Pune: Suraj (name changed), a teacher in rural Maharashtra, would stop mid-sentence, clutch his face and hide tears. Seeing their teacher struggle, students would cry for him. Between attacks, he looked completely normal and so his family assumed that it was an exaggeration of a dental problem. But what Suraj suffered from had nothing to do with his teeth.For thousands of patients like Suraj with trigeminal neuralgia, the road to relief may begin and repeatedly end in the dental chair. This diagnostic delay can be agonising as the condition is often confused with toothache because its pain travels through the cheek, jaw or gums. Unlike typical dental pain, trigeminal neuralgia causes sudden, intense, electric-shock-like attacks lasting seconds to two minutes, triggered by brushing, chewing, speaking or even a light touch.On the eve of World Trigeminal Neuralgia Awareness Day on Oct 7, experts cautioned that delay in diagnosis and incorrect treatment worsened the condition and could lead to more side effects. Trigeminal neuralgia is a chronic pain disorder. It causes intense pain attacks in the face. It happens when the trigeminal nerve is damaged or irritated, which could be triggered by simple daily routines like brushing, washing the face or eating. The fear of pain is so intense in patients that they often avoid brushing their teeth.Dr Jaydev Panchawagh, a senior consultant neurosurgeon at Sahyadri and Manipal Hospitals, who has operated upon more than 2,000 people with this condition, said, “In such cases, often medicine comes first. Drugs such as carbamazepine help most patients for a time. When doses keep rising and side effects take over life, one must ask about other options. In this case, the right scan matters. A high-resolution MRI might help, but a vessel touching the nerve on a scan is not proof on its own; the diagnosis rests on your description of the pain.”Dr Panchawagh, also the chairperson of the Synapse Brain and Spine Foundation, said microvascular decompression (MVD) remained the best option as it removes the cause and leaves the nerve whole. He said, “Of all the procedures available, it offers the highest chance of long-term, often permanent, relief. However, waiting has a cost. Years of compression inflame and scar the nerve; the pain can become constant and surgery grows harder. Most patients feel the difference the moment they wake up post-surgery. Soon they eat, talk and brush their teeth without fear.”A study, “Trigeminal Neuralgia and Associated Unwarranted Dental Treatment”, published in Oral Surgery, screened 14,952 patients attending multiple tertiary dental care centres across the country. The study identified 45 trigeminal neuralgia cases, giving a prevalence of 0.3% among dental OPD attendees. It reported that over 80% of patients had undergone at least one unnecessary dental procedure before receiving the correct diagnosis. The unnecessary treatment is more common among rural patients than city residents.A 2026 global analysis estimated annual prevalence at 45.38 cases per 1,00,000 people, suggesting the disorder may be substantially under-recognised.
