CLINICAL SCIENCES II I Involvement of dental occlusion and trigeminal neuralgia: A clinical report Takami Hirono Hotta, DDS, ~ Angela Bataglion, b Cesar Bataglion, DDS, PhD, ¢ and Osvaldo Luiz Bezzon, DDS, PhD d School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil In 1773, trigcminal neuralgia was denoted as tic douloureux or Fothcrgill's disease. 1During a pain epi- sode the facial muscles related to expression and masti- cation usually contract, which justifies the definition as tic douloureux. 2 Most patients reported in the literature were women aged 50 to 70 years, ~-6 with greater involve- ment of the right side of the face. ~,3,5The pain can be provoked by stimulating the triggering zones in some areas of the face; however, pain is provoked less fre- quently in the mucosal areas of the mouth. 4 Stimulation is usually caused by activities such as hair-combing, chew- ing, swallowing, tooth-brushing, yawning, and touch- ing one's face. s The major therapies for trigcminal neuralgia are drug treatment and surgical intervention.3,5The drug of choice is carbamazepinc, although it may have undesirable side effects after prolonged use. Other medications, such as diphenylhydantoin and baclofen, have bccn used with good clinical results y,s Surgical intervention is reserved for patients who no longer respond to drug treatment2; however surgery does not ahvays produce the expected results. It has been suggested that neuralgia may be associ- ated with pain because ofmyofascial dysfunction or some other temporomandibular disorder (TMD) and that functional and occlusal dental treatment may reduce pain. However, the patients in question may not have had genuine trigeminal neuralgia or may have had a su- perimposed TMD that, if properly treated, would have resulted in an improvement of symptoms .4 Physiotherapy with resources such as diathermy, thera- peutic ultrasonography, and therapeutic laser treatment for painful symptoms7 is fully acceptable in the treat- mcnt ofTMDs. 8,9Studies have demonstrated that these treatment methods significantly reduce the duration of symptoms provoked by these disorders. 7a°,u Gray et al. u recommended therapeutic laser applica- tions for a 4-week period and reported that the maximal effect of this type of treatment occurred during the third or fourth week. ~Denta[ Surgeon, Department of Restorative Dentistry. UPhysiotherapist in training, Service of Occlusion and Disorders of the TemporomandibularJoint. ~Assistant Professor, Discipline of Occlusion. dAssistant Professor, Discipline of Removable Partial Dentures. J Prosthet Dent 1997;77:34.3-5. Fig. 1. Dental condition. This clinical report presents the treatment of a pa- tient with trigeminal neuralgia. Because ofocclusal con- ditions, the patient was prescribed dental treatment. GLINICAL REPORT At examination, the 60-year-old patient had been feel- ing shocklike pains on the left side of his face for the past 2 years. These pains were affecting areas of the tem- poral muscles and scalp and the intraoral region, which affected the mucosac, dental structures, and the tongue. As a consequence, the patient was no longer able to cat, comb his hair, or shave in an adequate manner and needed to take medication at increasingly shorter inter- vals. The pain was so intense that the patient was no longer able to carry out routine activities or to engage in social interactions; he was also aware of the changes in his behavior. Regarding the patient's dental condition, many teeth were missing, principally premolars and molars. Some caries lesions were present, periodontal alterations were apparent, and occlusal and incisal wear of the remaining teeth was evident. However, the patient's mandibular movements were not limited (Fig. 1). TREATMENT PROCEDURES Physiothcrapeutic evaluation documented the subjec- tive aspects described by the patient and the clinical ob- servations made by palpation of the temporomandibu- lar joints, the muscles involved, and the sites of pain before, during, and after laser treatment, according to the criteria cited in the literature. 9 APRIL 1997 THE JOURNAL OF PROSTHETIC DENTISTRY 343