Background & Aims

Trigeminal neuralgia (TN) is a rare pain condition that causes sudden, episodic electric shock like pain. Triggers include light touch, washing, eating, or brushing teeth. People can withdraw socially due to the intensity of the pain and the fear of pain re-occurring which can lead to depression, loss of employment, and relationship breakdowns 1,2.
Diagnosing TN is challenging for non-specialist clinicians because it can be difficult to distinguish from other types of orofacial pain. People often visit a dental practitioner before going to a general practitioner. This can result in unnecessary irreversible dental treatment and it can take 4-7 years for people to get an accurate diagnosis 3,4.
Our preliminary work identified no validated diagnostic tools that can be used by dental practitioners to support, or refute, the diagnosis of TN 5. The aim of this study is to co-produce a new tool to help dental practitioners to identify TN more effectively and be able to refer for treatment

Methods

The study is underpinned by the key principles of co-production 6.
We invited people with TN and health professionals to attend an online consensus meeting. The purpose of the meeting was to draw on evidence and expertise to reach consensus on key questions to inform the content of the new tool. Prior to the meeting we discussed potential questions with international orofacial pain/headache experts.

Participants were randomly allocated to two multidisciplinary groups and discussions based around pre-determined questions. Results were presented at a plenary session and participants voted to gain consensus on which questions should be included. We used a nominal group technique 7 to ensure that the key questions generated were important to both health professionals and people with TN.
The study team interpreted the results of the meeting to inform the content and structure of the new tool. Further work will be done to test its validity in a facial pain service .

Results

In total 18 delegates attended the consensus meeting, eight people with TN, eight primary care dental practitioners, one retired general practitioner and one trainee in oral medicine.
It was agreed that the new tool would be a self-administered screening questionnaire, simple for a patient to complete as part of a routine dental appointment and all questions clear and easy to understand. Participants agreed that the new tool should include questions about onset of pain, duration, location, pain intensity, pain characteristics, common triggers, use of over-the-counter medication and effect of pain on usual activity.
Following the consensus meeting the study team met to develop the structure and content of the tool based on the results of the meeting. We drew on evidence from existing oral facial tools5 to decide on the wording of questions. A draft of the tool was sent those that attended the meeting for feedback before the final version was ready to test.

Conclusions

TN can easily be confused with dental pain and a dental practitioner can often be the first person to see someone with potential TN. We have co-produced a new tool suitable for use as a paper or electronic questionnaire to help improve the identification of TN in general dental practice. People with TN have been key throughout the development process. The new tool, once validated and adjusted, if necessary will help dental practitioners to identify possible TN as part of their routine patient assessment and refer on to TN specialists if indicated.

References

1. Melek LN, Devine M, Renton T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. International journal of oral and maxillofacial surgery. 2018;47(7):869-78.
2. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017;158(6):1166-74.
3. von Eckardstein KL, Keil M, Rohde VJNR. Unnecessary dental procedures as a consequence of trigeminal neuralgia. 2015;38(2):355-60.
4. Tripathi M, Sadashiva N, Gupta A, Jani P, Pulickal SJ, Deora H, et al. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surg Neurol Int. 2020;11:455.
5. Teshima et al (2023) A systematic review of screening diagnostic tools for trigeminal neuralgia British Journal of Pain 0 (0) 1-12

6. Hickey G, Brearley, S., Coldham, T., et al. Guidance on co-producing a research project. Southampton: INVOLVE. 2018.
7. Van de Ven AH, Delbecq AL. The nominal group as a research instrument for exploratory health studies. American journal of public health. 1972;62(3):337-42.

Presenting Author

Joanna M Zakrzewska

Poster Authors

Joanna Zakrzewska

MD

Professor

Lead Author

Rachel Potter BSc

MSc

Lead Author

Robert Coveney BDS

Lead Author

Turo Nurmikko MB

BS

Lead Author

Adrian Hale

Lead Author

Topics

  • Assessment and Diagnosis