[Dental trigeminal neuralgia]

Although the majority of patients with recurrent hyperalgesia of the nervus trigeminus may benefit from drug treatment or invasive (thermocoagulation) and other surgical interventions, a minority of patients does not respond to these strategies. Hence, unusual etiologies must be taken into consideration.

Mrs F., a 74-year-old women suffered from acute left-side trigeminalgia ten days after receiving a new dental prosthesis (upper jaw). Intensive pain attacks occurred spontaneously when she was speaking and could also be evoked by gentle exogenous pressure at the upper lip.

The painful area has been identified by careful clinical evaluation. Local administration of antibiotics combined with laser coagulation successfully cured the trigeminalgia after 4 weeks which did not recur in the follow-up period over 2 months.

Since patients longer history revealed pain attacks of minor severity we suggest that local inflammation at the gingiva might have stimulated quiescent nociceptors over time. The local pressure to this area evoked by the new prosthesis seems to be definitive trigger factor to intensify the nociceptor response resulting in higher number of trigeminalgia attacks of marked severity. We therefore conclude that differential diagnosis of symptomatic trigeminalgia should include dental gingival mechanisms at least in a case exhibiting resistances to other treatment.