Many people can’t sleep well for days when they have toothache, especially when they brush their teeth with strong and severe pain, and even taking painkillers can’t reduce the symptoms. When dental examination does not reveal tooth decay or other dental diseases, you should be alert to whether trigeminal neuralgia is playing a role. Since trigeminal neuralgia is easily missed or even diagnosed as toothache alone, the two should be differentiated. 1. The pain characteristics are different. The pain caused by dental inflammation is chronic and persistent; typical trigeminal neuralgia is a severe pain like electric shock, which usually lasts for a few seconds and is unbearable several times a day. 2. No disease is found in the dental examination. During the examination, if no relevant inflammation such as tooth decay or periodontitis is found, but the tooth is still painful, then it may be trigeminal neuralgia. 3.Ordinary painkillers are ineffective. If the toothache does not improve after taking ordinary painkillers, but the pain can be relieved after taking carbamazepine, then inflammatory pain such as periodontitis can be ruled out, and trigeminal neuralgia can be identified. Trigeminal neuralgia has a “trigger point” The trigeminal nerve is a sensory nerve located on both sides of the face and is divided into three branches. The first branch is the ophthalmic branch, which innervates the eye and the area above the eye; the second branch is called the maxillary branch, which innervates the section of skin between the fissure of the eye and the fissure of the mouth; and the third branch is called the mandibular branch, which innervates the sensation of the face below the fissure of the mouth. When trigeminal neuralgia attacks, the pain is often confined to one side, with the combined pain of the second and third branches on one side being the most common, accounting for about 95% of cases, with the pain being most pronounced in the cheek, upper and lower jaw and tongue. This is followed by the third branch pain alone, while the first branch pain alone is the least common. During the onset of the disease, patients feel radiating bouts of severe pain, such as pins and needles, cuts, tears or electric shocks, which are often unbearable once the attack occurs. In severe cases, it is often accompanied by a reflex twitch of the facial muscles, with the corners of the mouth pulled to one side, also known as “painful twitch”. Trigeminal neuralgia often has a “trigger point”, usually at the lips, nose, corners of the mouth, teeth, palate, buccal mucosa, eyebrows, etc., and the slightest touch will cause a painful attack. Because of the fear of causing painful episodes, patients often do not brush their teeth, do not wash their faces, even eat carefully, often use gestures to express their thoughts, and do not dare to let doctors touch them. Over time, patients may show haggard and depressed faces. There are two types of trigeminal neuralgia etiology After the diagnosis of trigeminal neuralgia, it is necessary to find the cause and identify whether the pain is primary or secondary. Primary trigeminal neuralgia refers to those who do not show neurological signs, and no obvious organic or functional lesions related to the onset of the disease are found by various examinations, which may be caused by microvascular compression, nerve ischemia, etc. Secondary trigeminal neuralgia refers to painful symptoms caused by lesions of the trigeminal nerve itself or adjacent tissues, with neurological signs in addition to pain. It can be secondary to tumors, vascular malformations, aneurysms, arachnoiditis and multiple sclerosis in the pontocerebellar angle, trigeminal nerve root or hemianopsia. The treatment of trigeminal neuralgia includes medication, such as oral carbamazepine, and surgery, such as microvascular decompression and sensory rhizotomy. When suffering from severe toothache, it is important to visit the hospital in time and think about the possibility of trigeminal neuralgia after dental-related diseases are ruled out. Patients should choose different treatment options according to their conditions to get the best results and ensure a good quality of life.