The vast majority of cases of trigeminal neuralgia that I have seen in my pain practice over 35 years, are due to jaw misalignment. They present at the extreme end of a pain continuum involving the trigeminal nerve that goes all the way from mild tooth hypersensitivity, to vague facial pain, to pain of varying degrees at various places on the head. Diagnostic splint therapy confirmed that the cause of trigeminal neuralgia and the vast majority of all these pain conditions is from jaw misalignment.
Jaw misalignment (a dental orthopedic defect) in most cases is either inherited or due to poor orthodontics or dental crowns. This causes the muscles suspending the lower jaw to work excessively, thus increasing tonicity within the nerve which serves these muscles- the trigeminal nerve. This is the start of dysfunction within the nervous system which compounds itself in time.
The trigeminal nerve is unique in that it has one hundred times more dense pain fibers (C fibers) than any other nerve. C fibers send their signal to the brain primarily by a neuropeptide called “substance P”. With increased tonicity within the trigeminal nerve, substance P levels become chronically elevated. Substance P has two primary effects on the body: 1)hypersensitizes all sensory neurons = i.e. lowers cell membrane potential and 2) mediates the inflammatory response.
Thus, in time, with chronically elevated substance P, trigger zones can develop anywhere in the body due to hypersensitization. And because of hypersensitization, the response becomes exaggerated to the amount of the sensory input (i.e. severe facial pain to light touch). Some people develop trigger zones in the face (trigeminal neuralgia), some fibromyalgia, and some various other types of neuralgias as a result of systemically elevated substance P. Of the many trigeminal neuragia cases that I have treated, I have found no cases in which trigeminal neuralgia symptoms did not respond to dental orthopedic correction.
Hypersensitization mandates that any jaw alignment treatment be done precisely or else it will make the patient worse, rather than better. Precision dental orthopedics is an area of dentistry that is not well understood. It is based on Biomechanical Principles of Occlusion. This treatment is based on assessment of jaw function, not occlusion (dentists usually check occlusion, but not jaw function). Three things are required for ideal function: 1) open and close on fair arc 2)bite and talk on same trajectory and 3) jaw relaxed position is with minimal space between upper and lower jaws (i.e. not agape).
Treatment in my practice is done through the use of twin block crozats, a dental
orthopedic appliance. These appliances allow the jaw to be repositioned precisely with maximal control and minimal functional interference.