Differentiating Trigeminal Neuralgia From Persistent Idiopathic Dentoalveolar Pain and Persistent Idiopathic Facial Pain in Oral and Maxillofacial Surgery.

The diagnostic distinction between trigeminal neuralgia (TN), persistent idiopathic dentoalveolar pain, and persistent idiopathic facial pain remains a challenge for oral and maxillofacial surgeons. While neurovascular compression is often viewed as a definitive indicator for surgical intervention, recent evidence suggests that neurovascular compression is frequently an incidental finding in patients with nociplastic pain. This paper explores the nociplastic signature of persistent idiopathic dentoalveolar pain and persistent idiopathic facial pain, emphasizing that central sensitization and central neuroinflammation-rather than peripheral mechanical compression-drive its pathology. We examine the morphological differences between simple vascular contact and true nerve deformation, the complexities of venous versus arterial compression, and the role of glial activation in chronic pain. By integrating clinical phenotyping, advanced imaging such as magnetic resonance neurography, and psychosocial screening tools, surgeons can avoid biologically futile procedures and improve outcomes for patients with complex orofacial pain.