Dental CPD Australia

Treatment of Trigeminal Neuralgia

Treatment of Trigeminal neuralgia may be medical or surgical, with the medical method preferred. Medical treatment involves the use of anticonvulsant drugs, centrally acting muscle relaxants, neuroleptics, and even local anesthesia. The aim of surgical treatment is the interruption of peripheral trigeminal pathways or removal of causes such as tumors.

The drug of choice for the medical treatment of Trigeminal neuralgia is Carbamazepine, which is an anticonvulsant drug and works to control the pain in its early

stages. Phenytoin is another anticonvulsant and was the first used to treat Trigeminal neuralgia. Oxcarbazepine is a newer medication that is structurally similar to Carbamazepine but with less side effects. Baclofen is a muscle relaxant whose effect increases when combined with Carbamazepine or Phenytoin. It is important to note that anticonvulsants become less effective over time and therefore patients may need to take a higher dose or a second drug.

Surgical treatment of Trigeminal neuralgia may be percutaneous or open. The percutaneous method, meaning through the skin, is preferred in older patients, medically frail patients, and patients with Multiple sclerosis. The open method is done on younger, healthier patients. The types of surgical procedures that may be done include: Neurovascular decompression, which is preferred, Radiofrequency Rhizotomy Balloon Compression, Glycerol Rhizotomy, Radio surgery. It is important to inform patients that surgical treatments have different success rates and may have side effects including facial numbness and even recurrence of the pain.

Dentists should ultimately educate patients with Trigeminal neuralgia about the importance of maintaining a good oral hygiene. When pain attacks, patients are usually reluctant to brush or floss; therefore compromising oral hygiene. Dentists may suggest frequent rinsing of the mouth with water if tooth brushing triggers pain. Because of the possibility of a patient's poor oral hygiene practice during episodes of pain, the need for regular preventive dental care should be emphasized by the dentist. Dentists should advise patients to seek dental treatment during remission periods and should perform all necessary treatments to prevent dental problems during pain attacks.

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