Monday, March 4, 2013

Interview with a doctor: jaws and trigeminal neuralgia

Margaret Dennis, DMD, practiced general dentistry in Jacksonville, Florida eleven years before enrolling in the University of Kentucky, College of Dentistry Orofacial Pain program. She has an established practice in Jacksonville, where she treats individuals who have neuropathic facial pain, neuralgias, and tempormandibular joint disorders (TMJD). She joins me for a question and answer session. 

Q: Dr. Dennis, many times individuals have told me that  trigeminal neuralgia (TN) was healed by having their jaws "fixed." Would you explain how TMJD and TN are closely related?

A: The trigeminal nerve innervates the jaw and the face and all their structures. Damage in the jaw joint irritates the trigeminal nerve, leading to symptoms of continuous and/or intermittent neuropathic pain.

Q. What exactly is neuropathic pain?

A: Neuropathic pain simply means pain in a nerve. It differs from other types of pain in that it generally is electrical or burning, shooting or stabbing. This type of pain is not dull, not aching. Throbbing is usually muscular in origin, but it sometimes can be attributed to neuropathic pain.

Q: Does that mean that all facial nerve pain is TN?

A: No. There are twelve sets of cranial nerves (one on each side of the face) and several of these can cause facial nerve pain. The glossopharyngeal, geniculate, and facial nerves are, besides the trigeminal nerve, the most likely candidates to cause neuropathic pain.

Q: Is it possible to have facial nerve pain and as a result of TMJD?

A: Yes. The damage inside the temporomandibular (TM) joint can irritate the nerve. It is like a ball and socket with a cartilage disc between the bone of the head (skull) and the lower part of the jaw. This disc can become displaced, usually by trauma, and nerves and blood vessels that lie behind the ball part can be pulled forward on top of the ball part and cause pain. This pain travels over the trigeminal pathway. 

Q: How can one determine if he or she is experiencing which type of pain- TMJD or TN?

A: Two things facilitate the diagnostic process. A unique MRI of the TMJ itself is the gold-standard for diagnosing TMJD. Another way to diagnose the origin of the pain is to perform an ariculotemporal nerve block with local anesthetic. This block numbs the TM joint itself, not the trigeminal nerve. If a person has TN, the pain will continue. If the TM joint is involved, the pain will significantly reduce.

Q: It sounds as though a person can have nerve pain along the trigeminal pathway and still not have trigeminal neuralgia. Is this correct?

A: Yes. When this occurs, we call the syndrome atypical facial pain or neuropathic facial pain. Correct treatment for TMJD can resolve the issue if the dysfunction is treated early enough. If the problem has persisted over a long course, correct treatment can still significantly relieve the pain.

Dr. Dennis will join us for more discussions about facial pain. In the meantime, feel free to ask a question in the comments section of this post.

You can learn more about orofacial pain at her website.
Orofacial Pain Center, Jacksonville


  1. I had surgery last summer to have the blood vessel taken off of the nerve, which I had 2 blood vessels on the nerve. Now my tongue, teeth and lips are always numb and have tingling in it, and my cheek feels like some one has hit me. Is there a chance that this will get better? Also now I get headaches is this normal?

    1. I am not a physician and not qualified to make a diagnosis- even if you were sitting in front of me. I do know that some people have issues with neuropathic pain, and I am hoping you will discuss this with your surgeon or neurologist who can examine you. I am sorry that you are still experiencing pain. God bless you.

  2. Hello Dr Gilbert,
    I am a 52 year female, recently diagnosed with TN. I had had pain off and on for about 9 months and had dental surgery to remove a tooth as it was thought that was the root of the pain. My neurologist has put me on two medications so far however I have had severe side effects. I am also an insulin type-1 diabetic. I have had diabetes since I was 14. No other ailments.

    I am looking for help with my TN. My MRI showed no nerve pinching so I am being told I am not a candidate for any treatment other than medications.

    Can you point me to anyone else I can speak with about options? I am located between NYC and Philadelphia.

    Thank you!

    1. Hi, this is Kathy, the rehabilitation counselor who writes the blog. I interviewed Dr. Dennis, and I will ask her to reply to you. I am sorry you are having so much pain. Thank you for contacting us. Try not to get discouraged. I am confident that you can find quality care.

    2. I am so sorry you are having such a difficult time. I see people from all over the country and would be more than happy to help. Unfortunately, I personally don't know anyone to refer you to in your area. I belong to several TN groups on Facebook. The people in the groups have seen multiple practitioners. Maybe one of them could direct you somewhere. Put in TN in the Facebook search and the groups should pop up. Just ask to join. There are some really wonderful people in the groups. There is also a wonderful site, The Facial Pain Association, that has a forum. Again, there are many people there who have seen many practitioners, and might be able to direct you. Let me know if I can help in any way.
      Dr. Dennis