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