Trigeminal neuralgia is a condition characterized by severe, stabbing, intermittent pains in the face that are triggered by mild stimuli like brushing teeth or talking. It is caused by compression or irritation of the trigeminal nerve by blood vessels. Diagnosis is based on the pain characteristics and location. Treatment involves medications to reduce nerve activity or surgeries like microvascular decompression to relieve nerve compression. Dental procedures require special care in patients with trigeminal neuralgia to avoid triggering pain flare ups.

1. TRIGEMINAL
NEURALGIA
presented by:
TARANA D RAGHANI
Guided by:
DR. JYOTI KARANI mam
DR. SALONI MISTRY mam

2. CONTENTS:
 TERMINOLOGIES FOR NEUROLOGICAL
DISTURBANCES
 ANATOMIC AND FUNCTIONAL CONSIDERATION OF
TRIGEMINAL NERVE
 WHAT IS TRIGEMINAL NEURALGIA
 EPIDEMIOLOGIC STUDIES
 ETIOLOGY
 CLINICAL CHARACTERISTICS
 RISK FACTORS
 DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS
 TREATMENT MODALITIES
 DENTAL CONSIDERATIONS IN TRIGEMINAL NEURALGIA

3. TERMINOLOGIES FOR
NEUROLOGICAL
DISTURBANCES
ALLODYNIA pain due to stimulus that does not
normally provoke pain
ANALGESIA absence of pain in response to
stimulation that will normally be
painful
ANAESTHESIA loss of any or all sensation

4. PARESTHESIA an altered sensation, which is not
pleasant, like tingling, crawling,
burning, itching
DYSAESTHESIA an unpleasant painful abnormal
sensation, either spontaneous or
evoked. Patient c/o burning,
stabbing or burrowing type of pain
HYPERAESTHESIA increased sensitivity to stimulus.
HYPOAESTHESIA decreased sensitivity to stimulus.

5. HYPERGESIA increased response to
stimulus that is normally
painful
HYPOGESIA decreased response to
stimulus that is normally
painful
AGEUSIA loss of taste sensation

6. NEURITIS an inflammation of a
nerve
NEURALGIA transmission of pain
impulse along the
course of nerve

7. ANATOMIC AND
FUNCTIONAL
CONSIDERATION OF
TRIGEMINAL NERVE
 It is the largest cranial
nerve.
 it comprises three
branches
1. OPHTHALMIC
2. MAXILLARY
3. MANDIBULAR
B D CHAURASIA’s HUMAN ANATOMY , 5th edition

8. SENSORY FIBRES
The sensory fibres arise from the gasserian
ganglion
MOTOR FIBRES
The motor fibres arise from the superior and
inferior nuclei
B D CHAURASIA’s HUMAN ANATOMY , 5th edition

10. OPHTHALMIC NERVE
BRANCHES
A. Infratrochlear
B. Anterior Ethmoid
C. Posterior Ethmoid
D. Lacrimal
E. Supraorbital
F. Supratrochlear
G. Nasociliary
B D CHAURASIA’s HUMAN ANATOMY , 5th edition

11. MAXILLARY NERVE
BRANCHES
A. Zygoticaticotemporal
B. Zygomaticofacial
C. Post. Sup. Alveolar
D. Nasopalatine
E. Greater Palatine
F. Lesser Palatine
G. Mid. & Ant. Alveolar
H. Infraorbital
B D CHAURASIA’s HUMAN ANATOMY , 5th edition

12. MANDIBULAR NERVE
BRANCHES
A. Auriculotemporal
B. Lingual
C. Inferior Alveolar
D. N. to the Mylohyoid
E. Mental
F. Buccal
B D CHAURASIA’s HUMAN ANATOMY , 5th edition

13. TRIGEMINAL
NEURALGIA
Trigeminal neuralgia is
defined as sudden, usually
unilateral, severe, brief,
stabbing, lancinating type of
pain in the distribution of
one or more branches of the
5th cranial nerve
Oral and maxillofacial surgery by neelima malik

14. EPIDEMIOLOGICAL
STUDIES
YEAR SCIENTISTS CONCLUSIONS FROM
THEIR STUDIES
1972 YOSHIMASU,
KURLAND and
ELVELVACK
TN is more common in
females than males in US
1996 JACOB AND
RHOTON
the incidence of TN occurs
predominantly in females
Prevalence of trigeminal neuralgia: A systematic review.
J Am Dent Assoc. 2016 Jul;147(7):570-576.e2. doi:
10.1016/j.adaj.2016.02.014. Epub 2016 Mar 24

15. 2004 VALLE et al
evaluated the
dental conditions
of 50 patients with
TN
 72 % showed intraoral
trigger zone
 16% had TMJ disorders
 6% had burning mouth
syndrome
 42% of the patients show
limitations for the
performance of daily
activities
1998 SHANMUHAS-
NTHARAM et al
investigated the
clinical
characteristics of
TN in 44 Asian
patients
female predominance
Right side 5 times more
affected than the left side (in
unilateral cases)
Largest frequency was in the
age group of 60-70 years

16. A RETROSPECTIVE STUDY OF 72
CASES DIAGNOSED WITH
IDIOPATHIC TRIGEMINAL
NEURALGIA IN INDIAN POPULACE
by DR SUNIL YADAV and others

17. A retrospective study of 72 cases diagnosed with idiopathic trigeminal neuralgia
in indian populace

18. ETIOLOGY
i. Neurovascular compression
ii. Multiple sclerosis
iii. Tumor and cyst
iv. Diabetes mellitus
v. Herpes simplex virus
vi. Allergy
http://tnaaustralia.org.au/dental-care-and-tn/

19. CLINICAL
CHARACTERISTICS
 It is characterized by sudden,
unilateral, intermittent paroxysmal,
sharp, shooting, lancinating, like pain.
 Pain is elicited by slight touching
superficial ‘Trigger points’ which
radiates from that point, across the
distribution of one or more branches of
trigeminal nerve.

20. The location of Trigger point depends
on which division of Trigeminal nerve
is involved
In V2 – points are located on the
skin of upper lip, ala of nose,
cheek, or on upper gums
In V3 – lower lip, teeth or gums of
lower jaw
In V1 – Supraorbital ridge

21. TRIGGERS
A variety of triggers may set off the pain
of trigeminal neuralgia, including:
 Shaving
 Touching your face
 Eating
 Drinking
 Brushing your teeth
 Talking
 Putting on makeup
 Encountering a breeze
 Smiling
 Washing your face

22. RISK FACTORS
1) Multiple Sclerosis (major)
2) Hypertension (common in the age
group at risk)
3) Familial tendency – in a
retrospective study by POLLOCK et
al females with bilateral TN had a
higher rate of familial TN

23. DIAGNOSIS
 Your doctor will diagnose trigeminal
neuralgia mainly based on your
description of the pain, including:
 TYPE OF PAIN related to
trigeminal neuralgia is sudden,
shock-like and brief.
 LOCATION. The parts of your face
that are affected by pain will tell
your doctor if the trigeminal nerve
is involved.
 TRIGGERS Trigeminal neuralgia-
related pain usually is brought on
by light stimulation of your cheeks,
such as from eating, talking or
even encountering a cool breeze.

24.  A NEUROLOGICAL EXAMINATION.
Touching and examining parts of your
face can help your doctor determine
exactly where the pain is occurring and
— if you appear to have trigeminal
neuralgia — which branches of the
trigeminal nerve may be affected. Reflex
tests also can help your doctor determine
if your symptoms are caused by a
compressed nerve or another condition.

25.  MAGNETIC RESONANCE IMAGING
(MRI).
Your doctor may order an MRI scan of your
head to determine if multiple sclerosis or a
tumor is causing trigeminal neuralgia. In
some cases, your doctor may inject a dye
into a blood vessel to view the arteries and
veins and highlight blood flow (magnetic
resonance angiogram).
http://tnaaustralia.org.au/dental-care-and-tn/

26. DIFFERENTIAL DIAGNOSIS
OF TRIGEMINAL
NEURALGIA
 SECONDARY TRIGEMINAL NEURALGIA
 PAIN OF DENTAL ORIGIN
a. Pulpal pain
b. Periodontal pain
c. Parafunction induced alveolitis
d. Crack tooth syndrome
 EXTRACRANIAL
a. Sinusitis
b. Temporomandibular disorders

27.  NEUROPATHIC
a. Pretrigeminal neuropathy
b. Trigeminal neuropathy
c. Glossopharyngeal neuralgia
d. Post herpetic neuralgia
e. Nerve compression
 NEUROVASCULAR
a. Migraine
b. Cluster headache
c. Chronic paroxysmal hemicrania
d. Giant cell arteritis
 PSYCHOGENIC
http://tnaaustralia.org.au/dental-care-and-tn/

28.  Medications are the first line of treatment
for TN and include carbamazepine,
phenytoin, gabapentin & baclophen.
 As the disease progresses and pain
becomes more frequent & severe,
increased doses of medications are
required which may lead to intolerable
side effects and/or inadequate pain
control.
 The surgical procedures then considered
are either Microvascular decompression
or some form of nerve injury procedure
(Rhizotomies).
TREATMENT MODALITIES

29. TREATMENT WITH MEDICATIONS
Anticonvulsant medications, which slow down the
nerve’s conduction of pain signals, are usually the
first treatment option. These include:
 Tegretol (carbamazepine)
 Trileptal (oxcarbazepine)
 Carbatrol (carbamazepine)
 Dilantin (phenytoin)
 Lamictal (lamotrigine)
 Topamax (topiramate)
 Neurontin (gabapentin)
 Klonopin (clonazepam)
Tegretol (carbamazepine) is the primary drug used to
treat TN.

30. SURGICAL TREATMENTS
 Microvascular Decompression (MVD)
 Balloon Compression
 Glycerol Injection
 Radiofrequency Lesioning
 Radiosurgery (GammaKnife,
CyberKnife, etc.)

31. PALLIATIVE TREATMENT
 Acupuncture
 Biofeedback
 Capsaicin
 Homeopathy
 Nutritional therapy
 Electrical Nerve Stimulation
 TENS (Transcutaneous Electrical Nerve Stimulation)
 Upper cervical chiropractic
 Vitamin B-12 Injections
 Botox
http://tnaaustralia.org.au/dental-care-and-tn/

33. DENTAL
CONSIDERATIONS
IN TRIGEMINAL
NEURALGIA

34. ACRYLIC RESIN
STENT in situ.
ANALGESIC GEL IS
COATED ON FITTING
SURFACE
ACRYLIC RESIN
STENT AS VEHICLE
FOR MAINTAINING
TOPICAL
APPLICATION OF
ANALGESIC GEL TO
TISSUES
Neuropathic implications of prosthodontic treatment
Robert E. Delcanho, BDSc, MS a
Perth Pain Management Center, Applecross, Western Australia

35. PREVENTING TN
FLARE-UPS AFTER
DENTAL WORK
 Anesthesia should be WITHOUT
EPINEPHRINE FOR THE LOCAL
ANAESTHETIC.
 long acting local anesthesia should
be used to avoid multiple injections
 the dentist should inject the local
anesthetic at a site as far away as possible
from the trigger point for the TN pain
http://tnaaustralia.org.au/dental-care-and-tn/

36. CONCLUSION
 Though there are not definitive signs
and symptoms of this condition we
should examine our patients
carefully with a proper detailed
record of case history and render
the dental treatments in such
patients carefully

37. REFERENCES
 B D CHAURASIA’s HUMAN ANATOMY, 5th edition
 Peterson’s text book of oral and maxillofacial surgery
 Oral and maxillofacial surgery by neelima malik
 Monheim’s book of Local anesthesia
 Malamed’s book of local anesthesia
 http://tnaaustralia.org.au/dental-care-and-tn/
 http://trigeminalneuralgia-ronaldbrismanmd.com/Dental-
Issues.html
 A retrospective study of 72 cases diagnosed with idiopathic
trigeminal neuralgia in indian populace
 Neuropathic implications of prosthodontic treatment Robert E.
Delcanho, BDSc, MS a
 Perth Pain Management Center, Applecross, Western Australia