Diagnosis and Management of Trigeminal Neuralgia in Dentistry: A Literature Review
DOI:
10.29303/jossed.v6i2.12787Published:
2025-10-31Downloads
Abstract
Trigeminal neuralgia (TN) is a paroxysmal neuropathic pain disorder characterized by sharp, brief, and recurrent pain in the trigeminal nerve distribution. Because it occurs in the maxillofacial region, TN is frequently mistaken for odontogenic pain, leading patients to seek dental care and risk unnecessary procedures. This review aims to summarize current literature on the clinical features, diagnostic challenges and management of trigeminal neuralgia in dental practice, highlighting the important role of dentist in its detectione and care. The diagnosis of trigeminal neuralgia was based on multidisciplinary approach, including history taking according to ICHD-3 criteria, dental vitality testing, neurological examination and MRI, with specialist collaboration in complex cases. The results showed that trigeminal neuralgia is frequently misdiagnosed as odontogenic pain, requiring history, neurological exam, MRI, and dental evaluation for accurate diagnosis. Carbamazepine was the primary treatment, with surgery for refractory cases, and a multidisciplinary approach proved essential. Trigeminal neuralgia requires accurate evaluation and dentist involvement to ensure proper diagnosis and effective management.
Keywords:
Dentistry, Neuropathic pain, Odontogenic, Trigeminal neuralgiaReferences
Antonaci, F., Arceri, S., Rakusa, M., Mitsikostas, D.D., Milanoy, I., Todorov, V., Ramusino, M.C., Costa, A. (2020). Pitfals in recognition and management of trigeminal neuralgia. The Journal of Headache and Pain, 21(1), 1-8. https://doi.org/10.1186/s10194-020-01149-8
Liu, Y., Tanaka, E. (2025) Pathogenesis, diagnosis, and management of trigeminal neuralgia: a narrative review. Journal of Clinical Medicine, 14(2), 1-17. https://doi.org/10.3390/jcm14020528
Latorre, G., González-García, N., García-Ull, J., González-Oria, C., Porta-Etessam, J., Molina, F.J. (2023). Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology's Headache Study Group. Neurol, 38(1), 37-52. https://doi.org/10.1016/j.nrleng.2023.04.005
Mascarell, S., Marchi, V., Boucher, Y. (2022). Pulpitis in a dens invaginatus presenting as a Trigeminal Neuralgia: A case report. Journal of Clinical and Experimental Dentistry, 14(2), 217-220. https://doi.org/10.4317/jced.57881
Tizzoni, R., Tizzoni, M., Clerici, C.A. (2021) Atypical odontalgia and trigeminal neuralgia: psychological, behavioral and psychopharmacological approaches in a dental clinic–an overview of pathologies related to the challenging differential diagnosis in orofacial pain. F1000Research, 10(317), 1-26. https://doi.org/10.12688/f1000research.51845.3
Rodriguez, B.F., Simonet, C., Cerdan, D.M., Morollon, N., Guerrero, P., Tabernero, C., Duarte, J. (2019). Familial classic trigeminal neuralgia. Neurologia, 34(4), 229-233. https://doi.org/10.1016/j.nrl.2016.12.004
Shinoda, M., Kubo, A., Hayashi, Y., Iwata, K. (2019). Peripheral and central mechanisms of persistent orofacial pain. Front Neurosci, 13, 1-10. https://doi.org/10.3389/fnins.2019.01227
Koh, W., Lim, H., Chen, X. (2021). Atypical triggers in trigeminal neuralgia: The role of A-delta sensory afferents in food and weather triggers. Korean J. Pain, 34(1), 66–71. https://doi.org/10.3344/kjp.2021.34.1.66
Wang, Z., Zhao, Z., Song, Z., Wang, Y., Zhao, Z. (2022). The application of magnetic resonance imaging (MRI) for the prediction of surgical outcomes in trigeminal neuralgia. Postgrad. Med., 134, 480–486. https://doi.org/10.1080/00325481.2022.2067612
Dabilgo,u A.A., Dravé, A., Kyelem, J.M.A., Sawadogo, Y., Napon, C., Milogo, A., Kabonè, J. (2020). Frequency of headache disorders in neurology outpatients at Yalgado Ouedraogo University teaching hospital. A 3-month prospective cross-sectional study. SN Compr Clin Med, 2(1), 301–307. https://doi.org/10.1007/s42399-020-00238-8
Melek, L.N., Devine, M., Renton, T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg. 47(7), 869–878. https://doi.org/10.1016/j.ijom.2018.02.006
Bendtsen, L., Zakrzewska, J.M., Abbott, J., Braschinsky, M., Stefano, G.D., Donnet A., Eide, P.K., Leal, P.R.L., Maarbjerg, S., May, A., Nurmikko, T., Obermann, M., Jensen, T.S., Cruccu, G. (2019). European academy of neurology guideline on trigeminal neuralgia. Eur J Neurol, 26(6), 831–849. https://doi.org/10.1111/ene.13950
O'Callaghan, L., Floden, L., Vinikoor-Imler, L., Symonds, T. (2020). Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England. J Headache Pain, 21(1), 1-10. https://doi.org/10.1186/s10194-020-01198-z
Renton, T. (2019). Chronic pain and overview or differential diagnosis of non-odontogenic orofacial pain. Prim Dent J, 7(4), 71–86. https://doi.org/10.1177/205016841800700414
Besi, E., Zakrzewska, J.M. (2020). Trigeminal neuralgia and its variants. Management and diagnosis. Oral Surgery, 13(4), 404-414. https://doi.org/10.1111/ors.12464
Campbell, W.W., Barohn, R.J., Col, L., Ziegler D. (2020). DeJong’s The Neurologic Examination 8th edition. Philadelphia, USA: Wolters Kluwer.
Cruccu, G., Finnerup, N.B., Jensen, T.S., Scholz, J., Sindou, M., Svensson, P., Treede, R.D., Zakrzewska, J.M., Nurmikko, T. (2016). Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology, 87(2), 220–228. https://doi.org/10.1212/WNL.0000000000002840
Takenoshita M., Miura A., Shinohara Y., Mikuzuki R., Sugawara S., Tu T.T.H., Kawasaki K., Kyuragi T., Umezaki Y., Toyofuku A. (2017). Clinical features of atypical odontalgia; three cases and literature reviews. BioPsychoSocial medicine,11(21), 1-5. https://doi.org/10.1186/s13030-017-0106-8
Jones MR, Urits I, Ehrhardt KP, Cefalu JN, Kendrick JB, Park DJ, et al. A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep. 2019; 23:74—80.
Slettebø, H. (2021). Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery. Scand J Pain, 21(4), 788-793. https://doi.org/10.1515/sjpain-2021-0045
Kolakowski, L., Pohl, H., Stieglitz, L., Tyndall, A.D.V., Soyka, M.B., Jaggy, P.R., Wagner, J., Marinescu, C.V., Brown, M.L., Blumer, M., Muller, G.T., Wegener, S. (2024). Interdisciplinary strategis for diagnosis and treatment of trigeminal neuralgia. Swiss Med Wkly, 154(3460), 1-9. https://doi.org/10.57187/s.3460
Zoller, S., Oertel, M.F., Stieglitz, L.H. (2022). Trigeminal Neuralgia—What Do We Know about the Causes, Diagnosis and Treatment?. Praxis (Bern 1994), 111(13), 731–737. https://doi.org/10.1024/1661-8157/a003918
Bendtsen, L,, Zakrzewska, J.M., Heinskou, T.B., Hodaie, M., Leal, P.R.L., Nurmikko, T., Obermann, M., Cruccu, G., Maarbjerg, S. (2020). Advances in diagnosis, classification, pathophysiology, and management of tri-geminal neuralgia. Lancet Neurol, 19(9), 784-796. https://doi.org/10.1016/S1474-4422(20)30233-7
Tang, Y., Ma, L., Li, N., Guo, Y., Yang, L., Wu, B., Yue, J., Wang, Q., Liu, J., Ni, J.X. (2016). Percutaneous trigeminal ganglion radiofrequency thermocoagulation alleviates anxiety and depression disorders in patients with classic trigeminal neuralgia: A cohort study. Medicine (Baltimore), 95(49), 1-5. https://doi.org/10.1097/MD.0000000000005379
Stefano, G.D., Truini, A., Cruccu, G. (2018). Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia. Drug, 78(14), 1433-1442. https://doi.org/10.1007/s40265-018-0964-9
Lorenc, A., Feder, G., MacPherson, H., Little, P., Mercer, S.W., Sharo, D. (2018). Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open, 8(10), 1-15. https://doi.org/10.1136/bmjopen-2017-020222
Holste, K., Chan, A.Y., Rolston, J.D., Englot, D.J. (2020). Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. Neurosurgery, 86(2), 182-190. https://doi.org/10.1093/neuros/nyz075
Sessle, B.J. (2021). Chronic Orofacial Pain: Models, Mechanisms, and Genetic and Related Environmental Influences. Int. J. Mol. Sci, 22(13), 1-27. https://doi.org/10.3390/ijms22137112
Maarbjerg, S., Stefano, G.D., Bendtsen, L, Cruccu, G. (2017). Trigeminal neuralgia - diagnosis and treatment. Cephalalgia, 37(7), 648–57. https://doi.org/10.1177/0333102416687280
Singhota S., Tchantchaleishvili N., Wu J., Zrinzo L., Thorne L., Akram H., Zakrzewska J.M. (2022) Long term evaluation of a multidisciplinary trigeminal neuralgia service. The Journal of Headache and Pain, 23(114), 1-10. https://doi.org/10.1186/s10194-022-01489-7
Allsop, M.J., Twiddy, M., Grant, H., Czoski-Murray, C., Mon-Williams, M., Mushtaq, F., Phillips, N., Zakrzewska, J.M., Pavitt, S. (2015). Diagnosis, medication, and surgical management for patients with trigeminal neuralgia: a qualitative study. Acta Neurochir (Wien), 157(11), 1925-1933. https://doi.org/10.1007/s00701-015-2515-4
Ghiai, A., Mohamed, T.Y., Hussain, M., Hayes, E., Zakrzewska, J.M. (2019). The role of a clinical nurse specialist in managing patients with trigeminal neuralgia. Br J Pain 2019, 14(3), 180-187. https://doi.org/10.1177/2049463719892027
Zakrzewska, J.M., Wu, N., Lee, J.Y.K, Werneburg, B., Hoffman, D., Liu, Y. (2018). Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States. Clin J Pain, 34(8), 691-699. https://doi.org/10.1097/AJP.0000000000000595.
Toledo, I.P.D, Reus, J.C., Fernandes, M., Porporatti, A.L., Peres, M.A, Takaschima, A., Linhares, M.N., Guerra, E., Canto G.D.L. (2016. Prevalence of trigeminal neuralgia: A systematic review. J Am Dent Assoc, 147(7), 570-576. https://doi.org/10.1016/j.adaj.2016.02.014.
Silva, M., Quanounou, A. (2020). Trigeminal Neuralgia: Etiology, Diagnosis and Treatment. Medicine, 2, 1585-1592. https://doi.org/10.1007/s42399-020-00415-9
Daniel, H.C, Poole, J.J., Klein, H., Huang, C., Zakrzewska, J.M. (2021). Cognitive Behavioral Therapy for Patients with Trigeminal Neuralgia: A Feasibility Study. J Oral Facial Pain Headache, 35(1), 30-34. https://doi.org/10.11607/ofph.2664.
Poole, J., Mercadante, V., Singhota, S., Nizam, K., Zakrzewska, J.M. (2021). Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making. Br J Pain, 16(2), 237-242. https://doi.org/10.1177/20494637211045877
Schytz, H.W., Amin, F.M., Jensen, R.H., Carlsen, L., Maarbjerg, S., Lund, N., Aegidius, K., Thomsen, L.L., Bach, F.W., Beier, D., Johansen, H., Hansen, J.M., Kasch, H., Munksgaard, S.B., Poulsen, L., Sorensen, P.S., Schmidt-Hansen, P.T., Cvetkovic, V.V., Ashina, M., Bendtsen, L. (2021). Reference progamme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020. J Headache Pain, 22(22), 1-31. https://doi.org/10.1186/s10194-021-01228-4
Amrhein, T.J., Kranz, P.G. (2019). Spontaneous Intracranial Hypotension: Imaging in Diagnosis and Treatment. Radiologic Clinics of North America, 57(2), 439-451. https://doi.org/10.1016/j.rcl.2018.10.004
Obermueller, K., Shiban, E., Obermueller, T., Meyer, B., Lehmberg, J. (2018).Working ability and use of healthcare resources for patients with trigeminal neuralgia treated via microvascular decompression. Acta Neurochirurgica, 160, 2521-2527. https://doi.org/10.1007/s00701-018-
Haviv, Y., Khan, J., Zini, A., Almoznino, G., Sharav, Y., Benoliel, R. (2016). Trigeminal neuralgia (part I): Revisiting the clinical phenotype. Cephalalgia, 36(8), 730-746. https://doi.org/10.1177/0333102415611405.
Gerwin, R. (2020). Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome- An Evidence-Based Narrative Review and etiological Hypothesis. Int J Environ Res Public Health, 17(10), 1-20. https://doi.org/10.3390/ijerph17197012
Dzhafarov, V., Rzaev, J., Moysak, G., Voronina, E. (2020). Facial pain as an initial manifestation of intramedullary cervical spinal cord tumor: A case report and literature review. Surg Neurol Int, 11(173), 1-6. https://doi.org/10.25259/SNI_546_2019
Tripathi, M., Sadashiva, N., Gupta, A., Jani, P., Pulickal, S.J., Deora, H., Kaur, R., Kaur, P., Batish, A., Mohindra, S., Kumar, N. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surg Neurol Int, 11(455), 1-5. https://doi.org/10.25259/SNI_729_2020
Forssell, H., Alstergren, P., Bakke, M., Bjørnland, T., Jääskeläinen, S.K. (2016). Persistent facial pain conditions. Nor Tannlegeforen Tid, 126, 36-42. Retrieved from: https://www.tannlegetidende.no/asset/2016/P16-01-36-42.pdf
Stefano, G.D., Stefano, G.D., Caramia, F. (2020). Concomitant continuous pain in patients with trigeminal neuralgia is associated with trigeminal nerve root atrophy. International Headache Society, 40(1), 1502-1510. https://doi.org/10.1177/0333102420949206
Eller, M., Goadsby, P.J. (2016. Trigeminal autonomic cephalalgias. Oral Dis, 22(1), 1-8. https://doi.org/10.1111/odi.12263.
So, R.J., Kalluri, A.L., Storm, K., Nair, S.K., Budihal, B.R., Huang, J., Lim, M., Bettegowda, C., Xu, R. (2023). A racial analysis of pain outcomes following microvascular decompression for trigeminal neuralgia. J Neurosurg, 139(3), 633-639. https://doi.org/10.3171/2022.12.JNS221884.
Kolakowsi, L., Pohl, H., Kleinsorge, M.T., Wegener, S. (2024). Phenytoin relieves acute exacerbations of trigeminal neuralgia: Results of a retrospective case series. Cephalalgia Reports, 139(3), 633-638. https://doi.org/10.1177/25158163241268880
Moore, D., Chong, M.S., Shetty, A., Zakrzewska, J.M. (2019). A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth, 123(2), 385-396. https://doi.org/10.1016/j.bja.2019.05.026.
Benoliel, R., Svensson, P., Evers, S., Wang, S.J., Barke, A., Korwisi, B., Rief, W., Treede, R.D. (2019). The IASP classification of chronic pain for ICD-11: chronic secondary headache or orofacial pain. Pain, 160(1), 60-68. https://doi.org/10.1097/j.pain.0000000000001435.
Kalluri, A.L., So, R.J., Ran, K.R., Xie, M.E., Kilgore, C., Nair, S.K., Huang, J., Bettegowda, C., Xu, R. (2023). Preoperative Characteristics and Postoperative Pain Outcomes in Trigeminal Neuralgia With Concomitant Autoimmune Disease. Neurosurgery, 93(5), 1075-1081. https://doi.org/10.1227/neu.0000000000002549.
License
Copyright (c) 2025 Susanna Halim, Nadia Putri Sania

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with Journal of Science and Science Education, agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Attribution 4.0 International (CC BY 4.0). This license allows authors to use all articles, data sets, graphics and appendices in data mining applications, search engines, web sites, blogs, and other platforms by providing an appropriate reference. The journal allows the author(s) to hold the copyright without restrictions and will retain publishing rights without restrictions.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Journal of Science and Science Education.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).


