Trigeminal neuralgia: dental considerations

For the medical management of trigeminal neuralgia, see Trigeminal neuralgia and other cranial neuralgias.

Patients with trigeminal neuralgia may mistake their symptoms for toothache. Dental pain, particularly pulpitis, is qualitatively similar to trigeminal neuralgia, so careful evaluation of the teeth is required. If the findings from an oral examination and tests (eg pulp tests, radiographs) do not suggest a dental pathology, or if initial dental treatment does not reduce the pain, consider the possibility of trigeminal neuralgia. Do not undertake further dental treatment or perform invasive or irreversible procedures unless a dental pathology is confirmed. If facial pain is not dental in origin, refer the patient for medical assessment.

In patients with unstable trigeminal neuralgia, dental treatment can exacerbate pain, even if performed at other sites in the mouth. Treating the area afflicted by trigeminal neuralgia with a local anaesthetic block can reduce the degree of exacerbation.