Another source of facial pain can result from a damaged nervous system, which can result from aging, infection or trauma. Most of these syndromes are called neuralgias, and are commonly seen and treated in an orofacial pain office.
Two Types Of Neuralgias: Constant and Intermittent
The classic neuralgia is Trigeminal Neuralgia or “Tic Doloreaux,” which tends to occur in older people (over age 50) and becomes more common in the later decades of life. The syndrome usually starts as a mild, occasional toothache that often sends the patient to the dentist where no problem is found upon examination. Over time, the toothaches become more severe and more frequent until they cause extremely severe pain. The pain usually only lasts for seconds, but is severe enough to bring the sufferer to a degree of complete agony.
Trigger zones appear on the face, which will set off the attacks. The most common trigger points are at the corner of the mouth and upper lip near the nostril. Talking, chewing, shaving, applying makeup, encountering a light breeze or entering an air conditioned room will often trigger attacks. Unfortunately, this condition is often misdiagnosed and many of these patients have unnecessary root canal treatments and extractions before the problem is found. After these dental treatments, the pain may go away for a short period of time, but it returns days or weeks later.
The first line of treatment for trigeminal neuralgia is a class of medications called anticonvulsives, which stop nerves from firing as often. Because they have this particular mode of action, they are sedating and can cause cognitive side effects such as short-term memory loss, blurred vision, etc. However, patients do adapt to these side effects and lead normal lives. In most cases, these medications must be taken on a permanently. Examples of some of these medications are gabapentin carbamazepine and valproic acid. If patients cannot be controlled by medication, then neurosurgery may be required, which decompresses or cuts the trigeminal nerve.
Neuralgias may result from nerve trauma after surgery and cause constant pain. They also may be caused by infection such as the Herpes Zoster virus (Shingles) or the actual inflammation of nerves, which is called neuritis. The most common neuritis occurs after tooth extraction and is called “dry socket.” These problems are treated by topical applications, anticonvulsives, antivirals, steroids and tricyclic antidepressives.