When a child is brought to my South Manhattan pediatric dental practice with complaints of facial pain, my first step is to evaluate the child’s mouth to check for cavities, infection, trauma and temporomandibular joint disorder (TMJD). If those problems are ruled out, I then consider the possibility that the child may have trigeminal neuralgia. Because this disorder most often appears in women over the age of 50, the diagnosis is easily missed in children and, although it’s extremely rare in children, it can appear.
What is Trigeminal Neuralgia?
The trigeminal nerve, which is cranial nerve #5 (of 12 total cranial nerves) helps the body produce saliva and tears, and also sends signals to the body about touch, pressure, discomfort and temperature. Trigeminal neuralgia, called TN or TGN for short, is a disorder in cranial nerve #5 that causes sharp, stabbing pain along the side of the face with the affected nerve. TN is not serious in and of itself, and can be effectively treated.
Symptoms of Trigeminal Neuralgia
Symptoms in children include a sudden pain in the face that causes the child to refuse to eat or drink, and to cry out as if he was suddenly shocked. It can occur at any time, including during sleep. Some children experience TN pain first in the ears, which may appear red during an episode. The pain may last just a second or longer, and can come and go at random, making diagnosis challenging, as the child may not be having pain when he or she is taken to the pediatrician or dentist for examination. As time progresses, discomfort can occur more often and increase in severity.
Here are two “indicators” that help physicians and pediatric dentists to identify TN:
- In TN, the child will avoid touching her face because itmakes the pain worse.
- If the child has TN, the pain subsides between attacks while, with other dental problems such as a cavity or infected tooth, the pain continues until the tooth is treated.
Since the pain may not be present when you bring your child to see me, it’s helpful for you to monitor your child’s painful episodes and the duration of discomfort. Does the pain come and go suddenly with no apparent cause? Does the child refuse to allow you to touch her face or look in her mouth during a painful episode? Both of these are clues that TN might be the problem.
Causes of Trigeminal Neuralgia
In most cases, there is no known cause for the development of trigeminal neuralgia.
Treatment of Trigeminal Neuralgia
Most children respond well to a course of medication such as carbamazepine. Very rarely, laser treatments, surgery or radiation are used if medication alone fails to provide relief.
If your child has pain in the jaw, face, or inside the mouth, don’t hesitate to schedule an appointment to see me. Most likely it’s something other than trigeminal neuralgia, as again, TN is extremely rare. It’s always a good plan to bring in your child if you have any concerns about his or her oral health! Just call my office at (212) 267-0029.