Two-thirds of the patients had received incorrect diagnoses of dental problems, Dr. Graff-Radford said. The group had undergone 101 unnecessary dental procedures, he said, including root canals, extractions, and splints applied to the jaw. Only one person had had a dental problem -- a cracked tooth. All had experienced pain for six or seven years.
The real problem lay in the trigeminal nerve, which arises in the brain stem, enters the face and divides into three major branches, Dr. Graff-Radford said. When the trigeminal nerve becomes irritated or is squeezed by a blood vessel, pain is felt in the distant nerve endings -- a condition called neuralgia, he said.
In classical trigeminal neuralgia, the pain strikes like lightning, lasting for a few seconds or minutes. Victims describe an electric shock sensation that is triggered by simple acts like washing, shaving, talking or brushing teeth and say the pain comes and goes without warning. The pain is so intense that patients wince, giving it the name "tic douloureux," meaning painful twitch in French.
"Every dentist who graduates from school learns there is a disease called trigeminal neuralgia," Dr Solberg said "But the problem doesn't always present itself in the classic fashion."
"Pretrigeminal neuralgia, an early stage of trigeminal neuralgia, is characterized by intermittent, aching pains that last minutes to hours and perfectly mimic toothache or temporomandibular joint disorder (TMJ)," Graff-Radford said. This pain confuses patients and dentists alike.
"The patient comes in complaining of a toothache," Dr. Solberg said, "He does not wince or blink. The teeth look normal. Results of the neurological examination are normal. The dentist is perplexed."
At this point, Dr. Solberg said, patients may beg the dentist to try something, anything to kill the pain. "They complain that you missed something, that you don't know what you're doing," he said.
"A damaged tooth would show signs of inflammation," Dr. Solberg said. It would change over days and weeks, getting better or worse. Healthy teeth would look normal. But the dentist, prodded by the patient, thinks, "Gee, maybe I missed something," Dr. Solberg said. "He loses confidence and operates."
Sometimes the patient gets worse pain, Dr. Solberg said. Other patients seem to get better for a while, but then the pain comes back with a new trigger point.
Patients and dentists need to take more time to evaluate facial pain before doing invasive procedures, Dr. Graff-Radford said. The source of the problem can often be traced by injecting anesthetics into various parts of the nerve, he said, and can be treated with anticonvulsant drugs or surgery on the nerve.
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