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Statistical Analysis of Dental Consultation History and Inappropriate Dental Treatment in Patients with Trigeminal Neuralgia Undergoing Microvascular Decompression

This retrospective study of 180 trigeminal neuralgia patients undergoing microvascular decompression reveals that the presence of toothache is the strongest independent risk factor for unnecessary irreversible dental treatments, highlighting the critical need for improved collaboration between dental and medical professionals to prevent misdiagnosis.

Original authors: Hiroki Inoue, Syoya MIzuno, Arihiro Nakamura, Marika Kakazu, Mari Fujiki, Tetsushi Oguma, Hiroshi Furuta, Atsushi Nakayama, Fuminari Komatsu, Yoko Kato, Atsushi Abe

Published 2026-07-10

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CC BY 4.0

Original authors: Hiroki Inoue, Syoya MIzuno, Arihiro Nakamura, Marika Kakazu, Mari Fujiki, Tetsushi Oguma, Hiroshi Furuta, Atsushi Nakayama, Fuminari Komatsu, Yoko Kato, Atsushi Abe

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your face has a super-sensitive alarm system called the trigeminal nerve. Sometimes, this alarm goes off with a jolt of electric-shock pain, a condition called Trigeminal Neuralgia (TN). The tricky part? This alarm often sounds exactly like a toothache. It's so convincing that many people rush to the dentist, thinking they have a bad molar, when the real trouble is actually a tiny blood vessel pressing on a nerve deep inside their head.

This study, which looked back at 180 people who eventually had surgery to fix this nerve pressure (called Microvascular Decompression), found that this "wrong alarm" happens a lot. In fact, 70.0% of these patients visited a dentist before they ever saw a brain surgeon.

The Great Dental Mix-Up

Here is the big reveal: Toothache was the single biggest reason people got the wrong treatment.

Think of the pain like a prankster hiding behind a door. If the prankster is standing behind the door labeled "Toothache," there is a massive chance you'll try to fix the door by pulling out the hinges (a tooth extraction) or drilling a hole in it (root canal). The study found that among the 83 patients who complained of toothache, 73.0% underwent irreversible dental work—like getting a tooth pulled or having a root canal—before the real diagnosis was made.

In contrast, for the 97 patients who didn't feel like their teeth hurt, only 5.0% got these irreversible treatments. The math is stark: if you have TN and feel like your teeth hurt, you are 33.4 times more likely to get unnecessary dental surgery than if you don't feel that specific pain.

The "Which Tooth?" Mystery

You might wonder, "Does it matter which part of the face hurts?" The researchers checked. They found that pain in the lower jaw (the V3 nerve area) was often linked to these mix-ups, but only because that area usually feels like a toothache. Once they accounted for the "toothache feeling" itself, the specific location of the nerve didn't matter as much as the type of pain. Pain in the eye area (V1) rarely led to dental mistakes, probably because it doesn't feel like a tooth problem.

The Surgery Fix

So, did all this unnecessary drilling and pulling mess up the final cure? Surprisingly, no. The study checked the results after the brain surgery and found that the success rate was almost identical for both groups. Whether a patient had their teeth messed with or not, about 84.1% of those with toothache and 83.7% of those without toothache felt much better after the surgery.

This suggests that while the dental confusion causes a lot of pain and unnecessary procedures, it doesn't actually ruin the final fix for the nerve. The surgery works just as well, regardless of how many wrong turns the patient took to get there.

The Bottom Line

The main takeaway is a warning to everyone: If you have a toothache that won't go away, or if it feels weird (like electric shocks), don't just assume it's a cavity. The study suggests that doctors and dentists need to talk to each other more. By realizing that a "toothache" might actually be a nerve alarm, we can stop people from getting unnecessary root canals and extractions. The surgery to fix the nerve works great, but it's much better if we can avoid the dental detour in the first place.

Technical Summary: Statistical Analysis of Dental Consultation History and Inappropriate Dental Treatment in Patients with Trigeminal Neuralgia Undergoing Microvascular Decompression

Problem Statement
Trigeminal neuralgia (TN) is a neuropathic disorder characterized by unilateral, electric shock-like facial pain. A significant clinical challenge arises because pain affecting the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve often mimics odontogenic pain. Consequently, patients frequently seek initial care at dental clinics, leading to misdiagnosis and unnecessary irreversible dental procedures, such as root canal treatments or tooth extractions. While previous studies have documented the prevalence of these inappropriate interventions, the specific clinical characteristics associated with irreversible dental treatment in patients who eventually undergo Microvascular Decompression (MVD) surgery remain unclear. Furthermore, the impact of these dental misdiagnoses on postoperative surgical outcomes has not been sufficiently investigated.

Methodology
This study employed a retrospective single-center design involving 180 consecutive patients diagnosed with TN who underwent MVD at Fujita Health University Bantane Hospital between January 2022 and December 2024. Patients with secondary TN, herpes zoster-associated neuralgia, or insufficient clinical data were excluded to ensure diagnostic accuracy based on surgical confirmation.

Data were extracted from medical records, capturing variables including demographics (age, sex, BMI), symptom duration, trigeminal nerve distribution (V1, V2, V3), responsible vessels, lifestyle factors (smoking, alcohol), and specific dental history. Key definitions included:

Toothache: Patient-reported pain perceived as originating from teeth prior to TN diagnosis.
Irreversible Dental Treatment: Composite resin restoration, root canal treatment, or tooth extraction.
Postoperative Outcome: Evaluated using the Barrow Neurological Institute (BNI) pain intensity score, where grades I–II indicated improvement.

Statistical analysis involved univariate tests (Student's t-test, Mann–Whitney U test, $\chi^2$ test, or Fisher's exact test) and multivariate logistic regression to identify independent risk factors for irreversible dental treatment.

Key Results

Dental Consultation and Referral: 70.0% (126/180) of patients visited a dental clinic before receiving a TN diagnosis. However, only 43.6% of these patients were referred to neurosurgery by dental practitioners, indicating a gap in specialist referral pathways.
Prevalence of Irreversible Treatment: Among the 83 patients presenting with toothache, 73.0% (60 patients) underwent irreversible dental treatment before diagnosis. In contrast, only 5.0% (5/97) of patients without toothache received such treatment ( $P < 0.001$ ).
Unnecessary Extraction: 23 patients (12.8% of the total cohort) underwent unnecessary tooth extraction.
Risk Factors:
- Univariate Analysis: V3 involvement was significantly associated with irreversible treatment ( $P = 0.0097$ ), while V1 involvement was negatively associated ( $P = 0.020$ ). Patients undergoing irreversible treatment were significantly younger ( $61.9 \pm 14.6$ vs. $66.0 \pm 14.3$ years, $P = 0.039$ ).
- Multivariate Analysis: Toothache was identified as the sole independent risk factor for irreversible dental treatment (Odds Ratio [OR] 33.4, 95% CI 12.0–93.0, $P < 0.001$ ). Trigeminal nerve distribution (V2/V3) and age were not independent predictors in the multivariate model.
Surgical Outcomes: The presence of toothache did not influence postoperative outcomes. BNI improvement rates were comparable between patients with toothache (84.1%) and those without (83.7%, $P = 0.947$ ).

Significance and Claims
The authors claim that this study provides valuable evidence regarding the frequency of dental consultations and inappropriate irreversible treatments in surgically confirmed TN patients. The primary contribution is the identification of toothache as the strongest independent predictor of inappropriate dental intervention, with an odds ratio of 33.4. This suggests that the symptom presentation (pain perceived as dental) is a more critical determinant of misdiagnosis than the anatomical distribution of the nerve alone.

The study concludes that while toothache significantly delays diagnosis and increases the risk of unnecessary dental procedures, it does not negatively impact the efficacy of MVD surgery. The authors emphasize that strengthening collaboration between dental and medical departments, along with increasing awareness of TN among dental practitioners, is essential to prevent unnecessary irreversible procedures and facilitate earlier diagnosis.

Limitations
The authors acknowledge several limitations: the retrospective, single-center nature of the study; potential selection bias; incomplete dental records from referring institutions; the inability to completely exclude concomitant dental diseases; and the exclusion of patients managed conservatively or via other surgical procedures. Consequently, the authors state that future multicenter, prospective studies are warranted to validate these findings.

The Great Dental Mix-Up

The "Which Tooth?" Mystery

The Surgery Fix

The Bottom Line

Technical Summary: Statistical Analysis of Dental Consultation History and Inappropriate Dental Treatment in Patients with Trigeminal Neuralgia Undergoing Microvascular Decompression

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