Trigeminal Neuralgia Versus Pulpitis in a Pregnant Patient: Challenges in Diagnosis and Endodontic Management—A Case Report

Background: Trigeminal neuralgia (TN) is a rare but debilitating neuropathic pain disorder characterized by severe, electric shock-like facial pain that can significantly affect maternal quality of life and pregnancy outcomes. Most patients with TN are initially misdiagnosed as having odontogenic pain, leading to inappropriate dental treatment.Objective: This case report aims to highlight how pregnancy-related hormonal changes, limitations in diagnostic procedures, and restricted therapeutic options influence the evaluation and management of TN during pregnancy.Case Report: A 31-year-old woman in the eighth month of pregnancy presented with pain described as an electric shock-like sensation affecting the lower right side of the face and the region around the corner of the lips. The symptoms first appeared during the eighth week of gestation. Initially, the patient underwent odontectomy and dental filling as recommended by the initial dentist. Because of severe pain, an access cavity was prepared by another dentist. However, the patient's symptoms persisted without improvement. Radiographic evaluation revealed radiolucency extending towards the pulp chamber of tooth 46. After consultation with obstetricians, root canal treatment was initiated under mandibular block anesthesia. The patient was subsequently referred to a neurologist for further evaluation and management of suspected TN.Conclusion: Clinical follow-up revealed improvement in the patient's condition. However, identifying and diagnosing orofacial pain during pregnancy remains challenging. A multidisciplinary approach involving dentists, obstetricians, and neurologists is essential for achieving an accurate diagnosis and ensuring safe and effective management of patients with TN during pregnancy.