Trigeminal Neuralgia (Tic doloureux) The most painful disease in all of medicine!

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Trigeminal neuralgia is not treated by dentists, but dentists are often involved in its diagnosis, mostly by way of misdiagnosis of toothaches.  Trigeminal neuralgia is often mistaken for very serious tooth pathology when it first appears, and almost invariably results in the loss of one or more of the patient's natural teeth.  This result is the tragic consequence of the rarity of the disease and the similarity of the symptoms of trigeminal neuralgia with the symptoms of an acute pulpitis (inflammation of the nerve inside a tooth) which may refer serious pain throughout large parts of the distribution of the trigeminal nerve.  The tipoff that this is not a normal toothache comes after the tooth (teeth) have been extracted, but the pain still persists unabated.  A dentist may practice for decades before seeing a case of trigeminal neuralgia.  His job is to relieve pain, and the worse the pain, the more pressing is the need to relieve it!  There are no definitive methods for the differentiation of the pain caused by trigeminal neuralgia from the pain that may be referred by a severe  pulpitis, so a misdiagnosis and the consequent extraction of one or more teeth is quite understandable in light of the severe pain the patient presents in the dental office.  The tooth may be a most likely culprit simply because trigeminal neuralgia may manifest (in part) as a severe toothache.

 

There is hope.  Trigeminal neuralgia can be treated in one of two ways:

 

  A number of anticonvulsant drugs are available to reduce the frequency, intensity and duration of attacks:

Several forms of surgical correction of trigeminal neuralgia are available.  They are generally effective, but not always permanent.  Most are done under general (complete) anesthesia and are considered safe for all categories of patient.  These surgeries fall into three general categories. 

The most frequently performed types are called rhizotomies.   A rhizotomy is done either by the chemical, electrical or mechanical ablation (destruction) of the Semi Lunar ganglion (also called the gasserian ganglion).   Rhizotomies usually result in permanent numbness of at least part of the effected side of the face.  The numbness is considered by most patients to be a small price to pay for relief from this painful condition. 

The second category of treatment is called microvascular decompression surgery and is done by the placement of Teflon implants between the nerve and the offending blood vessels.   This option rarely produces numbness, but is a complicated and very expensive procedure. 

The third and newest surgical treatment is not surgery at all.  It is called Gamma Knife Radiosurgery (GKRS), and it involves aiming 201 beams of cobalt-60 radiation focused precisely on a specific region in the brain--in this case the trigeminal nerve root.  This precise concentration of radiation radiates the structure in question without damaging surrounding areas.  The pain of TN usually subsides within several weeks. Click here to download an excellent brochure on this subject.  The brochure is in pdf format and requires Adobe acrobat (free download).  The Gamma knife is used for numerous brain lesions including virtual cures for some seizure disorders and Parkinson's disease.