Clinical features and diagnostic pathways of trigeminal neuralgia: a retrospective study in a tertiary orofacial pain clinic.

BACKGROUND

Trigeminal neuralgia (TN) is a neuropathic facial pain disorder that frequently mimics odontogenic and other orofacial pain conditions, leading many patients to initially seek dental care. This study aimed to characterize the clinical features and diagnostic pathways of patients with TN presenting to a tertiary orofacial pain clinic.

METHODS

This single-center retrospective study included newly diagnosed patients with TN who attended a tertiary orofacial pain clinic between 2024 and 2025. Data regarding their demographic characteristics, pain features, pain intensity, trigger factors, and trigeminal nerve distribution were collected, and their psychological characteristics were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the 10-item Perceived Stress Scale (PSS-10). Diagnostic pathways before referral, including dental procedures performed before diagnosis, were also evaluated.

RESULTS

A total of 36 patients were assessed (mean age 66.8 ± 10.7 years; 66.7% female), and most presented with severe paroxysmal electric shock-like pain, predominantly involving the maxillary and mandibular divisions of the trigeminal nerve. Pain episodes were found to be triggered by light facial touch, with additional common triggers including washing the face, tooth brushing, speaking, and chewing. Pain intensity at presentation was graded as severe, with a mean Numerical Rating Scale (NRS) score of 8.17 ± 1.08. Moderate to moderately severe depressive symptoms, moderate to severe anxiety, and moderate perceived stress were frequently observed. Notably, before referral, 22.2% of patients had undergone tooth extraction, and 2.8% had received root canal treatment without achieving pain relief.

CONCLUSIONS

Patients with TN presenting to a tertiary orofacial pain clinic exhibit characteristic neuropathic pain features, although their diagnostic pathways are variable, and a notable proportion undergo dental procedures before a confirmed diagnosis. Better recognition of these characteristic neuropathic pain features may facilitate earlier suspicion of TN, promote timely referral, and reduce unnecessary dental procedures.