Pretrigeminal neuralgia

Typical trigeminal neuralgia, brief electric shock like pain along distribution of trigeminal nerve, is well documented in literature but not much is available about pre trigeminal neuralgia. Pre-trigeminal neuralgia should be considered in the differential diagnosis of pain of dental origin because of its similar features.Symonds was the first person who noted dull, continuous and aching pain before the typical paroxysmal pain appeared in few patients.[1] Mitchell was the person to term this prodromal pain as “pre-trigeminal neuralgia.[2] Clinical features of this prodromal pain includesdull, continuous aching pain that may be triggered or aggravated by chewing food, drinking hot and cold liquids. Such patients pose a diagnostic challenge for dentist as examination may reveal absence of caries, gingival recession, sinusitis and symptoms are not relieved with analgesics like NSAIDs and opioids. Root canal treatment and extraction are also of no use in such patients because painpersists in the same region even after performing root canal treatment or extraction.[3] So a careful history and detailed dental and neurological examination is required in such patients to avoid misdiagnosis as dental disease.