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Trigeminal Neuralgia or Toothache

Difference in Pain Characteristics between Trigeminal Neuralgia and Toothache

Trigeminal Neuralgia or Toothache

Trigeminal neuralgia is often confused with dental pain. Trigeminal nerve has a bad temper. It literally has “impulse control issues”. Long lasting toothache tends to spread beyond the affected tooth and may involve the face, the opposite jaw or side and even radiate to the neck.
At this point the cause of pain becomes obscure. Only people with very good insight are still able to tell where the pain is coming from.
Carbamazepine, commonly used in trigeminal neuralgia, may help for toothache as well, which adds even more confusion. Practicing neurology for years, I have seen removed teeth in trigeminal neuralgia, as well toothache treated as trigeminal neuralgia.

Some pain features may point in the right direction.
First of all, where the pain was at the very beginning? If the pain started inside the mouth in a particular tooth, then it is likely to be a toothache. Dental procedures prior to the pain onset, local gum swelling and discharge, bad taste in the mouth, percussion and temperature sensitivity of a specific tooth – all point to the dental cause of pain.

If the pain started in the face, even if it is felt as shooting to the teeth, it is more typical for trigeminal neuralgia.

In toothache, the face is not sensitive to touch or temperature and vice versa – this sensitivity is almost a must in trigeminal neuralgia.

Having said all that, in real practice it is not so simple.
Some patient comes after seeing three dentists and two oral surgeons and having done all possible x-rays and CAT Scans and all five doctors clearly stated that there was absolutely nothing wrong with the teeth… Then, all five of them point there index fingers in the neurologist’s direction… Then, you see this patient and you have no doubt that the problem is … dental. Can you imagine the face of this person after a clear statement is made that the problem is dental?! This is what happens over and over again! But, if it is dental – it is dental and it has to be managed accordingly.


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