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SHORT COMMUNICATION
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 140

Pretrigeminal neuralgia


1 Department of Oral Medicine and Radiology, Gian Sagar Dental College and Hospital, Patiala, Punjab, India
2 Department of Pedodontics and Preventive Dentistry, Gian Sagar Dental College and Hospital, Patiala, Punjab, India

Date of Web Publication29-Aug-2016

Correspondence Address:
Sanjeev Jindal
Department of Oral Medicine and Radiology, Gian Sagar Dental College and Hospital, Patiala - 140 601, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-962X.189340

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How to cite this article:
Jindal S, Singla A. Pretrigeminal neuralgia. Indian J Dent 2016;7:140

How to cite this URL:
Jindal S, Singla A. Pretrigeminal neuralgia. Indian J Dent [serial online] 2016 [cited 2018 Dec 13];7:140. Available from: http://www.ijdentistry.com/text.asp?2016/7/3/140/189340

Typical trigeminal neuralgia, brief electric shock like pain along distribution of trigeminal nerve, is well documented in literature but not much is available about pre trigeminal neuralgia. Pre-trigeminal neuralgia should be considered in the differential diagnosis of pain of dental origin because of its similar features. Symonds was the first person who noted dull, continuous and aching pain before the typical paroxysmal pain appeared in few patients.[1] Mitchell was the person to term this prodromal pain as “pre-trigeminal neuralgia.[2] Clinical features of this prodromal pain includesdull, continuous aching pain that may be triggered or aggravated by chewing food, drinking hot and cold liquids. Such patients pose a diagnostic challenge for dentist as examination may reveal absence of caries, gingival recession, sinusitis and symptoms are not relieved with analgesics like NSAIDs and opioids. Root canal treatment and extraction are also of no use in such patients because painpersists in the same region even after performing root canal treatment or extraction.[3] So a careful history and detailed dental and neurological examination is required in such patients to avoid misdiagnosis as dental disease.

Differential diagnosis of pre trigeminal neuralgia includes dental pain of pulpal origin, sinusitis, myofacial pain dysfunction syndrome (MPDS), atypical facial pain, TMJ disorders and trigeminal neuralgia.[4],[5] Pain of pulpal origin can be differentiated with careful dental examination and intra oral radiographs. Presence of blocked nose, purulent nasal discharge, tenderness over cheek areas and paranasal sinus (PNS view) radiograph can help in diagnosis ofsimilar pain in maxillary premolar or molar region due to maxillary sinusitis. TMJ disorders and MPDS presents with chronic orofacial pain that aggravates with movement of jaws. Tenderness of muscles of mastication, clicking sound in TMJ and limited mouth opening are characteristic features of MPDS. Atypical facial pain is associated with psychogenic causesin which patient complains of poorly localized throbbing pain or burning sensation in apparently normal teeth or jaws that responds poorly to all treatment plans except antidepressants. Clinical presentation with brief electric shock like pain along the course of nerve, presence of triggering zones and triggering factors helps in differentiating typical trigeminal neuralgia from pre-trigeminal neuralgia.

Therapeutic diagnosis is the method to diagnose such cases by giving small doses of carbamazepine and baclofen for few days. A dosage of 100mg of carbamazepinethrice dailywas found sufficient forrelief of symptoms and to confirm the diagnosis.5

Although incidence of such cases is very low but dentist should be aware of such type of pain so that timely diagnosis can prevent the patient to undergo unnecessary root canal treatment or extraction..

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Symonds C. Facial pain. Ann R Coll Surg Engl 1949;4:206-12.  Back to cited text no. 1
    
2.
Mitchell PG. Pre-trigeminal neuralgia. Br Dent J 1980;149:167-70.  Back to cited text no. 2
    
3.
Merrill RL, Graff-Radford SB. Trigeminal neuralgia: how to rule out the wrong treatment. J Am Dent Assoc. 1992;123:63-8.  Back to cited text no. 3
    
4.
Wright E, Evans J. Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results. Cranio. 2014;32:193-98.   Back to cited text no. 4
    
5.
Fromm GH, Graff-Radford SB, Terrence CF, Sweet WH. Pre-trigeminal neuralgia. Neurology. 1990;40:1493-5.  Back to cited text no. 5
    




 

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