TRIGEMINAL

NEURALGIA
Guided by:
DR. JYOTI KARANI mam
DR. SALONI MISTRY mam

presented by:
TARANA D RAGHANI
CONTENTS:
 TERMINOLOGIES FOR NEUROLOGICAL
DISTURBANCES
 ANATOMIC AND FUNCTIONAL CONSIDERATION OF
TRIGEMINAL NERVE
 WHAT IS TRIGEMINAL NEURALGIA
 EPIDEMIOLOGIC STUDIES
 ETIOLOGY
 CLINICAL CHARACTERISTICS
 RISK FACTORS
 DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS
 TREATMENT MODALITIES
 DENTAL CONSIDERATIONS IN TRIGEMINAL NEURALGIA
 TERMINOLOGIES FOR
NEUROLOGICAL
DISTURBANCES
ALLODYNIA pain due to stimulus that does not
normally provoke pain

ANALGESIA absence of pain in response to

stimulation that will normally be
painful

ANAESTHESIA loss of any or all sensation

PARESTHESIA an altered sensation, which is not
pleasant, like tingling, crawling,
burning, itching

DYSAESTHESIA an unpleasant painful abnormal

sensation, either spontaneous or
evoked. Patient c/o burning,
stabbing or burrowing type of pain

HYPERAESTHESIA increased sensitivity to stimulus.

HYPOAESTHESIA decreased sensitivity to stimulus.

HYPERGESIA increased response to
stimulus that is normally
painful

HYPOGESIA decreased response to

stimulus that is normally
painful

AGEUSIA loss of taste sensation

NEURITIS an inflammation of a
nerve

NEURALGIA transmission of pain

impulse along the
course of nerve
 ANATOMIC AND
FUNCTIONAL
CONSIDERATION OF
TRIGEMINAL NERVE

 It is the largest cranial

nerve.
 it comprises three
branches
1. OPHTHALMIC
2. MAXILLARY
3. MANDIBULAR

B D CHAURASIA’s HUMAN ANATOMY , 5th edition

 SENSORY FIBRES

The sensory fibres arise from the gasserian

ganglion

MOTOR FIBRES

The motor fibres arise from the superior and

inferior nuclei

B D CHAURASIA’s HUMAN ANATOMY , 5th edition

OPHTHALMIC NERVE
BRANCHES
A. Infratrochlear
B. Anterior Ethmoid
C. Posterior Ethmoid
D. Lacrimal
E. Supraorbital
F. Supratrochlear
G. Nasociliary

B D CHAURASIA’s HUMAN ANATOMY , 5th edition

MAXILLARY NERVE
BRANCHES

A. Zygoticaticotemporal
B. Zygomaticofacial
C. Post. Sup. Alveolar
D. Nasopalatine
E. Greater Palatine
F. Lesser Palatine
G. Mid. & Ant. Alveolar
H. Infraorbital

B D CHAURASIA’s HUMAN ANATOMY , 5th edition

 MANDIBULAR NERVE
BRANCHES

A. Auriculotemporal
B. Lingual
C. Inferior Alveolar
D. N. to the Mylohyoid
E. Mental
F. Buccal

B D CHAURASIA’s HUMAN ANATOMY , 5th edition

 TRIGEMINAL
NEURALGIA

Trigeminal neuralgia is
defined as sudden, usually
unilateral, severe, brief,
stabbing, lancinating type of
pain in the distribution of
one or more branches of the
5th cranial nerve

Oral and maxillofacial surgery by neelima malik

 EPIDEMIOLOGICAL
STUDIES
YEAR SCIENTISTS CONCLUSIONS FROM
THEIR STUDIES
1972 YOSHIMASU, TN is more common in
KURLAND and females than males in US
ELVELVACK

1996 JACOB AND the incidence of TN occurs

RHOTON predominantly in females

Prevalence of trigeminal neuralgia: A systematic review.

J Am Dent Assoc. 2016 Jul;147(7):570-576.e2. doi:
10.1016/j.adaj.2016.02.014. Epub 2016 Mar 24
2004 VALLE et al  72 % showed intraoral
evaluated the trigger zone
dental conditions  16% had TMJ disorders
of 50 patients with  6% had burning mouth
TN syndrome
 42% of the patients show
limitations for the
performance of daily
activities

1998 SHANMUHAS- female predominance

NTHARAM et al Right side 5 times more
investigated the affected than the left side (in
clinical unilateral cases)
characteristics of Largest frequency was in the
TN in 44 Asian age group of 60-70 years
patients
A RETROSPECTIVE STUDY OF 72
CASES DIAGNOSED WITH
IDIOPATHIC TRIGEMINAL
NEURALGIA IN INDIAN POPULACE
by DR SUNIL YADAV and others
A retrospective study of 72 cases diagnosed with idiopathic trigeminal neuralgia
in indian populace
 ETIOLOGY

i. Neurovascular compression
ii. Multiple sclerosis
iii. Tumor and cyst
iv. Diabetes mellitus
v. Herpes simplex virus
vi. Allergy

http://tnaaustralia.org.au/dental-care-and-tn/
 CLINICAL
CHARACTERISTICS
 Itis characterized by sudden,
unilateral, intermittent paroxysmal,
sharp, shooting, lancinating, like pain.

 Pain is elicited by slight touching

superficial ‘Trigger points’ which
radiates from that point, across the
distribution of one or more branches of
trigeminal nerve.
The location of Trigger point depends
on which division of Trigeminal nerve
is involved

In V2 – points are located on the

skin of upper lip, ala of nose,
cheek, or on upper gums

In V3 – lower lip, teeth or gums of

lower jaw

In V1 – Supraorbital ridge
TRIGGERS
A variety of triggers may set off the pain
of trigeminal neuralgia, including:
 Shaving
 Touching your face
 Eating
 Drinking
 Brushing your teeth
 Talking
 Putting on makeup
 Encountering a breeze
 Smiling
 Washing your face
RISK FACTORS

1) Multiple Sclerosis (major)

2) Hypertension (common in the age
group at risk)
3) Familial tendency – in a
retrospective study by POLLOCK et
al females with bilateral TN had a
higher rate of familial TN
DIAGNOSIS
 Your doctor will diagnose trigeminal
neuralgia mainly based on your
description of the pain, including:
 TYPE OF PAIN related to
trigeminal neuralgia is sudden,
shock-like and brief.
 LOCATION. The parts of your face
that are affected by pain will tell
your doctor if the trigeminal nerve
is involved.
 TRIGGERS Trigeminal neuralgia-
related pain usually is brought on
by light stimulation of your cheeks,
such as from eating, talking or
even encountering a cool breeze.
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).

http://tnaaustralia.org.au/dental-care-and-tn/
 DIFFERENTIAL DIAGNOSIS
OF TRIGEMINAL
NEURALGIA
 SECONDARY TRIGEMINAL NEURALGIA

 PAIN OF DENTAL ORIGIN

a. Pulpal pain
b. Periodontal pain
c. Parafunction induced alveolitis
d. Crack tooth syndrome

 EXTRACRANIAL
a. Sinusitis
b. Temporomandibular disorders
 NEUROPATHIC
a. Pretrigeminal neuropathy
b. Trigeminal neuropathy
c. Glossopharyngeal neuralgia
d. Post herpetic neuralgia
e. Nerve compression

 NEUROVASCULAR
a. Migraine
b. Cluster headache
c. Chronic paroxysmal hemicrania
d. Giant cell arteritis

 PSYCHOGENIC
http://tnaaustralia.org.au/dental-care-and-tn/
 TREATMENT MODALITIES
 Medications are the first line of treatment
for TN and include carbamazepine,
phenytoin, gabapentin & baclophen.
 As the disease progresses and pain
becomes more frequent & severe,
increased doses of medications are
required which may lead to intolerable
side effects and/or inadequate pain
control.
 The surgical procedures then considered
are either Microvascular decompression
or some form of nerve injury procedure
(Rhizotomies).
 TREATMENT WITH MEDICATIONS
Anticonvulsant medications, which slow down the
nerve’s conduction of pain signals, are usually the
first treatment option. These include:
 Tegretol (carbamazepine)
 Trileptal (oxcarbazepine)
 Carbatrol (carbamazepine)
 Dilantin (phenytoin)
 Lamictal (lamotrigine)
 Topamax (topiramate)
 Neurontin (gabapentin)
 Klonopin (clonazepam)
Tegretol (carbamazepine) is the primary drug used to
treat TN.
 SURGICAL TREATMENTS
 Microvascular Decompression (MVD)
 Balloon Compression
 Glycerol Injection
 Radiofrequency Lesioning
 Radiosurgery (GammaKnife,
CyberKnife, etc.)
PALLIATIVE TREATMENT

 Acupuncture
 Biofeedback
 Capsaicin
 Homeopathy
 Nutritional therapy
 Electrical Nerve Stimulation
 TENS (Transcutaneous Electrical Nerve Stimulation)
 Upper cervical chiropractic
 Vitamin B-12 Injections
 Botox

http://tnaaustralia.org.au/dental-care-and-tn/
DENTAL
CONSIDERATIONS
IN TRIGEMINAL
NEURALGIA
 ACRYLIC RESIN
STENT AS VEHICLE
FOR MAINTAINING
TOPICAL
APPLICATION OF
ANALGESIC GEL TO
TISSUES

ACRYLIC RESIN
STENT in situ.
ANALGESIC GEL IS
COATED ON FITTING
SURFACE

Neuropathic implications of prosthodontic treatment

Robert E. Delcanho, BDSc, MS a
Perth Pain Management Center, Applecross, Western Australia
PREVENTING TN
FLARE-UPS AFTER
DENTAL WORK
 Anesthesia should be WITHOUT
EPINEPHRINE FOR THE LOCAL
ANAESTHETIC.
 long acting local anesthesia should
be used to avoid multiple injections
 the dentist should inject the local
anesthetic at a site as far away as possible
from the trigger point for the TN pain
http://tnaaustralia.org.au/dental-care-and-tn/
 CONCLUSION

 Though there are not definitive signs

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