[KoK! Health] Sudden Winter Toothache, Could It Be 'Neuralgia'?

Mr. A, a worker in his 50s, recently experienced sharp, electric shock-like pain in his right cheek and jaw as the weather suddenly turned cold. The pain worsened when brushing his teeth or eating, leading him to suspect a toothache and visit a dentist. However, the dentist said, "There is nothing wrong with your teeth," and recommended he see a neurologist. At the neurology clinic, Mr. A was diagnosed with a little-known condition called ‘trigeminal neuralgia’.

Trigeminal Neuralgia Easily Mistaken for Toothache
Photo by Gangnam Bedro Hospital

Trigeminal neuralgia is a type of neuralgia that occurs in the facial area. The trigeminal nerve refers to the fifth cranial nerve, one of the 12 pairs of cranial nerves, which mainly distributes to the face. It is named the trigeminal nerve because its sensory root branches into three parts. When the nerve is compressed or damaged, incorrect pain signals can occur even during routine activities, causing pain. Trigeminal neuralgia occurs when the trigeminal nerve is compressed by surrounding blood vessels such as arteries or veins. Sometimes, it can also result from nerve damage caused by diseases like brain tumors or cerebral aneurysms. It mainly appears more frequently on the right side of the face, and its incidence increases in winter when the sensory nerve reacts hypersensitively to cold stimuli.

In particular, trigeminal neuralgia often affects the mandibular nerve, which controls sensation and chewing functions around the jaw and mouth. This causes intense, electric shock-like pain in the cheek, teeth, and jaw area. It occurs in about 4 to 5 people per 100,000, making it relatively rare, and because the affected area is around the mouth, it is often mistaken for a toothache.

Trigeminal neuralgia can suddenly and unexpectedly occur during minor activities such as brushing teeth, talking, eating, shaving, or smoking, significantly lowering the patient’s quality of life. The pain is as severe as childbirth or intense electric shocks. In severe cases, patients may experience pain dozens of times a day, and the duration and pattern of pain are irregular, making it difficult to predict when the pain will occur.

Yoon Kang-jun, Chief Director of Gangnam Bedro Hospital
Photo by Gangnam Bedro Hospital

For symptom improvement, early diagnosis and appropriate initial treatment are crucial. Dr. Kangjun Yoon, Chief Neurologist at Gangnam Bedro Hospital, explained, “Although the cause of trigeminal neuralgia itself is not a nerve abnormality, continuous compression increases the risk of nerve damage, so precise diagnosis and early treatment are very important. If trigeminal neuralgia is caused by a specific disease, treating the underlying condition must come first, so accurate identification of the cause and establishing an appropriate treatment plan are essential.”

Treatment primarily involves conservative therapy using medications such as painkillers and anticonvulsants. However, if the condition frequently recurs, worsens, or does not improve after long-term treatment, surgical options like microvascular decompression can be considered. This neurosurgical procedure fundamentally resolves the cause of pain by separating the nerve from the compressing blood vessels. It involves making a 4 to 5 cm incision behind the ear, separating the problematic nerve and blood vessels, and inserting a cushioning material called Teflon to block the transmission of vascular pulsations. This surgery has been steadily performed for over 30 years with a high cure rate. Recently, with the use of brain magnetic resonance imaging (MRI) for precise monitoring and advanced surgical techniques, surgical outcomes have been improving further.