80-year-old Grandma Xu was already old. Although she had all her teeth extracted, she still felt toothache, so she went to a dentist near her home for treatment. The dentist asked Grandma Xu to go to a large hospital for a detailed examination to understand the real cause. Grandma Xu was introduced by relatives and friends to the outpatient clinic of the Pain Treatment Center of the Chang Gung Memorial Hospital (Dali Ren’ai Hospital) and kept complaining about toothache. After a careful interview and physical examination by the doctor, it was confirmed that Grandma was suffering from trigeminal neuralgia.
Trigeminal neuralgia is more common in women over 40 years old and is easily misdiagnosed as a dental disease
Dr. Wen Yongrui said that the trigeminal nerve is the main nerve responsible for controlling facial sensation. Trigeminal neuralgia refers to repeated paroxysmal severe pain in the area where the nerve is distributed, accompanied by facial twitching. Primary trigeminal neuralgia is more common in people over 40 years old, with women slightly more than men. It usually occurs on one side, more commonly on the right side, and less than 5% of patients will have bilateral attacks.
Typical trigeminal neuralgia attacks have no warning signs, and the pain appears suddenly like lightning, and the feeling is short and severe, similar to sharp, electric, needle, knife or tearing pain. Usually, it can be diagnosed based on symptoms alone. However, since there are many similar facial or head pains, patients are easily misdiagnosed as having dental diseases, resulting in multiple tooth extractions without proper treatment.
Trigeminal neuralgia may cause anxiety and depression. Medication or surgery can be chosen for treatment
Dr. Wen Yongrui said that patients often press the affected area with their palms or towels, or rub their faces vigorously to try to relieve pain. Sometimes, it may be accompanied by facial flushing, increased skin temperature, conjunctival congestion, tears and increased saliva secretion. In addition, some patients have clear “trigger points”. Once these sensitive areas are touched, such as brushing teeth, eating, washing face or talking, they may cause severe pain. In severe cases, frequent pain attacks may cause sleeplessness all night, further affecting the quality of life, and may lead to anxiety and depression, and even suicidal thoughts. Therefore, active treatment is crucial.
Director Lai Jingwen of the Pain Treatment Center pointed out that the initial treatment of trigeminal neuralgia is usually based on drugs, especially anti-epileptic drugs. In order to suppress the abnormal discharge of the trigeminal nerve system, acupuncture, Chinese medicine, physical therapy, massage and other methods can also be tried. If drug treatment is ineffective or the side effects are unbearable, surgical treatment may be considered, including minimally invasive interventional treatment (such as percutaneous transganglionic radiofrequency therapy), gamma knife treatment, and craniotomy (such as microvascular decompression surgery).
Can’t tell the difference between toothache and trigeminal neuralgia? Consult a doctor as soon as possible to receive treatment
Director Lai Xingwen emphasized that although trigeminal neuralgia is extremely painful, with appropriate diagnosis and treatment, the vast majority of patients can improve their symptoms and improve their quality of life. If the public or their relatives and friends experience similar symptoms, they must see a doctor as soon as possible, seek professional treatment, and restore a healthy life.
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