Extreme Toothache? Is It a Tooth Abscesses or Trigeminal Neuralgia? Here's What You Need to Know

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Extreme Toothache? Is It a Tooth Abscesses or Trigeminal Neuralgia? Here's What You Need to Know

17 November 2016
 Categories: Dentist, Articles

If you experience extreme pain in a tooth, you may have an infected root, or you may have a condition called trigeminal neuralgia. Or you may have both. The pain from both conditions can be extreme and feel similar, and this makes it difficult to determine what is wrong. Here's what you need to know. 

What kind of pain do you have and what triggers it? 

The type of pain you are experiencing is the first step in determining the difference between an abscessed tooth and trigeminal neuralgia. 

Tooth abscess. Tooth pain from an infected root causes an abscess when the pulp of the root becomes inflamed. Pain will often be triggered by cold temperatures or pressure on the tooth. There may be noticeable swelling in the affected area. The pain may be intense and become unbearable. 

Trigeminal neuralgia. Pain from trigeminal neuralgia is triggered by light touches to the face, talking, brushing teeth, eating, drinking, and shaving. This type of pain is often described as a bolt of lighting, burning, or shock that could last anywhere from a few seconds to two minutes for the classic form, and with the atypical form, this pain could be constant.

How do you get a proper diagnosis? 

The first step in getting a proper diagnosis for your pain is to see your dentist. Obviously, dentists are trained to recognize dental problems, but they are also trained to recognize when trigeminal neuralgia may be a problem, since the condition does affect the oral cavity. To diagnose a tooth abscess, your dentist will need to do an x-ray to see whether the abscess shows signs of an infection. If he or she doesn't find signs of an infection or abscess, you should be given a referral to a neurosurgeon to determine whether your pain is due to trigeminal neuralgia. 

A neurosurgeon will request an MRI of your facial region and your head so he or she can see the entire trigeminal nerve network, which is the fifth cranium nerve, to see if it is being compressed. If there are no obvious signs of trigeminal neuralgia, yet you have the clinical signs of having this condition, the clinician will give you medication to see if it will relieve your pain. This medication is typically an anticonvulsant to block the firing of the nerve. If the medication works to relieve your pain, you will likely be diagnosed with trigeminal neuralgia. 

What if you have both conditions? 

If your dentist finds an abscessed tooth and performs a root canal, but you still have pain, you may have both conditions. Ask your dentist for a referral to a neurosurgeon. If you do have both, you will need to do as much as possible to avoid needing retreatment of the root canal or an apicoectomy. An apicoectomy is the surgical removal of the apex, which is the tip of the root that was affected. 

The reason this is so important is that you want as little trauma as possible to the region so the trigeminal nerve is not damaged any further. Follow all the post-op procedures for your root canal. Make sure you take all the antibiotics you are prescribed, even after the swelling has gone down and the abscess pain is diminished or gone. Eat with great care while recovering from a root canal and avoid disrupting the wound. 

There may be a point in time when surgery is needed for trigeminal neuralgia due to the medication no longer being as effective. This surgery is called a microvascular decompression of the fifth cranium nerve and is done in the lower part of the back of your head close to the neck. 

Talk to a professional such as Samuel D Knight, DDS for more information.