Trigeminal neuralgia in the differential diagnosis of odontogenic pain

Patients with Trigeminal Neuralgia First Consult Dentists and Will Receive Treatment for Odontogenic Pain. Background: Trigeminal neuralgia (TN) is characterized by sharp, lancating pain, frequently involving the maxillary and the mandibular distribution of the trigeminal nerve. Hence, TN is an important differential diagnosis to odontogenic pain. Little is known about the frequency of dental misjudgment and unnecessary treatment. Material and Methods: We conducted a retrospective telephone survey of TN patients that were surgically treated at our institution. Patients were asked to identify whether a physician or dentist was initially consulted when TN symptoms first developed. Patients seen by a dentist were asked what further diagnostic tests were performed and what treatment they underwent. Furthermore, the time interval from first consultation to establishment of the correct diagnosis and diagnosis directed treatment was noted. Secondly, using a written questionnaire only, local dentists were asked to self-assess their level of confidence in identifying TN as a differential diagnosis to odontogenic pain. The study was approved by the Institutional Review Board. Results: Using the electronic operative log, we identified 118 surgical procedures (82 percutaneous rhizotomies, 33 microvascular decompressions and 3 other procedures) for TN in 93 patients from January 2003 until December 2008. Of these, 51 patients (55%) were accessible and willing to participate in the study. The majority (n=46, 84%) of included patients consulted a dentist first for the evolving symptoms. In only two of these cases (4,8%) the dentist established the diagnosis of TN, 27 (64%) of the remaining patients received various forms of treatment, including extractions of a total of 50 teeth in 14 patients and 13 root canal treatments in four patients. Nearly half the patients (46,4%) were refered to neurologic institution after 1 year or longer. Of 50 dentists that responded to our questionnaire (return rate of 51%), 74,5% felt they would be able to identify patients with TN. Conclusions: The vast majority of TN patients initially consult their dentist, and still a high percentage will receive dental surgical treatment before the correct diagnosis of TN is established. These figures have been underestimated so far, the number of actual cases might be higher. Better education by neurosurgical and neurological specialists is needed, focusing on the public as well as on dentists and dental surgeons, to overcome pitfalls in the diagnosis and treatment of this debilitating disorder. 2014-05-1