UNDESTANDING TRIGEMINAL NEURALGIA

Trigeminal Neuralgia (TN) is a chronic disorder that usually affects people in middle or later life and only rarely in children or young adults. It is an excruciating facial pain that tends to come and go in sudden shock-like attacks and is due to a chronic disorder of the trigeminal nerve (5th cranial nerve) which is the largest of the body’s 12 pairs of cranial nerves.

The trigeminal nerve has three branches which conduct sensation from the upper, middle and lower portions of the face and also the oral cavity, to the brain

The painful attacks of TN can involve one or more branches. Most commonly the middle branch or lower branch either individually or in combination with each other are involved. Only about 4% of patients experience pain in the upper branch. In rare instances, all three branches may be involved. The right side of the face is more frequently affected than the left and in a small percentage of patients, pain occurs on both sides of the face, but rarely at the same time.

Since the largest per cent of the patients have involvement of the middle and lower branches, many of the initial symptoms are felt in the teeth and gums. Many patients experience a dull, continuous aching and gum sensitivity to heat and cold prior to the onset of the more intense, classical symptoms of TN. This period, sometimes referred to as pre-trigeminal neuralgia presents a considerable diagnostic challenge, especially for dentists since they are, quite often, the first health professional to see the patient.

While true dental abnormalities do produce pain, the pain of TN is not caused by dental problems. What may appear as a toothache may actually be an early symptom of TN.

It is not unusual for a TN patient to see half a dozen or more dentists, oral surgeons, ear nose and throat and TMJ specialists etc. Many mode of treatment – root canals, extractions, oral surgeries etc – are pursued, to no avail, while the pain steadily worsens and more classic symptoms of TN develop.

TN is generally considered to be the most painful of all human afflictions but fortunately it is not fatal; rather it is a treatable disorder that can be effectively managed, and often times, long term control can be achieved.

POST HERPETIC NEURALGIA

Sometimes, TN symptoms can occur after shingles particularly if treatment with anti-viral medication is not commenced as soon as shingles is detected.

Post herpetic pain tends to be more constant than classic TN and also will often strike the eye/forehead region more than the cheek and lower jaw regions. This type of pain almost always goes away in time. It may be months for some or one or more  years for others but rarely lasting more than five years