Neuralgia do trigêmeo: demora no diagnóstico e procedimentos dentários desnecessários em pacientes referenciados à uma unidade terciária de saúde pública

Abstract

Trigeminal neuralgia (TN) is characterized by brief, recurrent episodes of shock-like facial pain that are evoked by innocuous stimuli and limited to the region of the distribution of the trigeminal nerve. Although the symptoms are characteristic, they could be mistaken for odontogenic pain and treated likewise before TN diagnosis is established. This study aimed to evaluate the first healthcare professional sought by the patient, the number of unnecessary dental procedures performed, and the time elapsed between the onset of TN and correct diagnosis in patients referred to a tertiary public university center. Seventy-eight patients presenting clinical criteria of TN were included. Clinical characteristics such as demographics, pain characteristics, and comorbidities, as well as previous diagnosis and dental procedures were assessed using a standard questionnaire completed during the consultation. The mean age of the patients was 66 ± 10.9 years. The maxillary (V2) and/or mandibular (V3) branch was affected in 82% of the cases. Sixty patients (77%) initially consulted a dentist, and 52 (87%) of them underwent some type of dental treatment. The number of dental extractions ranged from 1-28. The time elapsed between the first symptom and the diagnosis ranged from 1 week to 22 years. Our results suggested that TN remains underdiagnosed in the public health system and that dentists are the first professional sought by the patient when neuralgia affects the V2 and V3 branches of the trigeminal nerve. Furthermore, more than half of these patients undergo unnecessary dental treatments.