Trigeminal neuralgia is an extremely painful medical condition that dentists need to be aware of. In fact, according to the National Institutes of Health, trigeminal neuralgia is often misdiagnosed as a toothache. If you are a dentist or work in a dental office, it's important to understand trigeminal neuralgia so you can refer your patients to a neurosurgeon for appropriate medical care.
Symptoms of trigeminal neuralgia
Trigeminal neuralgia, often called the suicide disease, causes excruciating pain in the face along the 5th cranial nerve, which has three branches in the face. The pain is described as shock-like, as if an ice pick is being stabbed into the face. The pain can last for several seconds to several minutes, and it can occur many times throughout each day or once every few months, depending on the severity of the condition.
The pain is triggered by sensations, such as a light wind, or by facial movement, such as while eating, talking or brushing teeth. Due to the location of the pain, in the face and along the jaw, many people who experience the pain believe it to be a dental problem, an earache, or related to the sinuses. Conversely, since the pain is located in the face, it can cause people to neglect dental care out of fear of the pain being triggered.
Causes of trigeminal neuralgia
Trigeminal neuralgia is caused by damage to the nerve, which can occur in several ways.
- The nerve can be damaged by the compression of a blood vessel or a tumor where the nerve exits the brain stem. This can cause the myelin sheath (myelin sheath) of the nerve to wear away, which can cause the nerve to be sensitive.
- The nerve can be damaged during oral surgery or sinus surgery. If the protective coating of the nerve is damaged, the patient can develop trigeminal neuralgia.
- A facial injury could damage the nerve, such as a laceration or trauma.
Trigeminal neuralgia misdiagnosed as dental conditions
Since the pain is located along the side of the face and in the cheek and jaw regions, many people will assume it is dental-related and see their dentist first. Over the years, dentists have extracted teeth, performed root canals, and other dental treatments in hopes of finding relief for their patients, but to no avail.
If a patient presents to your office with pain along the nerves affected by trigeminal neuralgia, but their oral cavity, gum tissue and teeth appear to be healthy, refer them to a neurosurgeon who can determine whether or not the patient has trigeminal neuralgia. It is important that you do not probe any further until after the patient has been evaluated by a neurosurgeon, because you could cause further damage to the affected nerve.
Referral network with neurosurgeons
The pain of trigeminal neuralgia can be so severe that it can cause people to contemplate suicide. For this reason, a patient may demand that you do something to relieve them of the pain. The best thing you can do is to refer them to a neurosurgeon.
Build a referral network with neurosurgeons in your area. When building your referral network, you'll want to keep in mind the various medical insurance policies your patients have. That way, when you have a patient who you believe needs a medical evaluation for trigeminal neuralgia you will be able to refer them to a neurosurgeon who accepts their health insurance.
Given that one of the causes of trigeminal neuralgia involves damage to the nerve during oral surgery, it is extremely important for dentists to carry dental malpractice insurance. Also, insurance coverage may cover dental misdiagnoses that may prolong the patient from getting the appropriate medical care.