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Q: Trigeminal neuralgia ( Answered,   0 Comments )
Subject: Trigeminal neuralgia
Category: Health
Asked by: madan7655-ga
List Price: $10.00
Posted: 11 Dec 2003 03:19 PST
Expires: 10 Jan 2004 03:19 PST
Question ID: 285968
Can Dental extraction cause Trigeminal neuralgia ?
Subject: Re: Trigeminal neuralgia
Answered By: hlabadie-ga on 11 Dec 2003 09:12 PST
The answer appears to be a qualified yes. Theories backed by studies
propose that some cases of trigeminal neuralgia or atypical facial
pain (also called Tic Douloureux) can be traced to bone cavities,
often undetectable by radiography, resulting from tooth extraction.
The mechanism appears to be an antagonism between the severed nerves
of the extracted tooth and nearby nerves. The cause seems to be the
infiltration by microbes of the gap left by the extracted tooth. The
microbes grow and inhibit the formation of bone that normally would
close the gap. Removal of the microbes and the use of antibiotics to
prevent reinfection promotes bone growth, and results in cessation of
the pain.

However, there appears to be some controversy over the diagnosis of
this condition as trigeminal neuralgia. Osteocavitation, in the
opinion of some researchers, is misdiagnosed as trigeminal neuralgia.

Positive studies:

Jawbone cavities and trigeminal and atypical facial neuralgias.
Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS.

"The possible role of dental and oral disease in the etiology of
idiopathic trigeminal and atypical facial neuralgias has been
examined. Among thirty-eight patients with idiopathic trigeminal
neuralgia and twenty-three patients with atypical facial neuralgia,
there was in nearly all instances a close relationship between pain
experienced and the existence of cavities in alveolar bone and jawbone
of the patients. The cavities were at the sites of previous tooth
extractions and, although at times more than 1 cm. in a given
diameter, were usually not detectable by x-rays. A new method for
their detection and localization was developed empirically, based on
the observation that peripheral infiltration of local anesthetic into
or very close to the bone cavity rapidly abolished trigger and pain
perception by patients during persistence of the anesthetic action.
Histopathologic examination of bone removed from cavities by curettage
revealed, in both idiopathic trigeminal and atypical facial
neuralgias, a similar pattern characterized by a highly vascular
abnormal healing response of bone. Some lesions presented a mild
chronic inflammatory (lymphocytic) infiltration. Preliminary
microbiologic studies of material from the walls of the cavities
showed the existence within them of a complex, mixed polymicrobial
aerobic and anaerobic flora. Treatment consisted of vigorous curettage
of the bone cavities, repeated if necessary, plus administration of
antibiotics to induce healing and filling-in of the cavities by new
bone. Responses of patients to the above treatment consisted of marked
to complete pain remissions, the longest of which has been for 9
years. Complete healing leads to complete and persistent pain
remissions. It was concluded that in both idiopathic trigeminal and
atypical facial neuralgias, dental and oral pathoses may be major
etiologic factors."

Primary trigeminal neuralgia (algophoric deafferentation
hypersensitivity syndrome).
Zurak N.
Department of Neurology, Clinical Medical Center, Rebro, Zagreb.

"In the article the author presents his theory of the pathogenesis of
primary trigeminal neuralgia, explaining the occurrence of this
mysterious disease by algophoric deafferentation hypersensitivity.
Tooth extraction is the sole cause of algophoric deafferentation
hypersensitivity, which, culminating in epileptiform discharges of the
trigeminal nociceptive pathway neurons, leads to clinical features of
characteristic neuralgic paroxysms. Trigger mechanism is explained by
ephaptic transmission between the broken fibers for phasic pain of the
tooth pulp and neighbouring fibers of epicritic and proprioceptive
sensitivity. The typical occurrence of periods with remission of
neuralgic paroxysms the author explains by his original theory of
biorhythms neogenesis with the involvement of two antagonistic neural
subsystems (nociceptive and antinociceptive system). The concept is
based on indisputable clinical, anatomical, pathoanatomical,
experimental and pharmacologic facts, which the author quotes as the
contribution to his theory."

The "missing link" in the origin of trigeminal neuralgia: a new theory
and case report.
Miller DB.

"Tic Douloureux (Trigeminal Neuralgia) has afflicted mankind for
centuries, perhaps for all time. This sharp stabbing paroxysm of pain
along the branches of the trigeminal nerve is described as " of
the most painful problems that plagues mankind." Many theories about
the cause of trigeminal neuralgia have been previously presented.
Often these theories build on the previous foundations when new
research presents itself. The complete picture still eludes
researchers today. Much of the mechanism has been proposed, but
researchers lacked one essential component. There has never been an
answer to why these pains only occur in cranial segments and why,
thankfully, TN is rare. What sets the stage for the development of TN?
The unique neurophysiology of the trigeminal nerve and the
accompanying ability of the Temporomandibular Joints to create a
sensitized neural system are the last piece of the puzzle. This
central sensitization of the Trigeminal Nerve allows the development
of a small cluster of neurons that act as a central trigger for the
paroxysmal pain. The role of the TMJ in trigeminal neuralgia is
illustrated by this case report."

Contrary opinion:

Osteocavitation lesions (Ratner bone cavities): frequently
misdiagnosed as trigeminal neuralgia--a case report.
Shankland WE 2nd.

"The disorder termed osteocavitation lesion has been described in the
literature since at least 1976. This disorder has often been
misdiagnosed as trigeminal neuralgia or atypical facial pain, and,
unfortunately, patients have either continued to suffer or
inappropriate treatment or treatments have been prescribed in an
attempt to rid the patient of this terrible pain disorder. These
symptoms, which can be misinterpreted as trigeminal neuralgia, include
a history of undiagnosed facial pain, a history of tooth extraction,
the presence of trigger areas and normal radiographic findings. A
confirmed diagnosis of osteocavitation lesion can be treated only with


Searched PubMed for "trigeminal neuralgia dental extraction".

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