My colleagues and I appreciate Dr. King’s comments regarding our article. We, too, believe that early dental evaluation is critical for determining whether or not a patient has trigeminal neuralgia (TN) or another facial/mandibular/oral pain syndrome.
However, one should not confuse atypical facial pain syndromes or other mechanical or infectious orofacial pain syndromes with those of typical and atypical TN. There is no dental treatment that cures or abates the pain of typical or atypical TN and if, in fact, a dental intervention does rid the patient of pain, the patient did not have true TN to begin with. TN is likely a consequence of ephaptic transmission within the trigeminal nerve near its root entry zone with abnormal cross talk between different types of neurons and axons that are responsible for conduction of pain sensation.
Many feel the location of this abnormality is at the junction between the central and peripheral nervous system myelin (the Obersteiner-Redlich zone). There are a number of procedures that benefit patients with trigeminal neuralgia, including glycerol rhizotomy, balloon compression rhizotomy, radiofrequency rhizotomy, stereotactic radiosurgery and microvascular decompression. However, as far as we and our dental colleagues know, there is no known dental treatment (including peripheral trigeminal nerve sectioning and blocks) for true typical or atypical TN.
While we acknowledge the importance of a complete dental evaluation, we caution against premature peripheral nerve sectioning, mandibular and temporomandibular joint surgery and tooth extraction for any facial pain syndrome that suggests TN, until the individual has been assessed by a physician familiar with TN and its variety of presentations.
