Trigeminal neuralgia is a disease of fifth cranial nerve known as trigeminal nerve whereas as algia means pain. It is also sometimes referred to as Fothergill’s disease or Tic Douloureux. It is generally classified as trigeminal neuralgia 1 and 2 on basis of its presentation. Trigeminal neuralgia 1 consists of the typical presentation of the disease with clinical features of shooting and stabbing pain episodes lasting few seconds to few minutes. Trigeminal neuralgia 2 is atypical presentation with a continuous dull pain occurring in the background with the short episodes of severe pain occurring as supradded symptoms.
Trigeminal nerve has got two branches, namely, sensory branch which supplies the skin over the face and takes all the sensations of the skin like pain, touch, temperature etc. to the brain and a motor branch which supplies eight muscles, namely, four mastication muscles (temporal is, masseter, medial and lateral pterygoids) and four other muscles (tensor tympani, tensor veli palatini, mylohyoid and anterior belly of digastric.
Can Trigeminal Neuralgia Affect Just One Tooth?
The commoner branches to be involved in trigeminal neuralgia are the mandibular and the maxillary branch of sensory origin. The pain of trigeminal neuralgia is along the upper or lower jaw and sometimes rarely can radiate to a tooth. Isolated tooth involvement is also seen and most of the times it is presented to a dentist with toothache.
Dentist often treat it with the confusion of dental abscess or other dental pain causes and even perform a dental surgery or a root canal blockade procedure. However, the pain does not get relieved and persists even after the dental procedure, which after a series of tests leads to the detection of it as a case of other diseases like trigeminal neuralgia or temporal tendinitis etc.
The pain of trigeminal neuralgia is also triggered by eating hot and cold food items which is commonly the cause of confusion. Other factors which can trigger its pain are movement of jaw including talking, chewing, smiling and also sometimes by shaving, brushing teeth, touching, blowing of mouth, nose etc.
Does It Cause Swelling?
Trigeminal neuralgia is primarily a neuropathy associated with decrease in impulses through the 5th cranial nerve. Due to the absence of impulses there can be decrease in neural trophic factors supplied to the muscles via nerves. These trophic factors are responsible for the maintenance and development of the muscles. In the absence of these trophic factors the muscles can initially be swollen due to breakdown of muscle tissue in it which is seen as swelling on the face and later when these muscles are broken down to an extent where these cannot get repaired, then these are shrunken like in starvation and the swelling disappears. It can be associated with signs of inflammation like redness of cheeks, pain while eating, chewing, local rise of temperature around the affected area etc.
Swelling of face can also be seen due to repeated trauma in the affected area of the nerve because of lost sensations of that area. One rare cause of the swelling can be due to overuse of the muscle in facial tics or movements. Swelling can also result in cases of facial spasm which is the most common of them all.
Isolated dental pain or tooth ache is not very uncommon and is a common sight to be seen in the clinic of a dentist. It is commonly misjudged as dental abscess and gets treated for it. But the unrelieving nature of the pain even after treatment creates the suspicion of atypical presentation of trigeminal neuralgia. Swelling can also be seen in early cases of severe trigeminal neuralgia and can present with common signs of inflammation. Various other atypical presentations of trigeminal neuralgia are seen. It has clinical diagnosis with local examination and history taking as the most important part of it and usually no further investigations are required for its diagnosis.
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