In the October JADA article, "Trigeminal Neuralgia and Glossopharyngeal Neuralgia: Two Orofacial Pain Syndromes Encountered by Dentists," Dr. Michael Horowitz and his colleagues state, "Two orofacial pain syndromes that dentists may encounter early in their presentation include trigeminal neuralgia, or TN, and glossopharyngeal neuralgia, or GPN."
They emphasize the importance of recognizing "these two syndromes so that unsuccessful interventions such as extractions, endodontic treatment and temporomandibular joint repairs are avoided, and patients can be referred early on for definitive therapy."
In their conclusion, they state, "Referral to a neurosurgeon experienced in treating these rare disorders [is] rewarding for the patient." The authors further state that "92 percent of patients with typical TN who visited the University of Pittsburgh Medical Center for surgical intervention had not responded to medical therapy, while 96 percent of patients with atypical TN had not responded to medical therapy before seeking surgical intervention."1 They recommend surgery involving "a retromastoid craniectomy, exposure of the trigeminal nerve where it exits the pons and microvascular decompression, or MVD."
We agree that dentists should recognize TN and GPN, but we recommend a different sequence of referrals. When dentists encounter these syndromes early in their presentation, patients should be referred for medical workup through the appropriate medical avenues. Patients who do not respond to medical therapy should then be referred to dental pain experts before being considered for MVD, because a significant percentage of these patients require dentistry’s definitive treatment.
Members of the American Dental Association have been working for decades to develop a dental pain discipline and recognition of the dentist as a site pain expert. Dentistry has developed favorable nonsurgical protocols that produce results superior to the authors’ statistics for success and failure rates of MVD. Dental pain experts successfully treat patients diagnosed with trigeminal neuralgia, restoring them to pain-free status and validating the effectiveness of dentistry’s treatment approaches.
Using the "Accepted Therapy in Clinical Practice" figure on page 1541 of November JADA’s "The Integration of Clinical Research Into Dental Therapeutics: The Role of the Astute Clinician," by Drs. Sharon Gordon and Raymond Dionne, we are at the "report of a case series" stage of generally accepted knowledge and clinical research. No doubt members of the American Dental Association would be interested in publishing case reports of treatment for trigeminal neuralgia and glossopharyngeal neuralgia.
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