Trigeminal neuralgia – NHS

Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start. 

In most cases, trigeminal neuralgia affects just one side of the face, with the pain usually felt in the lower part of the face. Very occasionally the pain can affect both sides of the face, although not usually at the same time.

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People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may happen hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

Some people may then develop a more continuous aching, throbbing or burning sensation, sometimes accompanied by the sharp attacks.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice

See a GP if you experience frequent or persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, do not help and a dentist has ruled out any dental causes.

The GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?

Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

Trigeminal neuralgia can also happen when the trigeminal nerve is damaged by another medical condition, such as multiple sclerosis (MS) or a tumour.

The attacks of pain are usually brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can happen without a trigger.

Read more about the causes of trigeminal neuralgia.

Who’s affected

It’s not clear how many people are affected by trigeminal neuralgia, but it’s thought to be rare, with around 10 people in 100,000 in the UK developing it each year.

Trigeminal neuralgia affects more women than men, and it usually starts between the ages of 50 and 60. It’s rare in adults younger than 40.

Treating trigeminal neuralgia

Trigeminal neuralgia is usually a long-term condition and the periods of remission often get shorter over time. However, the treatments available do help most cases to some degree.

An anticonvulsant medicine called carbamazepine, which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia. Carbamazepine can relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medicine can build up in your bloodstream.

Unless your pain becomes much better, or disappears, the medicine is usually continued for as long as necessary, which could be for many years.

If you’re entering a period of remission, where your pain goes away, stopping carbamazepine should always be done slowly, over days or weeks, unless a doctor tells you otherwise.

If this medicine does not help you, causes too many side effects, or you’re unable to take it, you may be referred to a specialist to discuss alternative medicines or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open your skull and move any blood vessels that are compressing the trigeminal nerve. Research suggests this operation offers the best results for long-term pain relief, but it’s a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia.

Post-herpetic neuralgia

Post-herpetic neuralgia is a more common type of nerve pain that usually develops in an area previously affected by shingles.

Community content from HealthUnlocked

Page last reviewed: 06 August 2019
Next review due: 06 August 2022

Trigeminal neuralgia – Diagnosis and treatment

Diagnosis

Your doctor will diagnose trigeminal neuralgia mainly based on your description of the pain, including:

• Type. 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.

Your doctor may conduct many tests to diagnose trigeminal neuralgia and determine underlying causes for your condition, including:

• 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.
• 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).

Your facial pain may be caused by many different conditions, so an accurate diagnosis is important. Your doctor may order additional tests to rule out other conditions.

Treatment

Trigeminal neuralgia treatment usually starts with medications, and some people don’t need any additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options.

If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition.

Medications

To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.

• Anticonvulsants. Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it’s been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal), lamotrigine (Lamictal) and phenytoin (Dilantin, Phenytek). Other drugs, including clonazepam (Klonopin) and gabapentin (Neurontin, Gralise, others), also may be used.

  If the anticonvulsant you’re using begins to lose effectiveness, your doctor may increase the dose or switch to another type. Side effects of anticonvulsants may include dizziness, confusion, drowsiness and nausea. Also, carbamazepine can trigger a serious drug reaction in some people, mainly those of Asian descent, so genetic testing may be recommended before you start carbamazepine.

• Antispasmodic agents. Muscle-relaxing agents such as baclofen (Gablofen, Lioresal) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea and drowsiness.
• Botox injections. Small studies have shown that onabotulinumtoxinA (Botox) injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition.

Surgery

Surgical options for trigeminal neuralgia include:

• Microvascular decompression. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. During microvascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a soft cushion between the nerve and the arteries.

  If a vein is compressing the nerve, your surgeon may remove it. Doctors may also cut part of the trigeminal nerve (neurectomy) during this procedure if arteries aren’t pressing on the nerve.

  Microvascular decompression can successfully eliminate or reduce pain most of the time, but pain can recur in some people. Microvascular decompression has some risks, including decreased hearing, facial weakness, facial numbness, a stroke or other complications. Most people who have this procedure have no facial numbness afterward.

• Brain stereotactic radiosurgery (Gamma knife). In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take up to a month.

  Brain stereotactic radiosurgery is successful in eliminating pain for the majority of people. If pain recurs, the procedure can be repeated. Facial numbness can be a side effect.

Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy. In a rhizotomy, your surgeon destroys nerve fibers to reduce pain, and this causes some facial numbness. Types of rhizotomy include:

• Glycerol injection. During this procedure, your doctor inserts a needle through your face and into an opening in the base of your skull. Your doctor guides the needle into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. Then, your doctor will inject a small amount of sterile glycerol, which damages the trigeminal nerve and blocks pain signals.

  This procedure often relieves pain. However, some people have a later recurrence of pain, and many experience facial numbness or tingling.

• Balloon compression. In balloon compression, your doctor inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. Then, your doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. Your doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals.

  Balloon compression successfully controls pain in most people, at least for a period of time. Most people undergoing this procedure experience at least some transient facial numbness.

• Radiofrequency thermal lesioning. This procedure selectively destroys nerve fibers associated with pain. While you’re sedated, your surgeon inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull.

  Once the needle is positioned, your surgeon will briefly wake you from sedation. Your surgeon inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. You’ll be asked to indicate when and where you feel tingling.

  When your neurosurgeon locates the part of the nerve involved in your pain, you’re returned to sedation. Then the electrode is heated until it damages the nerve fibers, creating an area of injury (lesion). If your pain isn’t eliminated, your doctor may create additional lesions.

  Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure. Pain may return after three to four years.

More Information

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Alternative medicine

Alternative treatments for trigeminal neuralgia generally haven’t been as well-studied as medications or surgical procedures, so there’s often little evidence to support their use.

However, some people have found improvement with treatments, such as acupuncture, biofeedback, chiropractic, and vitamin or nutritional therapy. Be sure to check with your doctor before trying an alternative treatment because it may interact with your other treatments.

Coping and support

Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

You may find encouragement and understanding in a support group. Group members often know about the latest treatments and tend to share their own experiences. If you’re interested, your doctor may be able to recommend a group in your area.

Preparing for your appointment

Make an appointment with your primary care provider if you have symptoms common to trigeminal neuralgia. After your initial appointment, you may see a doctor trained in the diagnosis and treatment of brain and nervous system conditions (neurologist).

What you can do to prepare

• Write down any symptoms you’ve been having, and for how long.
• Note any triggers that bring on your attacks of facial pain.
• Make a list of your key medical information, including any other conditions for which you’re being treated and the names of any medications, vitamins or supplements you’re taking.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions in advance to ask your doctor at your appointment. Creating your list of questions in advance can help you make the most of your time with your doctor.

For possible trigeminal neuralgia, some basic questions to ask your doctor include:

• What’s the most likely cause of my pain?
• Do I need any diagnostic tests?
• What treatment approach do you recommend?
• If you’re recommending medications, what are the possible side effects?
• Will I need treatment for the rest of my life?
• How much do you expect my symptoms will improve with treatment?
• Is surgery an option?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may give you more time to go over points you want to discuss further. Your doctor may ask:

• What are your symptoms and where are they located?
• When did you first develop these symptoms?
• Have your symptoms gotten worse over time?
• How often do you experience bouts of facial pain, and have you noticed if anything seems to trigger your facial pain?
• How long does an attack of facial pain typically last?
• How much are these symptoms affecting your quality of life?
• Have you ever had dental surgery or surgery on or near your face, such as sinus surgery?
• Have you had any facial trauma, such as an injury or accident that affected your face?
• Have you tried any treatments for your facial pain so far? Has anything helped?
• What side effects have you experienced from treatment?

Trigeminal neuralgia – Care at Mayo Clinic

Trigeminial neuralgia care at Mayo Clinic

• Your Mayo Clinic care team. Mayo Clinic doctors trained in brain and nervous system conditions (neurologists), brain and nervous system surgery (neurosurgeons), brain imaging (neuroradiology), and dental specialties have extensive experience diagnosing and treating trigeminal neuralgia. Nearly 900 people with trigeminal neuralgia receive care at Mayo Clinic each year.
• Advanced diagnosis and treatment. Mayo Clinic neurosurgeons have expertise and experience performing complex surgical procedures, including stereotactic radiosurgery, Gamma Knife radiosurgery and other techniques, microvascular decompression, and other procedures.

Learn more about Mayo Clinic’s neurosurgery and neurology departments’ expertise and rankings.

Mayo Clinic in Rochester, Minn., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for neurology and neurosurgery by U.S. News & World Report. Mayo Clinic in Phoenix/Scottsdale, Ariz. , is ranked highly performing for neurology and neurosurgery by U.S. News & World Report. Mayo Clinic Children’s Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report’s 2021-2022 “Best Children’s Hospitals” rankings.

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Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care like they’ve never experienced. See the stories of satisfied Mayo Clinic patients.

Expertise and rankings

Mayo Clinic doctors provide comprehensive care for about 900 people with trigeminal neuralgia each year.

• Teamwork. Mayo Clinic doctors trained in brain and nervous system conditions (neurologists), brain and nervous system surgery (neurosurgeons), and doctors trained in treating children who have brain and nervous system conditions (pediatric neurologists) diagnose and treat people who have trigeminal neuralgia.
• The latest techniques and technology. Doctors at Mayo Clinic locations have access to the newest tools, such as intraoperative MRI, stereotactic radiosurgery and Gamma Knife radiosurgery.

Learn more about Mayo Clinic’s neurosurgery and neurology departments’ expertise and rankings.

Mayo Clinic in Rochester, Minn., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for neurology and neurosurgery by U.S. News & World Report. Mayo Clinic in Phoenix/Scottsdale, Ariz., is ranked highly performing for neurology and neurosurgery by U.S. News & World Report. Mayo Clinic Children’s Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report’s 2021-2022 “Best Children’s Hospitals” rankings.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

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Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn’t require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Learn more about appointments at Mayo Clinic.

Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer’s customer service number is printed on the back of your insurance card.

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Trigeminal Neuralgia, Facial Pain, Conditions

Overview

What is the trigeminal nerve?

The trigeminal nerve is the part of the nervous system responsible for sending pain, touch and temperature sensations from your face to your brain. It’s a large, three-part nerve in your head that provides sensation. One section called the mandibular nerve involves motor function to help you chew and swallow.

Function

What is the purpose of the trigeminal nerve?

The trigeminal nerve primarily helps you feel (sensory), although the mandibular nerve branch has both sensory and motor functions. The trigeminal nerve helps with:

• Biting, chewing and swallowing.
• Facial and scalp sensations.

Anatomy

Where is the trigeminal nerve?

The trigeminal nerve, also called the cranial nerve V (that’s the Roman numeral five), is the fifth of 12 cranial nerves.

You have two trigeminal nerves, one on each side of your body. They start in your brain and travel throughout your head.

What is the anatomy of the trigeminal nerve?

Like a tree extending from your brain throughout your face, the trigeminal nerves have roots and branches:

1. The trigeminal nerves begin within four nuclei — or collections of nerve cell bodies — in your brain. Three of these nuclei control the functioning of your senses. The fourth controls motor function (or your movement).
2. These three sensory nuclei merge to become one sensory root near the pons, which is the largest, central part of your brainstem.
3. This sensory root becomes the trigeminal ganglion as it leaves the brainstem on each side. (A ganglion is a collection of nerves outside the nervous system.) Each trigeminal ganglion is located near your temple at the side of your head, in front of your ear.
4. The trigeminal ganglion splits into three trigeminal nerve branches. These branches travel along each side of your head to different parts of your face.

What are the trigeminal nerve branches?

The trigeminal nerve has three branches that perform distinct functions:

• Ophthalmic: This branch sends nerve impulses from the upper part of your face and scalp to your brain. Ophthalmic refers to the eye. The ophthalmic nerve relates to your eyes, upper eyelids and forehead.
• Maxillary: This nerve branch is responsible for sensations in the middle part of your face. Maxillary refers to the upper jaw. The maxillary nerves extend to your cheeks, nose, lower eyelids and upper lip and gums.
• Mandibular: The mandibular (lower jaw) branch aids sensation to the lower part of your face, such as the jaws, lower lip and gum. These nerves also have a motor function. They help you bite, chew and swallow.

Conditions and Disorders

What conditions and disorders affect the trigeminal nerves?

Trauma and injuries can affect the trigeminal nerves. Accidents, tumors and damage from dental procedures or facial surgery can bruise or cut the nerves.

A trigeminal nerve injury may affect a small area, like part of your gum, or a large area, like one side of your face. The injury can cause problems with chewing and speaking. The extent depends on where the nerve damage occurs.

You may have ongoing numbness or facial pain in the area that the nerve serves. These symptoms are trigeminal neuropathy.

An injured trigeminal nerve often recovers its function in time. Rarely, surgery is needed to reconnect severed nerves. Some people need a nerve graft to replace the damaged nerve with a healthy one.

What is trigeminal neuralgia?

Trigeminal neuralgia is a type of trigeminal neuropathy brought on by nerve damage. The condition causes sudden, intense facial pain on one side of your face. The pain can feel like an electrical shock. Approximately 150,000 people develop trigeminal neuralgia every year. It’s also called tic douloureux.

What causes trigeminal neuralgia?

Causes of trigeminal neuralgia include:

• Primary trigeminal neuralgia occurs when an artery or vein wraps around the trigeminal nerve and causes irritation.
• Secondary trigeminal neuralgia occurs when a tumor, cyst or facial injury puts pressure on the trigeminal nerve. Multiple sclerosis also causes a form of secondary trigeminal neuralgia.

What are the signs of trigeminal neuralgia?

Trigeminal neuralgia tends to affect only one side of your face. Some people develop facial twitches (tics) after the pain subsides.

Healthcare providers classify the pain symptoms into types:

• Type 1 (TN1) causes sharp, shock-like facial pain that comes and goes. Your face may throb. The pain may last for a few seconds or as long as a couple of minutes. These stabbing pains can occur repeatedly throughout the day and night. Over time, the pain may intensify and last longer. Often, the brief pains are triggered by actions such as chewing, talking or touching the face.
• Type 2 (TN2) causes a constant (chronic) burning or aching feeling. You may also have stabbing pain, but it’s less intense than type 1.

How are trigeminal nerve problems diagnosed?

Trigeminal nerve problems can be challenging to diagnose because there isn’t a specific test to assess the health of these nerves. In addition, other conditions like cluster headaches, temporomandibular disorders and sinus infections can cause facial pain and similar symptoms.

Your healthcare provider may rely on symptoms and a physical examination to make a diagnosis. You may also get an MRI, CT scan or X-rays. These tests can show if a cyst, tumor or artery is pressing against the trigeminal nerve.

Care

How can I protect my trigeminal nerves?

These lifestyle changes can keep the nervous system healthy:

When to Call the Doctor

You should call your healthcare provider if you experience:

• Facial twitches (tics).
• Intense facial pain.
• Loss of sensation in the face or scalp.

A note from Cleveland Clinic

The trigeminal nerves play essential roles in helping your face feel pain, touch, warmth or cold. The mandibular branches of the trigeminal nerves help you bite, chew and swallow. In some cases, people develop numbness or other signs of trigeminal neuropathy from an accident, dental procedure or facial surgery. Trigeminal neuralgia can cause stabbing, shock-like facial pain or a constant burning sensation. Talk to your provider about finding relief from these trigeminal nerve conditions.

Trigeminal neuralgia – Illnesses & conditions

There are a number of treatments available that can offer some relief from the pain caused by trigeminal neuralgia.

Identifying triggers and avoiding them can also help.

Most people with trigeminal neuralgia will be prescribed medication to help control their pain, although surgery may be considered for the longer term in those cases where medication is ineffective or causes too many side effects.

Avoid triggers

The painful attacks associated with trigeminal neuralgia can sometimes be triggered or made worse by a number of different things. Therefore, in addition to your medical treatment, it may help to try to avoid these triggers, if possible.

For example, if your pain is triggered by wind or even a draught in a room, it may help to avoid sitting near open windows or the source of air conditioning, and wearing a scarf wrapped around your face in windy weather. A transparent dome-shaped umbrella can also protect your face from the weather.

Hot, spicy or cold food or drink may also trigger your pain, so avoiding these can help. Using a straw to drink warm or cold drinks may also help prevent the liquid coming into contact with the painful areas of your mouth. It is important to eat nourishing meals, however, so if you are having difficulty chewing, consider eating mushy foods or liquidising your meals. 

Certain foods seem to trigger attacks in some people, so you may want to consider avoiding things such as caffeine, citrus fruits and bananas.

Medication

As normal painkillers such as paracetamol are not effective in treating trigeminal neuralgia, you will normally be prescribed an alternative medication, such as an anticonvulsant medication (usually used to treat epilepsy) to help control your pain.

These medications were not originally designed to treat pain, but they can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain.  

They need to be taken regularly, not just when the pain attacks occur, but can be stopped when the episodes of pain cease and you are in remission.  Unless otherwise instructed by your GP or specialist, it is important to build up the dosage slowly and reduce it again gradually over a few weeks. Taking too much too soon and stopping the medication too quickly can cause serious problems.

Initially, your GP will probably prescribe a type of anticonvulsant called carbamazepine, although a number of alternatives are available if this is ineffective or unsuitable.

Carbamazepine

The anticonvulsant carbamazepine is currently the only medication licensed for the treatment of trigeminal neuralgia in the UK. It can be very effective initially, but may become less effective over time.

You will usually need to take this medicine at a low dose once or twice a day, with the dose slowly increasing up to four times a day until it provides satisfactory pain relief.

Carbamazepine often causes side effects, which may make it difficult for some people to take. These include:

• tiredness and sleepiness
• dizziness (lightheadedness)
• difficulty concentrating and memory problems
• confusion
• feeling unsteady on your feet
• feeling sick and vomiting
• double vision
• a reduced number of infection-fighting white blood cells (leukopenia)
• allergic skin reactions, such as urticaria (hives)

You should speak to your GP if you experience any persistent or troublesome side effects while you are taking carbamazepine, especially allergic skin reactions, as these could be dangerous.

Carbamazepine has also been linked to a number of less common but more serious side effects, including thoughts of self-harm or suicide. You should immediately report any suicidal feelings to your GP. If this is not possible, call the NHS 24 111 service. 

Other medications

Carbamazepine may stop working over time. If this occurs, or if you experience significant side effects while taking it, you should be referred to a specialist to consider alternative medications or procedures.

There are a number of specialists you may be referred to for further treatment, including neurologists specialising in headaches, neurosurgeons and pain medicine specialists (for example, at a pain clinic).

In addition to carbamazepine, there are a number of other medications that have been used to treat trigeminal neuralgia, including:

• oxcarbazepine
• lamotrigine
• gabapentin
• pregabalin
• baclofen 

None of these medications are specifically licensed for the treatment of trigeminal neuralgia, which means they have not undergone rigorous clinical trials to determine whether they are effective and safe to treat the condition.

However, this is largely only because trigeminal neuralgia is a rare condition, and clinical trials are difficult to carry out on such a painful condition because giving some people an inactive, “dummy” medication (placebo) to compare these medications to would be unethical and impractical.

However, many specialists will prescribe an unlicensed medication if they think it is likely to be effective and the benefits of treatment outweigh any associated risks.

If your specialist is considering prescribing an unlicensed medication to treat trigeminal neuralgia, they should inform you that it is unlicensed and discuss possible risks and benefits with you.

With most of these medications, the side effects can be quite difficult to cope with initially. Not everyone experiences side effects, but if you do, try to persevere because they do tend to diminish with time or at least until the next dosage increase, when you may find a further period of adjustment is necessary. Talk to your GP if you are finding the side effects unbearable.

Surgery and procedures

If medication does not adequately control your symptoms or is causing persistently troublesome side effects, you may be referred to a specialist to discuss the different surgical and non-surgical options available to relieve your pain.

There a number of procedures that have been used to treat trigeminal neuralgia, so you will need to discuss the potential benefits and risks of each treatment with your specialist before making a decision. It is wise to be as informed as possible and to make the choice that it right for you as an individual.

There is no guarantee that one or any of these procedures will work for you but, once you have had a successful procedure, you won’t need to take your pain medications unless the pain returns. If one procedure does not work, you can always try another or remain on your medication temporarily or permanently.

Some of the procedures that can be used to treat people with trigeminal neuralgia are outlined below.

Percutaneous procedures

There are a number of procedures that can offer some relief from trigeminal neuralgia pain, at least temporarily, by inserting a needle or thin tube through the cheek and into the trigeminal nerve inside the skull.

These are known can “percutaneous” (through the skin) procedures, and they are carried out using X-rays to guide the needle or tube into the correct place while you are heavily sedated with medication or under a general anaesthetic (where you are asleep).

Percutaneous procedures that can be carried out to treat people with trigeminal neuralgia include:

• glycerol injections – where a medication called glycerol in injected around the Gasserian ganglion (where the three main branches of the trigeminal nerve join together) 
• radiofrequency lesioning – where a needle is used to apply heat directly to the the Gasserian ganglion 
• balloon compression – where a tiny balloon is passed along a thin tube inserted through the cheek and is inflated around the Gasserian ganglion to squeeze it; the balloon is then removed

These procedures work by deliberately injuring or damaging the trigeminal nerve, which is thought to disrupt the pain signals travelling along it. You are usually able to go home the same day, following your treatment.

Overall, all of these procedures are similarly effective in relieving trigeminal neuralgia pain, although there can be complications with each, and these vary with the procedure and the individual. The pain relief will usually only last a few years, and sometimes only a few months. Sometimes these procedures do not work at all.

The major side effect of these procedures is numbness of part or all the side of the face, and this can vary in severity from being very numb or just pins and needles. The sensation, which can be permanent, is often similar to that following an injection at the dentist. Very rarely, you can get a combination of numbness and continuous pain called anesthesia dolorosa, which is virtually untreatable.

The procedures also carry a risk of other short- and long-term side effects and complications, including bleeding, facial bruising, eye problems and problems moving the facial muscles.

Stereotactic radiosurgery

An alternative way to relieve pain by damaging the trigeminal nerve that doesn’t involve inserting anything through the skin is stereotactic radiosurgery. This is a fairly new treatment that uses a concentrated beam of radiation to deliberately damage the trigeminal nerve where it enters the brainstem.

Stereotactic radiosurgery does not require a general anaesthetic and no cuts (incisions) are made in your cheek.

A metal frame is attached to your head with four pins inserted around your scalp (a local anaesthetic is used to numb the areas where these are inserted) and your head, complete with the frame attached, is held in a large machine for an hour or two (which may make you feel claustrophobic) while the radiation is given. The frame and pins are then removed, and you are able to go home after a short rest.

It can take a few weeks – or sometimes many months – for this procedure to take effect, but it can offer pain relief for some people for several months or years. Studies into this treatment have shown similar results to the other procedures mentioned above.

The most common complications associated with stereotactic radiosurgery include facial numbness and pins and needles (paraesthesia) in the face. This can be permanent and, in some cases, very troublesome.

Microvascular decompression

Microvascular decompression (MVD) is an operation that can help relieve trigeminal neuralgia pain without intentionally damaging the trigeminal nerve. Instead, the procedure involves relieving the pressure placed on the nerve by blood vessels that are touching the nerve or wrapped around it.

This is a major procedure that involves opening up the skull, and is carried out under general anaesthetic by a neurosurgeon.

During MVD, the surgeon will make an incision in your scalp, behind your ear, and remove a small circular piece of skull bone. They will then either remove or relocate the blood vessel(s), separating them from the trigeminal nerve using an artificial pad or a sling constructed from adjoining tissue.

For many people, this type of surgery is effective in easing or completely stopping the pain of trigeminal neuralgia. It provides the longest lasting relief, with some studies suggesting that pain only recurs in about 30% of cases within 10-20 years of surgery.   Currently, this is the closest possible cure for trigeminal neuralgia.

However, it’s an invasive procedure and carries a risk of potentially serious complications, such as facial numbness, hearing loss, stroke and even death (in around 1 in every 200 cases).

More information and support

Living with a long-term and painful condition such as trigeminal neuralgia can be very difficult.

You may find it useful to contact local or national support groups, such as the Trigeminal Neuralgia Association UK, for more information and advice about living with the condition, and to get in touch with other people who have the condition to talk to them about their experiences.

Research has shown that groups that have support from health care professionals provide high-quality help, which can significantly improve your ability to manage this rare condition. Learning from others how to cope can help remove the fear of more pain and reduce the risk of depression.

However, you need to be wary of potentially unreliable information you may find elsewhere, especially if offering “cures” for the condition. There is a great deal of misinformation on the internet, so do your research only on reliable websites, not on open forums or on social media.

There are a number of research projects running both in the UK and abroad to determine the cause of this condition and to find new treatments, including new medications, so there is always hope on the horizon.

Dental (Odontogenic) Pain

Rev Pain. 2011 Mar; 5(1): 2–7.

, BDS MDSc PhD FDS RCS FRACDS (OMS) ILTM

Tara Renton

Professor in Oral Surgery, King’s College London Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RS

Tara Renton, Professor in Oral Surgery, King’s College London Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RS;

This article has been cited by other articles in PMC.

Abstract

• This article provides a simple overview of acute trigeminal pain for the non dentist.

• This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain.

• Dental pain is the most common in this group and it can present in several different ways.

• Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders.

• It is crucial to exclude these disorders whilst managing patients with chronic trigeminal pain.

Introduction

Orofacial pain is pain within the trigeminal system. The trigeminal nerve supplies general sensory supply to face, scalp, and mouth (). A vast proportion of the sensory cortex represents the trigeminal input (over 40%).

The trigeminal nerve sensory distribution and its representation in the sensory cortex

The trigeminal sensory region is very complex, incorporating the cranium, ears, eyes, sinuses, nose, pharynx, infratemporal fossa, jaw joint, teeth, jaws, salivary glands, oral mucosa, and skin. As many medical students are rarely exposed to ear, nose, and throat (ENT), otolaryngology, and dentistry, this region remains an enigma to most, with their singular experience of trigeminal pain being based on trigeminal neuralgia in relation to neurosurgical procedures.

Aetiology of acute orofacial pain

Orofacial pain can be associated with pathological conditions or disorders related to somatic and neurological structures. There are a wide range of causes of acute orofacial pain conditions, the most common being dental pain (toothache). Dental disease of the hard tissues (caries of enamel, dentine, and cementum), and soft tissues and supporting bone (gingivitis/periodontitis) are recognized as the most common diseases to afflict the general population. These conditions are largely diagnosed by dental practitioners by history, dental clinical examination, and radiographs. By far the most common forms of oral pain are the acute form of pains that tend to last for short periods of time. These include toothache (dental pulpitis), gum pain (pericoronitis in 80% of the population), periapical periodontitis (owing to apical infection or postendodontic therapy of high occlusal contact). Dentine sensitivity affects 40% of the adult population; dry socket is an intense postsurgical pain that affects 10% of patients after extraction of their teeth. Other orofacial acute pain conditions include trauma or infection of the orofacial tissues.

Odontogenic pain

Odontogenic pain refers to pain initiating from the teeth or their supporting structures, the mucosa, gingivae, maxilla, mandible or periodontal membrane.

‘A toothache, or a violent passion, is not necessarily diminished by our knowledge of its causes, its character, its importance or insignificance.’ TS Eliot

Toothache is caused by inflammation of the dental pulp (), most commonly as a result of dental caries (tooth decay), the most common human infective disease worldwide, affecting 60–90% of school children worldwide.

Diagram of a lower molar tooth

Periodontal disease (gum disease) is the second most common infection, and similar to chronic mycobacteria infections, for example Leprosy, is painless. The two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, are associated with resistance to standard treatments for gum disease. Other risk factors include smoking and there is very likely a genetic predisposition to developing this silent painless disease, which is the leading cause of tooth loss, and is found in 5–400% of middle-aged adults¹. The diagnosis and management of this condition remain outwith this article’s remit.

The role of all medical personnel in improving oral health in children is being recognised². Caries is preventable using fluoride toothpaste and simple dietary advice such as reducing the frequency of sugar intake. Despite this, the numbers of children undergoing general anaesthetic for dental extractions due to caries continues to increase^3,4.

Prevalence

The prevalence of dental pain and its characteristics were recorded using standard measures of pain (WHO criteria). In a study of 1,052 individuals the prevalence of reported toothache in schoolchildren in the last six months was 33. 6% (31.1–36.8, 95% CI). Multiple logistic and ordinal polytomous regression analysis showed a significant association of both the prevalence and severity of dental pain with lower social class, later birth order, failure at school and attendance at the dentist only when in trouble. The major predictor of the prevalence and severity of pain was the pattern of dental attendance (p<0.001)⁵.

Dental pulpitis (‘toothache’)

In health, teeth only perceive pain due to dentine sensitivity to cold, sweet or physical stimulus. Dental pulpitis may be due to infection from dental caries close to the pulp (, ), or by inflammation from chemical or thermal insult subsequent to dental treatment. It may be reversible or non-reversible. Intermittent sharp, shooting pains are also symptomatic of trigeminal neuralgia, so care must be taken not to mistakenly label toothache as neuralgia.

Dentalpantomograph (DPG) showing extensive dental caries (radiolucent areas in the tooth crowns and roots) affecting the crowns of several teeth, and periapical abscess formation (radiolucent areas at the end of the root). Arrows indicate caries and abscess formation on two mandibular teeth.

Insult of the tooth due to caries (causing bacterial products to infiltrate the pulp via the dentine tubules) or iatrogenic insult (dental restoration close to the dental pulp or trauma) will cause pulpal inflammation. This results in extreme sensitivity to cold and sweet flavours with short sharp ‘neuralgic’ pain. Protection of the pulp to bacterial infection and chemical irritation by dietary and salivary content must be undertaken promptly to minimise the risk of acute pulpitis evolving into chronic irreversible pulpitis. This treatment will involve a filling or restoration.

If the insult persists the pulpitis will become irreversible. The increased pulpal vascularity results in a rise in intra pulpal pressure, which induces ischaemia and sensitivity, with prolonged pain to heat. Once necrosis of the dental pulp has occurred, the infection spreads through the apex of the tooth into the surrounding bone and periodontal membrane, initiating periodontal inflammation and eventually a dental abscess causing spontaneous long lasting pain and pain on biting on the tooth. Typically the pain associated with an abscess is described as spontaneous aching or throbbing lasting hours sometime days. Associated swelling in the jaw, trismus or lymphadenopathy may be indicative of an acute spreading infection. Thus different stages of infection have different clinical presentations ().

The stages and characteristics of dental pulpal pain.

Management

Management for dental pulpitis is excavation of the tooth decay with restoration (filling). If the pulpitis becomes irreversible then pulpectomy (pulp removal) and root canal treatment will be required. Acute spreading infection may require additional drainage intra or extraorally via drainage of involved tissue tissue spaces.

Apical pain can be caused by infection spreading through the apical foramen of the tooth into the apical periodontal region causing inflammation (apical periodontitis) and ultimately a dental abscess if left untreated (). This is treated by either root canal treatment of the tooth or extraction of the tooth with or without concomitant courses of antibiotics⁷. Iatrogenic apical pain may result after dental treatment including premature contact if a restoration is left high in occlusion. This is characterized by an initial sharp pain which becomes duller after a period. The pain is due to a recent tooth restoration that is ‘high’ compared with the normal occlusion when biting together and

Postendodontic surgery pain

This is severe aching pain following endodontic treatment such as root canal therapy or apicectomy. While the majority of patients improve over time (weeks), a few will develop a chronic neuropathic pain state (see section on persistent post surgical trigeminal pain). There is considerable variation in the pain reported by patients, but it commonly starts as a sharp stabbing pain that becomes progressively dull and throbbing. At first the pain may be caused by a stimulus, but it then becomes spontaneous and remains for a considerable time after removal of the stimulus. The pain may radiate and be referred to other areas of the mouth. This type of pain tends to cause the patient to have difficulty sleeping and may be exacerbated by lying down. Heat may make the pain worse whereas cold may alleviate it. The pain may be intermittent with no regular pattern and may have occurred over months or years. If there is periapical infection present, patients may no longer complain of pain in response to a thermal stimulus, but rather of sensitivity on biting.

Exposed cementum or dentine

There is tooth sensitivity from cold fluids and/or air, a reflection of a healthy pulp. With gingival recession, recent scaling, or tooth wear due to a high acid diet or gastric reflux, there may be generalised dentine sensitivity. However, with caries, fractured fillings and cracked cusps, the pain tends to be localised to the affected tooth. The tooth root surface comprises of a thin layer of cementum overlaying dentine, may be exposed from excessive and/or incorrect tooth brushing. Dentine underlying the enamel crown is constituted of tiny tubules which are fluid filled and connect directly to the nerve ending in the dental pulp. The current hypotheses for dental pain includes the osmolality theory, whereby the dentine fluids elicit an action potential within the A delta and C fibres in the pulp when stimulated by mechanical stimulation.

Management

For root sensitivity the use of a desensitising toothpaste and a reduction in acid in the diet will help resolve the symptoms. Modification of harmful tooth brushing habits that contribute to tooth abrasion is recommended. The use of a fluoride mouth-rinse may also help. In the case of caries, a lost filling or fractured tooth, coverage of the exposed dentine with a temporary restoration will usually relieve the symptoms.

Fractured tooth

If the crown of a tooth is fractured by trauma and the broken fragment is available, it should be stored in a physiological medium (milk) until a dentist can assess the patient. Coverage of exposed dentine on the fractured crown with a temporary restoration is desirable to protect the underlying pulp tissue⁶.

Placement of temporary restorations

Although it is unlikely that many general medical practitioners will have temporary filling materials available in their surgeries, dentine that has been exposed by caries, a lost filling or tooth fracture can be covered relatively easily with glass ionomer cement (GIC) or zinc oxide eugenol (ZOE) materials. Most GIC materials are dispensed in capsules but a hand-mixed material is available, consisting of a powder, liquid and conditioner. The surface of the cavity is painted with the conditioner, then rinsed and dried, before placement of the filling. Zinc oxide eugenol materials consist of a powder and liquid (oil of cloves) that are mixed to a putty-like consistency before placement in the tooth.

Pericoronitis

Pain commonly arises from the supporting gingivae and mucosa when infection arises from an erupting tooth (teething or pericoronitis). This is the most common cause for the removal of third molar teeth (wisdom teeth). The pain may be constant or intermittent, but is often evoked when biting down with opposing maxillary teeth. This elicits pain in the inflamed mucosa and gingivae surrounding the partially erupted tooth. If the infection is acute and spreading then antibiotics must be prescribed. Reccurrent pericoronitis is the main indication for removal of wisdom teeth⁸. Chronic periodontitis with gradual bone loss, rarely causes pain and patients may be unaware of the disorder until tooth mobility is evident. There is quite often bleeding from the gums and sometimes an unpleasant taste. Food impaction in these areas can cause localised gingival pain. Poor contact between adjacent teeth and the presence of an occluding cusp forcing food into this gap can also cause a build-up of food debris and result in gingival inflammation. This is usually a generalised condition, however, deep pocketing with extreme bone loss can occur around isolated teeth. Acute pericoronitis involves bacterial infection around an erupting orr partially erupted tooth and usually affects the lower third molar (wisdom tooth). The condition is often aggravated by the upper molar impacting on the swollen flap of soft tissue covering the unerupted tooth. There may be associated trismus due to the fact that the lower 8 site is close to the mandibular insertion of the temporalis muscle.

Management

Advise the use of an analgesic to relieve symptoms (ibuprofen), or if ibuprofen is contraindicated or unsuitable, paracetamol is recommended first-line. Paracetamol and ibuprofen can be taken together if pain relief with either alone is insufficient. For adults, if paracetamol and ibuprofen together does not provide enough pain relief, consider adding codeine phosphate or switching to an alternative nonsteroidal anti-inflammatory drug (NSAID). For women who are pregnant or breastfeeding, paracetamol is preferred. A short course of codeine may be added if paracetamol alone is insufficient. Antibiotics are generally not indicated for otherwise healthy individuals when there are no signs of spreading infection. Only prescribe an antibiotic for people who are systemically unwell or if there are signs of severe infection (e.g. fever, lymphadenopathy, cellulitis, diffuse swelling).

Dental management for dental abscess is either root canal procedure with removal of the necrotic pulp or tooth extraction. Periapical inflammation can lead to a cellulitis of the face characterised by a rapid spread of bacteria and their breakdown products into the surrounding tissues causing extensive oedema and pain. If systemic signs of infection are present, for example, fever and malaise, as well as swelling and possibly trismus (limitation of mouth opening), antibiotic treatment alone is not recommended as this is a surgical emergency. If pus is present, it needs to be drained, the cause eliminated, and host defences augmented with antibiotics. The microbial spectrum is mainly gram positive including anaerobes. Appropriate antibiotics would include a penicillin or a ‘first generation’ cephalosporin, combined with metronidazole in more severe cases.

Alveolar osteitis

After extraction, the most common complication is a ‘dry socket’ which is a condition whereby the clot formation within the socket fails at 3—5 days. Healing fails, resulting in an empty socket which traps food and debris. The resultant pain is caused by necrotic foodstuff aggravating bony nerve endings. Interestingly this condition is devoid of the usual acute inflammatory markers (absence of lymphadenopathy, local inflammation and swelling). A dull throbbing pain develops two to four days after a mandibular tooth extraction. It rarely occurs in the maxilla. Smoking is a major predisposing factor as it reduces the blood supply. The tissue around the socket is very tender and white necrotic bone is exposed in the socket. Halitosis is very common. The incidence of this condition is between 1–9%. Patients undergoing mandibular surgical tooth removal should be routinely warned of a possible incidence of 5%.

Management

Irrigation of the socket using saline or chlorhexidine and then an obtundant dressing usually soaked in bacteriorstatic solution (alvogyl paste, BIPP (bismuth iodoform paraffin paste), cotton wool or gauze soaked in iodoform). Immediate pain relief is usually attained and patients rarely re-present for additional treatment. Patients should be shown how to irrigate the area and told to do this regularly. Analgesics are indicated as pain may persist for several days. Although opinion is divided as to whether or not dry socket is an infective condition, we do not recommend the use of antibiotics. If the patient returns with ongoing pain then osteomyelitis should be excluded and localised bony sequestrate should be excluded.

Maxillary sinusitis ‘mimicking’ toothache

Recurrent maxillary sinusitis may cause widespread pain in the maxillary teeth. The pain tends to be increased on lying down or bending over. There is often a feeling of ‘fullness’ on the affected side. The pain is usually unilateral, dull, throbbing and continuous. Quite often the patient feels unwell generally and feverish. It can mimic the maxillary sinusitis-like symptoms in temporomandibular disorders (TMD)⁹ or neuropathic pain. These dental conditions rarely present as chronic pain unless misdiagnosed.

Management

Inflammation of the maxillary sinuses is best treated using local and systemic decongestants and, if persistent, antibiotics may be prescribed¹⁰. Pain originating from the sinus arises mainly from pressure. Decongestants can help sinus drainage. Antibiotics probably have only a minor role in mild cases. Referral to an otorhinolaryngologist for endoscopic sinus surgery may be indicated in chronic cases¹¹.

Acute necrotising ulcerative gingivitis is a rapidly progressive infection of the gingival tissues that causes ulceration of the interdental gingival papillae. It can lead to extensive destruction. Usually young to middle-aged people with reduced resistance to infection are affected (diabetes, HIV infection, chemotherapy). Males are more likely to be affected than females, with stress, smoking and poor oral hygiene being predisposing factors. Halitosis, spontaneous gingival bleeding, and a ‘punched-out’ appearance of the interdental papillae are all important signs. The patients quite often complain of severe gingival tenderness with pain on eating and tooth brushing. The pain is dull, deep-seated and constant. The gums can bleed spontaneously and there is also an unpleasant taste in the mouth and obvious halitosis.

Management

As there is an acute infection with mainly anaerobic bacteria, treatment follows surgical principles and includes superficial debridement, use of chlorhexidine mouthwashes and a course of metronidazole tablets. Treating the contributing factors should prevent a recurrence.

Which tests can assist in diagnosis?

There are several simple tests that may assist in diagnosis of dental pain.

• Pulp sensitivity test. Dry ice on a cotton bud, or an ordinary ice stick (made in a plastic or glass tube), is placed on the cervical third (neck region) of the tooth crown. A response (pain is the only sensory response from the dental pulp) to the stimulus indicates that the pulpal tissue is capable of transmitting nerve impulses and is vital. No response may indicate pulp necrosis.

• Percussion test. Using an instrument handle, the tooth is tapped in the longitudinal axis. A painful response suggests possible periapical inflammation due to inflammatory sensitivity of the mechanosensory receptors in the periodontal membrane surrounding the tooth.

• Probing. Placing a fine, blunt probe gently into the gingival sulcus surrounding the tooth enables the health of the gingival tissues to be assessed. Bleeding and/or sulcus depths greater than 3–4 mm indicate gum disease due to inflammation.

• Mobility test. Holding a tooth firmly on the buccal (cheek) and lingual sides between the fingers enables mobility to be assessed. All teeth have a small amount of mobility (<0.5 mm), but visible movement suggests loss of bone support around the root of the tooth.

• Palpation. Careful palpation around the area of concern may reveal tenderness and the type and extent of swelling.

• Sinus formation. Chronic dental abscesses tend to drain buccally through the mucosa causing mucosal sinuses. Rarely lower mandibular teeth with chronic abscesses may drain buccally (below the buccinator muscle attachment) or inferiorly below the mylohyoid muscle resulting in dermal sinuses that are often mistaken for skin lesions remaining resistant to routine dermatological remedies.

• Radiographic examination. If it is possible to obtain a screening radiograph, such as an orthopantomograph (), this may assist in the diagnosis and localisation of the cause of the pain. The radiograph should show clearly the apical and periapical structures of teeth and associated tissues. The relationship of the maxillary molars and premolars to the floor of the maxillary sinus can be examined, and radiographs may reveal recurrent caries or periapical radiolucencies associated with an established infection ().

Non-odontogenic facial pain

Non-odontogenic facial pain can be caused by inflammation due to tumour, infection, or trauma. Topographical classification is often applied to this complex region. Regions often presenting as orofacial pain complaints include the sinuses, salivary gland, ears, eyes, throat, mandibular, and maxillary bone pathology. Often in patients with chronic orofacial pain there will be multiple causes of discomfort including inflammatory odontogenic pain alongside a neuropathic, neurovascular or idiopathic cause. Thus dental knowledge is crucial in order to exclude common and easily treated odontogenic causes of pain.

References

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Trigeminal Neuralgia (Facial Pain) Causes and Treatments

What Is Trigeminal Neuralgia?

Trigeminal neuralgia is an ongoing pain condition that affects certain nerves in your face. You might also hear it called “tic douloureux.”

People who have this condition say the pain might feel like an electric shock, and it can sometimes be intense.

Doctors have treatments that can help, including medicine and surgery.

Mapping the Nerves in Your Face

To learn about trigeminal neuralgia, it helps to know a little about how the affected nerves are laid out.

In your head, you have 12 pairs of what are called cranial nerves. The trigeminal nerves are among these pairs, and they let you feel sensations in your face. One nerve runs down each side of your head.

Each trigeminal nerve splits into three branches, controlling the feeling for different parts of your face. They are:

• The ophthalmic branch. It controls your eye, upper eyelid, and forehead.
• The maxillary branch. This affects your lower eyelid, cheek, nostril, upper lip, and upper gum.
• The mandibular branch. It runs your jaw, lower lip, lower gum, and some muscles you use for chewing.

The disorder can affect any of the three nerve branches, meaning you could feel pain from your forehead to your jaw. Usually, you’ll feel pain on only one side of your face. Some people feel it on both sides. When that happens, it’s called bilateral trigeminal neuralgia.

Trigeminal Neuralgia Symptoms

You may feel as though your pain came out of nowhere. Some people with this condition start out thinking they have an abscessed tooth and go to a dentist.

For people who have what’s called “atypical” trigeminal neuralgia, known as type 2, the pain is usually less intense, but constant.

Doctors consider sudden and intense bouts of pain to be signs of “classic” trigeminal neuralgia. If your pain is more of an aching, burning sensation, you might have the atypical form.

Common symptoms of trigeminal neuralgia may include:

• Brief periods of stabbing or shooting pain.
• Pain triggered by things such as brushing your teeth, washing your face, shaving, or putting on makeup. Even a light breeze against your face might set off your pain.
• You may feel it coming on, as burning or achiness, before it becomes very painful.
• Episodes last a few seconds to several minutes.
• The attacks happen several times a day or a week, followed by periods during which you have none at all. These pain-free periods are known as remission.
• Pain usually affects only one side of the face.
• Pain may affect just one part of your face or spread to a wider area.
• Episodes happen more often over time, and the pain can worsen.
• You feel the pain mostly in your cheek, jaw, teeth, gums, and lips. The eyes and forehead are affected less often.
• After an attack, your face may twitch uncontrollably.

Some people with this condition also have anxiety because they are uncertain when the pain will return.

Trigeminal Neuralgia Triggers

Any number of things may cause trigeminal neuralgia pain, such as:

• Gently touching your face
• Shaving
• Washing your face
• Brushing your teeth
• Applying makeup
• Blowing your nose
• Eating or drinking, especially hot or cold foods or drinks
• Talking
• Smiling
• Having wind or a breeze blow at you

Trigeminal Neuralgia Causes and Risk Factors

This starts with irritation of the trigeminal nerve. You might have a blood vessel pressing on the nerve, damaging the protective coating around it, which is called the myelin sheath.

Certain diseases, such as multiple sclerosis, also can injure the myelin sheath. Sometimes a tumor or a tangle of arteries presses on the nerve.

Your trigeminal nerve can also be injured — perhaps by surgery, an accident, or a stroke.

• Some people are more likely to get trigeminal neuralgia than others:
• Women are more likely than men to get trigeminal neuralgia.
• The disease is more common in people older than 50.
• The disorder may run in families, perhaps because of how blood vessels are formed in the brain.
• It may also be linked to high blood pressure.

Although the pain can be intense, the condition is not life-threatening. It can be a progressive disease, though, meaning that it gets worse over time.

Trigeminal Neuralgia Diagnosis

If you have facial pain — especially sensations that keep coming back or don’t respond to over-the-counter pain relievers — make an appointment with your doctor.

Be ready to tell your doctor about how your pain first appeared, how often you feel it, and what seems to trigger it.

Expect your doctor to ask lots of questions about your condition. You may also have a neurological exam, in which your doctor touches various parts of your face. They can test your reflexes to figure out whether a nerve is compressed.

An imaging test such as an MRI can show if a tumor or multiple sclerosis is an underlying cause of your problem.

Trigeminal Neuralgia Treatments

Treatment for this condition may include medication and surgery.

Medication: Typical pain medications don’t work well for people with trigeminal neuralgia, but your doctor may prescribe different types of drugs:

• To keep the nerves from reacting to irritation, you may take anticonvulsant medications.
• You also may take muscle relaxants — alone or along with anticonvulsants.
• Your doctor may suggest a tricyclic antidepressant to manage your symptoms.
• Some research suggests that Botox shots may be helpful when other medication doesn’t relieve trigeminal neuralgia pain. More research is needed before doctors can prescribe this widely.

Surgery: Over time, your medication may help you less and less. If that happens, you have several surgical options.

Some of these procedures are outpatient, meaning you don’t have to be admitted to a hospital. For some, you’ll need general anesthesia, which means you won’t be awake during the surgery.

Your doctor can help you decide which surgery is right for you, based on your overall health, which nerves are involved, and your preferences.

Procedures to treat trigeminal neuralgia include:

• Gamma knife radiosurgery, which uses radiation focused on your trigeminal nerve.
• Balloon compression, in which doctors thread an empty balloon into a space between the trigeminal nerve and the base of the skull. When the balloon is inflated, the nerve is pressed against hard bone, damaging the insulation to the nerve, so that you don’t perceive pain from light touches.
• Glycerol shot, which is injected into the spinal fluid surrounding the trigeminal nerve at the base of the skull. This injures the insulation around the nerve, which relieves pain.
• Radiofrequency ablation, in which doctors and patients pinpoint the exact area within the trigeminal nerve causing excessive pain. Then the doctor can send electrical current to the spot to dull the sensation.
• Microvascular decompression, which moves or takes out blood vessels that are affecting the nerve.
• Neurectomy, in which the trigeminal nerve is partly cut to relieve pain.

Natural Treatment for Trigeminal Neuralgia

You can explore alternative ways to help manage the symptoms of trigeminal neuralgia. These are some you may want to ask your doctor about:

• Acupuncture (a Chinese tradition that uses very thin needles to balance the flow of energy in your body)
• Aromatherapy (the use of plant oils such as peppermint, lavender, etc. , to help healing)
• Meditation
• Yoga
• Biofeedback (learning how to control your body to reduce pain)
• Chiropractic care

90,000 Teeth and inflammation of the trigeminal nerve: useful news at panoramamed.ru

Many people are familiar with the problem – teeth ache intolerably, and the dentist does not see any caries or pulpitis, and as a result … at your urgent request, he removes a healthy tooth. But you still can’t get rid of the pain. Many patients are stripping themselves of several teeth, trying to escape the pain, and ultimately to no avail. Why? Ashot Harutyunyan, dentist of the Panorama Med medical center, reports.

When teeth hurt, the cause may be not only in the teeth themselves, but also in a completely different disease – inflammation of the trigeminal nerve or neuralgia. The trigeminal nerve consists of three branches – the upper, lower and middle. The lower branch innervates the lower jaw and masticatory muscles, the middle branch innervates the upper jaw and cheeks, and the upper branch innervates the upper part of the face. Therefore, with trigeminal neuralgia, pain can be given both to the upper or lower teeth, and to the eye, nose, ear, cheek, depending on which part of the nerve is inflamed.

The nature of the neuralgic pain is shooting, paroxysmal. The pain suddenly appears and disappears. Attacks are rare and very frequent, because of which the pain already pesters constantly. At the same time, a person cannot accurately determine its source. If you have a toothache, it is not clear which one. In most cases, one part of the head is affected. Neuralgic pain resembles the sensation of a migraine. A characteristic feature of trigeminal neuralgia is that it never causes edema.

However, it is not easy to diagnose this disease. Diagnostics occurs by the method of exclusion. The dentist carefully examines the patient, revealing the presence or absence of chronic dental diseases – caries, pulpitis and others. Then, with the help of palpation and tapping, it determines the source of pain. In order for the doctor to make a correct diagnosis, it is recommended not to take pain relievers before visiting the dentist.

Neuralgia is treated with sedatives and physiotherapy.The duration of the disease can be different: in one patient, the disease lasts a week, in another – a month.

Of course, you shouldn’t sacrifice healthy teeth in the hope that neuralgic pain will go away. It is better to immediately contact an experienced dentist who will determine the source of painful sensations and prescribe the correct treatment. Then the disease will not last long and the teeth will remain intact.

90,000 Facial neuralgia – forms, symptoms and causes.How to treat?

Neuralgia of one of the branches of the cranial nerve group can be either an independent disease or a consequence of trauma to the jaw system, unsuccessful tooth extraction or implantation. Symptoms are expressed depending on the degree of damage to a particular nerve.

Forms of facial nerve neuralgia

• neuritis – minor inflammation of the facial nerve (or part of it),
• paresis is a partial lesion in which there is weakness of the muscles of the face, slight numbness.This disease usually belongs to the category of neurological. But, like complete paralysis, it can be the result of advanced neuritis,
• paralysis – complete defeat. This is a difficult stage in which there is numbness of the face (usually of one part of it) and blockage of the motor activity of the muscles.

Symptoms of neuralgia

• tingling or sharp “slipping” pain,
• numbness of a certain part or the entire half of the face, lack of sensitivity and motor activity,
• drooping of the eyelids and skin around the eyes,
• drooping of the corners of the lips (on the side where muscle paralysis is observed),
• smoothing wrinkles on the cheeks and forehead,
• pronounced facial asymmetry.

Causes of neuralgia

• viral infection or inflammation (ear, throat, nose),
• hypothermia,
• inflammatory processes in the roots of teeth and bone tissue of the jaw,
• nerve injury during tooth extraction or when installing implants,
• needle damage during the introduction of anesthesia,
• jaw injuries,
• old age and natural aging of the body.

The facial nerve belongs to the cranial group (along with the trigeminal nerve, the branches of which are the mandibular and maxillary nerves). It also consists of many branches that run through almost the entire human skull. Depending on which branch is affected, the numbness of a certain part of the face will depend. It is the trigeminal nerve that can be damaged in relation to implantation or complex surgical interventions.

Nerve damage after tooth extraction

As a rule, this problem arises when a tooth is difficult to remove, namely, a dystopic or impacted one, that is, located inside the bone tissue and not completely erupted.Removing these teeth requires sawing the bone and using special forceps. If the load is too heavy and the nerve is closely located, the doctor can touch it.

The prognosis in such a situation is usually positive – the state of the nerve is restored after the therapy.

Trigeminal neuralgia as a complication of implantation

Unfortunately, one of the most common causes of damage to the facial (more precisely, trigeminal) nerve is dental implantation.According to recent studies, the frequency of such complications at this time does not exceed 2.95% (that is, it occurs in 5 out of 169 patients), and only 1.7% of patients are diagnosed with persistent neuropathy, requiring microsurgical correction of the situation ¹ . With an incorrectly selected implant in length, with increased pressure during its installation, there is a high risk of damage to one of the branches of the trigeminal nerve (passing on the lower or upper jaw). As a result, soreness or numbness in a certain area, long-term rehabilitation.

Injuries are caused by compression of a given nerve, its stretching, partial or complete damage. In the case of stretching or compression without violating the integrity of the trigeminal nerve, sensations pass rather quickly – up to 7 days as blood circulation in the bone tissue improves. But if there was a partial damage to the fibers of the nerve bundle, then the rehabilitation process can take from 14 days to 6 months. Reinstallation of implants may be necessary in cases of severe trauma, as the body of the implant interferes with the restoration of axons (processes) in the nerve bundles.

In our clinic, before the operation, a thorough computer planning of the placement of implants is carried out, after which surgical templates are printed that protect the patient and the doctor from incorrect installation of implants. Immediately, or the next day after the operation, a control computed tomography is performed, on which the control commission (consultation of doctors), in accordance with international quality assessment protocols, compares the placement of implants with the original plan and makes a conclusion about the success of the operation, or makes recommendations to the attending physician about the need to take additional measures.

Important! Do not confuse nerve damage and compression on it that occurs in the bone as a result of edema after the installation of implants close to the nerve endings. The compression goes away with the swelling and numbness is normal in this situation. Most often, such symptoms typically appear 2-3 days after multiple implantation, they are a normal reaction of tissue injury when the implants are screwed in and damage to the intraosseous capillaries. Improvements will be noticeable almost immediately after the installation of the prosthesis on the implants and the activation of the chewing load, and with it the restoration and blood circulation in the bone.

We draw your attention to the fact that it makes no sense for the doctor and the clinic to hide the fact of damage to the trigeminal nerve, he will still reveal himself – this is the first thing. Secondly, even if this happened, the consequences are eliminated by properly selected therapy and joint work of the doctor and patient. Yes, if damage occurs, then the patient will have to undergo rehabilitation for a rather long period (up to 6 months), but in difficult clinical situations of complete absence of teeth and low quality of bone tissue, the doctor works in very limited conditions, therefore, unfortunately, there are some consequences, but not threatening life and health dysfunction, it is not always possible to avoid.

Expert opinion

Namdakov Nikolay Vladimirovich

Maxillofacial surgeon, implantologist, orthopedist
Work experience 17+

“In one-stage implantation, we very often use elongated implant models that are installed in deep sections of the bone tissue. Naturally, this increases the risk of damage to the nerves, which in this case are located very close to the implants.Nevertheless, in our work we use three-dimensional visualization – we carefully work out the implantation process in a computer program, where we set all the parameters of the jaw system of a particular patient. This allows us to eliminate the likelihood of damage to the facial nerve during surgery, even in difficult clinical conditions of bone atrophy. ”

Treatment of lesions of the facial or trigeminal nerve

The first thing to do (if the cause of the lesion is not known) is to go through a full diagnosis and find out why this problem occurred.This will allow the doctor to choose the right treatment tactics.

It is very important to see a doctor as soon as possible when the first symptoms of complications occur after tooth extraction or implantation. If treatment is started promptly, complete restoration of muscle functionality can be achieved. It is also important that if numbness persists for 3 months and no measures have been taken, it will most likely not be possible to restore the affected nerve, since persistent degenerative changes develop in it.

Diagnostics

• blood test for viral or bacterial infection that may have caused nerve damage,
• CT or MRI of the skull and brain to determine the affected area,
• electromyography, which involves direct exposure to nerve endings to establish the level of impairment in the passage of impulses along the nerve.

Treatment

• Drug therapy: This group includes anti-inflammatory drugs, pain relievers and anticonvulsants, as well as antidepressants and sedatives.
• physiotherapy: facial gymnastics, specialist massage, electrical stimulation and acupuncture,
• Microsurgery: An operation is performed to restore the integrity of the damaged nerve. This is a rather serious surgical procedure that should be performed by a professional surgeon. An operation is an extreme method of solving a problem, it is needed only in case of a serious defeat and if the first two options did not bring any result.

Restoration of teeth in the presence of neuralgia

Neuralgia of the facial or cranial nerve in 70% is a curable disease.However, it can recur. In addition, the patient needs a very long treatment to recover: he needs to do gymnastics, talk as much as possible, inflate balloons, etc. In addition, the violation of facial expressions can also affect chewing – it can be difficult. That is why, in the absence of teeth, very increased requirements are imposed on the prosthesis: it must be comfortable, it must not fall out of the mouth so that the patient cannot choke on it.

In the acute stage of neuralgia, it is worth postponing the restoration of teeth.At least 2-3 weeks later, if the treatment has yielded positive results, you can contact your dentist with a question about prosthetics.

Removable prosthetics are not recommended, since the structures are quite massive, cause discomfort and long-term addiction. In addition, they do not have good enough fixation. Therefore, the best option would be to use implantation. However, not classical, but one-stage – it involves the use of modern technologies of 3D visualization of the treatment process, as well as a simpler and less traumatic installation of implants.

We remind you that the most important thing in dental implantation is a professional doctor who thoroughly diagnoses the condition of the patient’s jaw system, knows its anatomical structure and uses progressive methods of planning and installing implants that minimize the risks of complications.

¹ According to research carried out at the Department of Surgical Dentistry, Odessa State Medical University named afterN.I. Pirogov.

90,000 why a toothache if the nerve is removed?

My name is Gogia Tea Zurabovna, I am a dentist-therapist of the NOVOSTOM STsNT. Many patients asked me the same question, so I decided to tell you about it in detail.

Most people are sure that if you remove a nerve from a tooth, it will never hurt again. What can hurt if the nerve is removed?

As soon as a patient catches a cold or just freezes, such teeth begin to make themselves felt.Patients are surprised to learn at the dentist’s appointment that the anxiety is caused by inflammation at the root of the tooth and they need to re-treat the root canals.

“They’ve already been treated to me!” They say: “What can hurt there if the nerve is removed? A tooth is dead without a nerve! ” This is the most common misconception of patients, which leads to forced re-treatment.

It is important to know that if a tooth was pulped, or, as we used to say, a nerve was removed from it, this does not mean that this tooth will never hurt.

Pulped teeth must also be observed. There is such a situation when, several years after the removal of the nerve and treatment, inflammation may occur at the apex of the tooth and periodontitis treatment is necessary. It may not bother the patient, and he will not suspect about it until a picture is taken at the dentist’s office.

Or until, due to the decrease in immunity caused by a simple seasonal viral disease, the root inflammation does not worsen and the tooth becomes painful, causing trouble for the patient.

There can be several reasons for periodontitis:

• The main reason for the development can be poor-quality treatment of the canals in the tooth: all root canals must be well processed and tightly filled to the full length. If the dentist missed the canal, did not remove the remnants of the instrument, allowed perforation of the canal, then this may subsequently be the cause of the inflammatory process and root canal treatment will be required.
• However, periodontitis often develops with well-treated canals due to a large load, the so-called overload, on the tooth, caused by the anatomical features of the patient’s bite, when due to trauma, cracks, allergic reactions to medicines and toxins, the tightness of the tooth is disrupted and an infection occurs …

Most often, microorganisms begin to multiply in the area of ​​the apex of the root at the junction of bone and soft tissue. They release toxins, resulting in bone defect surrounding the tooth. This is the case shown in the picture (Fig. 1 and Fig. 2).

It is for this reason that dentists recommend examining the teeth six months after treatment, and then at least once a year to take an X-ray for diagnostic purposes. It is important to know that with a certain frequency, which depends on the individual characteristics of the patient, and which should be clarified with the attending dentist, it is necessary to take not only an aiming image and a panoramic image of the tooth of the previously cured tooth.

On OPTG Lower 3.6 tooth.

Sighting shot of 3.6 tooth

For a more accurate diagnosis, it is also necessary to periodically do cone-beam computed tomography (CBCT), which is usually abbreviated as CT. This technique improves the quality of diagnostics, often avoiding many mistakes in the process of treatment and diagnostics, and will not let you miss the moment of the necessary treatment.

When conducting a study using CT, we get a 3D image, which allows you to better study the condition of the patient’s jaws, examining them on the screen in different projections.Thanks to CT scan of teeth, you can see each tooth not only from the front, but also from below, from above, from the side, while deploying it at any angle.

Often, an inflammatory focus may not be visible on a sighting or on a panoramic image of a tooth: these are two-dimensional images, and the inflammatory focus can be covered by the root of the tooth or other structures.

On CT the same tooth as on the aiming image and on the OPTG.

Re-treatment of a tooth is particularly difficult.No one can guarantee a 100% positive result during retreatment, since even with strict adherence to all the rules of treatment, the canal cannot be completely eliminated from the microbes that have got into it. Much also depends on the patient’s body, his immunity.

The treatment methods used in modern dentistry help us significantly reduce the likelihood of periodontitis: tooth isolation using a rubber dam, dental treatment under a microscope for processing and studying the anatomy of the tooth, good and high-quality medical and mechanical treatment of root canals.

Paying attention to all these points when choosing a clinic and a doctor, and not forgetting that the most important thing for your teeth is regular observation and good hygiene, you can make your visits to the dentist painless and pleasant.

Source

Undisclosed mystery of dentistry: exploding teeth

• Thomas Morris
• BBC Future

March 11, 2016

Photo author, Getty

Photo caption,

Toothache torture sometimes makes the sufferer literally

to climb the wall

In the 19th century, there were cases when, after months of excruciating toothache, patients found their teeth exploding with a bang in their mouths.The force of the explosion was sometimes such that one woman could hardly stay on her feet. Correspondent

BBC Future is exposed to dark mysteries in the history of dentistry.

In the 19th century, a Pennsylvania dentist named William Henry Atkinson encountered symptoms best described by the term “nightmare.”

In an article published in January 1861 in Dental Cosmos, the first professional publication for American dentists, Atkinson documented a kind of exploding tooth epidemic.

He noted this phenomenon in three patients. The first was the Reverend D.A. of Springfield, Pennsylvania, whose share of this painful and unpleasant experience fell in 1817:

This behavior was not very befitting of a clergyman, but it may give you some idea of ​​how much pain he was in. …

The epidemic continues

In the days when affordable and effective dentistry did not yet exist, toothache could become sheer torture.

So, during the trial, conducted in the English county of Sussex in 1862, the story of how a man committed suicide after continuous five months of suffering from toothache became public.

Photo author, Thinkstock

Photo caption,

Perhaps the metals of the first fillings reacted to the release of hydrogen, which exploded in the mouths of patients

“During this time, others saw him crying day after day for many hours in a row,” in the materials of the investigation.

The story of the unfortunate priest had a happier ending:

Thirteen years after this sad incident, something similar happened to a patient named Mrs. Leticia D. who lived just a few miles from Springfield.

For a long time she suffered from a toothache, “which disappeared as soon as the tooth exploded, followed by immediate relief.”

The last of the three recorded cases of this dental disaster occurred in 1855.Mrs. Anna P.A. said that one of her fangs split in half from edge to edge:

As unusual as these stories are, they are not unique.

The editors of the British Dental Journal recently republished a lively correspondence from the magazine’s archives that first saw the light of day in 1965.

It details the history of exploding teeth.

The editors included in this list a case reported in 1871 by another American dentist, Jay Phelps Hibler.

He was treating a young girl whose toothache was impressively gone after her large molar “exploded with a crash and with such force that she could hardly stand on her feet.”

The explosion was so loud that she became deaf after that for several days.

Sugar and tooth decay

Although five or six cases of tooth explosions were reported in the 19th century, there were no more similar events after the 1920s.

Hugh Devlin, professor of therapeutic dentistry at the University of Manchester School of Dentistry, says that while bad teeth are often destroyed, he has never heard of them exploding.

Author of the photo, Getty

Caption to the photo,

The caption under the photo of the dentist’s office in 1926 read: “It won’t hurt.”

He recalled how, in the 1960s, polar explorers talked about their sudden cracking teeth, but at that time it was believed to be the result of extreme frost.

He, however, believes that the real cause of the problem was tooth decay (tooth decay) caused by a diet high in sugar.

So what led to such dramatic cases as sudden tooth explosions?

In 1860, Atkinson proposed two possible explanations in his article.The first version said that a certain substance, which he called a substance of “unlimited temperature”, accumulates in the tooth and causes a sharp increase in pressure in the dental pulp.

This hypothesis can be ruled out immediately as it is based on outdated scientific theory.

For many years it was believed that heat consists of a certain liquid, called “thermal”, which possessed the property of self-repulsion.

While this would be a plausible reason for the pressure rise, we now know that no such fluid exists.

Atkinson’s second idea, at first glance, seems to be more credible.

He suggested that the process of rotting inside the tooth may be triggered by the accumulation of gas, which eventually causes the tooth to crack.

Could this explain the riddle?

Devlin is skeptical: “The chances of gas accumulating in a tooth sufficient to destroy it by an explosion is extremely small – the teeth are very strong. Dentists of the 19th century did not understand the cause of caries – they believed that it appeared from the inside of the tooth.Only in the last century did we begin to understand that caries is caused by the human diet and bacteria that accumulate on the surface of the teeth. “

However, the answer can be found by paying attention to the chemicals that were used for filling in the past.

All Chemistry

Before the advent of mercury amalgam to dentistry in the 1830s, many different metals were used to fill teeth, including lead, tin, silver and various alloys.

Andrea Sella, professor of inorganic chemistry at University College London, points out that if two different metals were used for the filling, it could lead to the formation of an electrochemical cell.

Photo author, Thinkstock

Photo caption,

Without understanding the cause of the explosion of the teeth, we cannot be sure that in the future this trouble will not befall another patient.

In fact, the patient’s mouth turned into a low-voltage battery.

“As a result of the proximity of various metals in the mouth, the electrolysis process could suddenly begin there.I prefer the explanation according to which, in the event of poor-quality filling, part of the cavity of the hollow remains unsealed, which can lead to the accumulation of hydrogen inside the tooth. ” hydrogen could explode due to ignition if the patient smoked at the time, or an iron seal could spark a spark in his mouth. …

Unfortunately, there is no evidence that any of those patients were actually filled with fillings.

Thus, either the explosions were caused by some unknown process, or the patients exaggerated the symptoms, which were much more commonplace.

At least now it seems that the secret of exploding teeth will remain an unsolved mystery.

Scientists have established why pain shoots from a cold tooth

Scientists have discovered a property that makes our teeth hypersensitive to cold.Thanks to this discovery, the researchers were also able to identify an active substance that will help get rid of such a toothache.

Teeth sensitivity to cold occurs for various reasons. Many people feel severe pain due to a cavity in the tooth, which has arisen, for example, due to caries. Teeth sensitivity is also increased in people with gum disease.

Sometimes the teeth become sensitive to cold in cancer patients undergoing chemotherapy with platinum preparations.Sometimes, even blowing cold wind into their face can cause them to have severe toothaches. It comes to the point that some patients stop because of this much needed treatment.

Scientists emphasize that the causes of toothache are rather difficult to establish, because for any serious manipulations with a tooth, it needs to be opened.

The research team had to carry out a series of experiments involving mice. To provoke a toothache in rodents, their molars were damaged under anesthesia.The scientists then determined whether their mentees had tooth aches by how much they drank the sweetened water.

The fact is that mice with diseased teeth drink 300% more sweet water than rodents from the same droppings, but without dental problems.

Also in previous studies, scientists have identified the protein TRCP5, “encoded” in the gene of the same name. The activity of this gene is observed in the nervous tissue in different parts of the body and is associated with temperature sensitivity, and in particular with pain from cold.

In the course of new work, the researchers found that rodents without the TRCP5 gene did not respond to tooth damage. They did not drink large amounts of sweetened water and generally behaved like mice with healthy teeth.

“We now have clear evidence that temperature-sensitive TRCP5 causes the odontoblast to respond to cold, causing the nerve to become agitated, leading to pain and hypersensitivity,” explains co-lead author Dr. Jochen Lennerz ( Jochen Lennerz from Massachusetts General Hospital.

Let us explain that odontoblast cells are located in dentin, the hard tissue of the tooth just below the enamel. It turns out that they are also sensitive to cold.

Perhaps the sensitivity to cold helps the body protect the damaged tooth from re-injury?

Scientists have found that the TRCP5 protein is produced in large quantities by cells near the tooth pulp inflamed from caries, and it is this protein that causes an increase in the electrical signal sent from the tooth root to the brain, which perceives pain.

Sensitivity during gum recession (when they recede and expose the roots of the teeth) is explained by the fact that odontoblasts begin to feel cold in unusual places that were previously protected by the gum.

“The metabolism of most cells and tissues slows down in the cold, so donor organs are put on ice. However, TRCP5, on the contrary, activates cells in response to cold, and this ability of odontoblasts to respond to low temperatures thanks to TRCP5 is amazing,” said Dr. Lennerz.

Scientists had to work hard to find the accumulation of TRCP5 protein in damaged teeth. To begin with, all the calcium had to be washed out of the extracted human teeth to make them more pliable. Then the teeth were immersed in epoxy and cut into thin layers, in which TRCP5 was then found.

Researchers have also confirmed the benefits of clove oil, which has been used for thousands of years to treat toothaches. It turns out that the main component of this essential oil, eugenol, blocks TRCP5 receptors.

Although the active ingredient is already used in dentistry, it can now be used to target cold sensitivities in teeth and also to be prescribed to patients undergoing chemotherapy to reduce the unpleasant side effects of the treatment.

The study was published in the scientific journal Science Advances.

Previously Vesti. Ru wrote about a denture, which itself disinfects the gums and about toothpaste, which restores tooth enamel.We also reported that the new hydrogel will save a sick tooth from death.

More news on the science of pain management can be found in the corresponding section on the website Look.rf.

90,000 Causes of curvature of the jaw in an adult and changes in deep bite

Jaw deformities occur in 80% of adults, so not all of them can boast of a beautiful Hollywood smile. The process of curvature of the jaw itself is formed at an early age, if not stopped, in the future this can lead to serious problems.

Why do adults have jaw curvature?

There are a number of factors that lead to occlusion disorders:

• Genetics. One of the most common reasons for the development of dental deformities in adults. Unfortunately, it is impossible to influence genetics. However, if you analyze the dentition of the parents, you can predict what dental problems their children may have.
• Anomalies of the development of the dentition. A crooked jaw in an adult can develop due to the characteristics of the diet.The predominance of soft food often leads to a violation of the development of the dentoalveolar apparatus, which subsequently causes curvature of the teeth.
• Early loss of deciduous teeth. Violation of the physiological processes of changing teeth often leads to a change in their position during eruption. A similar situation can occur in adults when removing injured or refractory teeth.
• Abnormal position of dental embryos. The deviation of the axis of eruption of the units of the dentition, which persists into adulthood, often leads to a curvature of the jaw.
• Wisdom teeth. Eights are distinguished by late maturation, therefore, by the time they erupt, as a rule, there is not enough space in the dentition. Having a great potential for eruption, they begin to displace adjacent units, which causes the development of dentoalveolar anomalies.
• Somatic diseases. For the normal development and functioning of the upper jaw, nasal breathing is imperative. In the presence of otolaryngological pathologies, oral breathing develops, which leads to underdevelopment of the maxillary bone and curvature of the dentition.
• Problems with the locomotive system. Poor posture, problems with the spine and other factors often lead to dysfunction of the temporomandibular joint, which in turn contributes to the violation of occlusion.

Methods for correcting jaw curvature in adults

Modern dentistry offers a wide range of methods for the treatment of dentoalveolar anomalies. Depending on the degree of curvature of the jaw, the patient may be offered surgical or orthodontic treatment.

Radical techniques are relevant in advanced cases when there is pronounced asymmetry of the face, deformities of the cranial vault, chin dysplasia, speech impairment. After surgery, in a number of clinical situations, orthodontic treatment is additionally carried out, which improves the results of the operation.

Non-surgical correction of malocclusion is based on the use of braces that help restore normal occlusion.

7 problems of wisdom teeth

The wisdom tooth is the third molar, the 8th tooth in a row (it is also called the “eight”), the period of its eruption is 14-25 years.Outwardly, it is no different from the others, but the peculiarities of its development and growth can lead to an inflammatory process and to various diseases.

Problem 1 – impacted wisdom tooth! Represents a fully formed tooth, but remained in the jaw or partially erupted. There are two options for the development of events. The first – the tooth will not bother its owner at all, the second – over time, such a tooth will begin to bother, as well as move the adjacent teeth in the process of eruption, which leads to a change in the bite.If such a tooth is not removed in time, then problems with healthy teeth may subsequently arise.

Problem 2 – Dystopic Wisdom Tooth! This is a tooth whose growth occurs with deviations from the norm (at the wrong angle, on the wrong side). Unfortunately, in most cases, a dystopic wisdom tooth is removed. This is due to the fact that incorrectly positioned “eights” injure the surrounding tissues, provoking the occurrence of inflammation and abscesses, and also negatively affect the adjacent teeth and bite in general.

Problem 3 – Difficulty erupting a wisdom tooth. Since there was no milk tooth at the site of the eruption of the wisdom tooth, the gum in that place is not adapted for eruption. Because of this, there is often a swelling of the wisdom tooth eruption site and sometimes unbearable pain in the gums, and sometimes in the ear and even in the neck. In some cases, the pain is so unbearable that a person can hardly open his mouth. In such situations, it is necessary to seek the help of a specialist who will help to overcome the pain.On average, a wisdom tooth can erupt from several months to several years.

Problem 4 – G8 caries. Caries is perhaps the most common oral disease. Any teeth are susceptible to it, but eights in particular. The cause of this disease is the accumulation of bacterial plaque and poor hygiene. Despite the irrationality of preserving the figure eight, sometimes the doctor recommends abandoning extreme measures and prescribes treatment for the eighth tooth. But the more common outcome after such a diagnosis is the removal of the tooth decayed.

Problem 5 – caries of the wisdom tooth root! The main difference between root caries and all the others is its localization deep under the gum. And if a lesion in the cervical and root part of the tooth can be detected by visual inspection, then root caries is invisible and therefore the most dangerous of all. Caries can develop on the root of the “figure of eight” due to its improper eruption, when the root is bare, and there is also a risk of root caries development on the adjacent 7th tooth, in the case when a wisdom tooth moves the adjacent tooth during the eruption stage, exposing its root being an obstacle to normal hygiene in this area.

Problem 6 – Pericoronitis! In the process of erupting a wisdom tooth, a gingival hood appears above it, which can become inflamed, and it also delivers unbearable pain. In this place, purulent inflammation occurs. If the procedure to remove the gingival hood is not carried out in time, the inflammation can spread to the periosteum and even the bone.

Problem 7 – periodontitis! Chronic periodontitis of the wisdom tooth rarely bothers the patient, it is almost asymptomatic.Minor pains appear only when biting and tapping. On the gum in the projection of the wisdom tooth, there may be a fistula, from which a scanty purulent discharge will be released. Acute periodontitis of the wisdom tooth is manifested by the occurrence of sharp pain when biting, against the background of constant aching pains, there is a slight mobility of the tooth, swelling of the gums / cheeks may appear.

In any form and stage of the disease, if the wisdom tooth is very worried, this is a serious reason to go to the dentist.