CRC9: Management of trigeminal neuralgia in a patient after lower tooth extraction: A case report

Introduction: The occurrence of trigeminal neuralgia (TN) is most often secondary to trauma, such as inferior alveolar nerve injuries associated with extraction of mandibular tooth. Therefore, careful examinations and complete history are needed. Case Description: A 47 years old woman was referred for assessment of enigmatic pain in her lower right region. She complained of sharp, tingling, periodic, and sudden pain accompanied by headaches. These symptoms, first started 3 years ago after extraction of tooth 32 and reappeared after extraction of tooth 31 two years ago. Six months later, the pain rose again and spread to the area of extractions. The pain was getting severe, which made her difficult to talk, drink, eat, brush the teeth, and wash her face. Previous endodontic treatment and medication did not resolve her conditions. Diagnosis was established as TN. Administration of anticonvulsant drug (i.e., carbamazepine) is one of the treatment choices. Carbamazepine 100 mg twice daily was first administered for 3 weeks, followed by 200 mg twice daily. The pain slowly reduced after 5 months. Afterwards, the dose is reduced into 100 mg/ day for 7 weeks. At this time, she was able to do activities much more comfortable. Right now, the frequency of drugs becomes 3 times a week. Discussion: Patient’s complete history is very important. Drug of choice for TN is carbamazepine. It could reduce both the frequency and intensity of pain. The dose could be tapered once the pain has been controlled. Conclusion: Correct diagnosis of TN is very important in order to deliver appropriate treatment.