No, Your Dental Work Did Not Cause Trigeminal Neuralgia. But It's Often Misdiagnosed As Dental Pain.

"TGN is a neurological condition, not caused by dental procedures, but likely caused by a blood vessel pressing on the trigeminal nerve right at its root entry zone in the brainstem, or in some cases by identifiable masses in the brain."

I recently received a newsletter from @MedPro, a reputable medical malpractice insurer, about a court case that caught my attention. A patient had developed sudden facial pain after dental work, which a pain specialist diagnosed as trigeminal neuralgia (TGN), suggesting it was “probably caused” by the dental procedures. In court, however, an academic neurosurgeon testified in support of the dentists, explaining that TGN isn’t caused by dental work. The jury ultimately did not find the two dental providers guilty of causing TGN.

This case describes a very common occurrence where some patients and even medical providers mistakenly think TGN is caused by dental work: fillings, extractions, root canals, and other common work. TGN is a neurological condition, not caused by dental procedures but likely caused by a blood vessel pressing on the trigeminal nerve right at its root entry zone in the brainstem or, in some cases, by identifiable masses in the brain (1,2). This “neurovascular compression” can irritate the nerve and cause sudden, sharp, electric shock-like facial pain, sometimes described as "lancinating".

Why Dental Work Gets Blamed

Because TGN pain often feels like it’s coming from the teeth or jaw, many patients see a dentist first. In stark contrast to the above court case, TGN often gets mistaken as cracked teeth or other dental problems. Misdiagnosis of TGN as a dental issue can lead to unnecessary treatments such as extractions or root canals, but these procedures rarely improve the pain because the source of TGN is not in the teeth (3).

Getting the Right Diagnosis

Neurological guidelines recommend that patients with sudden onset facial pain be evaluated by a neurologist or oral medicine specialist or orofacial pain specialist. Dentists play an important role in recognizing when pain doesn’t match common dental problems and referring patients early (4,5).

References

[1] Hassan HA, et al. MRI evaluation of neurovascular compression in classical trigeminal neuralgia. Egypt J Radiol Nucl Med. 2022;53:154.

[2] Sindou M, et al. Anatomical findings in microvascular decompression for trigeminal neuralgia—correlation with pain relief and recurrence. J Neurosurg. 2020;133(2):411–419.

[3] Johnstone CS, et al. Misdiagnosis-driven dental extractions in patients with trigeminal neuralgia. J Multidiscip Healthc. 2023;16:2231–2240.

[4] Bendtsen L, Zakrzewska JM. Differential diagnosis of facial pain and role of neuroimaging. Scand J Pain. 2021;21(4):700–711.

[5] Cruccu G, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2020;94(1):87–94.