Association is a 501 (c) (3) non-profit organization assisting thousands of patients around the globe since 1990. FPA is the world’s largest organization providing information and healthcare guidance for people suffering with trigeminal neuralgia and related neuropathic face pain. FPA provides patient support services, education programs for patients and healthcare professionals and advocates for research to find a cure.