Diagnostic challenges of trigeminal neuralgia in dental settings: a retrospective study

Trigeminal neuralgia (TN), or Fothergill’s disease, is a neurological condition, known for episodic paroxysmal electrical shock-like pains across the sensory divisions of the trigeminal nerve. Being a serious cause of orofacial pain, referral to a dentist is sometimes necessitated. However, diagnosis can easily be confused, resulting in undertreated patients. This study aimed to evaluate the patterns of dentists’ interventions prior to accurate TN diagnosis and to assess the effectiveness of such interventions. Approval for conducting this retrospective analysis was obtained from the Ethics Committee of Ibn Sina University (ECC: ISU.4.2.24). Work was done at Dr. Saad Al-Witry Hospital for Neurosciences in Baghdad, Iraq. It targeted a total of 104 patients with TN from January 2020 to September 2023. Patient care was provided with the assistance of neurosurgical consultation. Patient management was done using different modalities. Of the 104 TN patients, 88 (84.6%) visited a dentist. The average age was 52.48 years, with ages ranging from 17 to 85 years. Females were affected in 60% of the cases. The right face was involved in 59 (67%) cases. Involvement of two branches of the trigeminal nerve, V2 and V3, occurred in 40.5% of patients, one branch in 31.7%, and all three branches in 12.5%. Dentists’ role was primarily tooth extraction, followed by medications and dental fillings, while temporomandibular joint related disorders were treated. ~67% of the patients did not show any response to the dental treatments. This study sheds light on the difficulties encountered by the dentists while managing and treating TN. In addition, it stresses the necessity of enhancing the diagnostic capabilities of dentistry students and dental professionals through focusing on TN management by broadening of their differential diagnosis list.