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Academic Clinical Fellow and Honorary Teacher in Oral Medicine, Eastman Dental Hospital, University College London Hospitals NHS Trust, 256 Gray's Inn Road, London, WC1X 8LD, UK
Trigeminal neuralgia (TN) is also known as ‘tic douloureux’ (in French, ‘painful twitch’). It is a rare chronic facial pain syndrome, characterized by severe, brief, stabbing, ‘electric shock-like’ recurrent pain attacks felt in one or more divisions of trigeminal nerve innervation areas. So intense is the elicited pain that TN has a significant effect on a sufferer's quality of life, rendering many patients unable to consider a future with the ongoing threat of recurrent pain. The aim of this article is to discuss the diagnosis and management of this disabling facial pain condition.
CPD/Clinical Relevance: As general medical practitioners may struggle differentiating TN from toothache, primary care dentists have an important role in excluding odontogenic cause of pain, diagnosing TN and referring patients to a facial pain clinic for further investigations and multidisciplinary team management.
Article
A detailed epidemiological study investigated the incidence and prevalence rates of TN from 1945 until 1984, and found an overall annual incidence rate of 4.7 per 100,000 in the Minnesota, USA, population. Females were affected twice as commonly as males (5.2 and 2.5 per 100,000 population per year, respectively).1 This study used strict inclusion criteria and may have missed the data of patients diagnosed in the community, thus creating an impression that TN is even less common. Two more recent studies from the UK2 and Netherlands3 found much higher annual incidence rates of 26.8 and 28.9 per 100,000 population per year, respectively. Both these studies used data from general practice research databases. However, a specialist might not have confirmed some of these patients' diagnoses. A recent study by Koopman and colleagues4 further investigated the results obtained from the general practice research database and patients with unclear TN diagnosis were reviewed by neurologists. The incidence rate of TN was found to be less than half that previously reported – 12.6 per 100,000 population. Again, females were more affected than males – 17.8 and 7.3 per 100,000, respectively.4
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