Trigeminal neuralgia or tic douloureux is a lancinating, paroxysmal pain in the distribution of one or more of the branches of the trigeminal nerve. Each paroxysm lasts only a few seconds and is frequently likened to an electric shock. It is a disease of middle and later life but occasionally appears in young subjects. In the beginning, the pain is confined to one branch of the nerve, most frequently the infra-orbital, but with the passage of time it tends to spread to the other branches. The mandibular branch is somewhat less often the site of origin and the supraorbital branch is very seldom involved primarily. The disease affects both sexes about equally and in approximately 2 per cent of the cases the pain is bilateral.
The cause of trigeminal neuralgia is not known. By the patient, however, the teeth are always looked upon with suspicion because of the location of the pain and because it resembles that produced when a dentist’s drill touches a sensitive pulp. Furthermore, the pain is frequently incited by touching a tooth or by chewing. Despite this, however, it can be said with authority that no dental condition, however neglected and aggravated, can cause tic douloureux. Within a few months of the onset, these sufferers have several or perhaps all of their teeth removed, usually at their own insistence and always to no avail. In the first complete description of this disease in 1804, Samuel Fothergill1 suspected that “the cause of these extreme pains in the. . .