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‘Electric shock’ when chewing or talking: When your jaw pain is more than a toothache
This sudden jolt of facial pain could be trigeminal neuralgia, says neurosurgeon Nicolas Kon who shares ways to recognise the early signs and treatment for the condition
What seems like dental pain could actually be pressure on a facial nerve, also known as trigeminal neuralgia.
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It begins suddenly – sharp, “electric-shock” bursts of facial pain that strike when chewing, talking, brushing teeth, or even when a light breeze touches your cheek.
These jolts often follow a distinct pattern along the jaw or cheek, making the pain easy to mistake for a dental problem. But when your dentist finds nothing wrong, the real cause may be trigeminal neuralgia
“Trigeminal neuralgia is a neurological condition that occurs when a blood vessel presses on the facial nerve, triggering intense misfires,” says Dr Nicolas Kon, a neurosurgeon and TN specialist at Neuro Asia Care
“TN pain is often mistaken for dental problems because it can feel as if it originates from the teeth or gums – similar to that of a toothache. As a result, some patients undergo multiple dental treatments or extractions before realising the pain is actually neurological.”
According to Dr Kon, TN is most often caused by a blood vessel pressing on the nerve, damaging its protective layer and causing it to send pain signals. In rarer cases, conditions such as multiple sclerosis or a small tumour may also irritate the nerve.
However, differentiating TN from dental pain is particularly tricky when the lower-jaw branch of the nerve is involved, which Dr Kon says is more common among Asian patients.
“TN pain is usually brief but extremely sharp and triggered by light touch. Dental pain, on the other hand, is more constant and pressure-sensitive, often worsening when biting down.”
The condition can significantly affect daily functioning. Dr Kon observes that some patients avoid solid food, stop talking or even smiling for fear of triggering pain, and that they find simple routines such as washing their face or putting on make-up daunting.
“This constant fear of sudden pain can lead to isolation. People may withdraw from social gatherings, avoid meals with friends or lose confidence at work. Over time, the stress can also lead to sleep problems and low mood,” he says.
Trigeminal neuralgia is often described as sudden, electric shock-like facial pain triggered by everyday actions such as talking.
INFOGRAPHIC: NEURO ASIA CARE
Is it trigeminal neuralgia or dental pain?
Early signs of TN include short bursts of sharp, electric-like shocks on one side of the face that last for a few seconds but return repeatedly, often triggered by a gentle touch or movement.
If the pain keeps recurring over days or weeks, or becomes more frequent, Dr Kon advises early diagnosis and treatment to prevent months, or even years, of unnecessary discomfort.
He notes that globally, TN affects about 10 to 300 people per 100,000. In Singapore, TN is slightly more common among women aged 40 to 60, though younger people can also develop it.
A detailed medical history, physical examination and a magnetic resonance imaging (MRI) scan to see if a blood vessel is pressing against the nerve can distinguish TN from dental conditions, notes Dr Kon.
“While trigeminal neuralgia itself is not life-threatening, a thorough evaluation is important to rule out rare but serious causes such as tumours or multiple sclerosis,” he adds.
While medication can help manage trigeminal neuralgia, surgery may offer longer-lasting relief.
INFOGRAPHIC: NEURO ASIA CARE
Treatments for trigeminal neuralgia
The first line of treatment for mild to moderate symptoms of TN is medication, says Dr Kon.
“These drugs help calm the overactive nerve signals that cause pain, but they control symptoms rather than cure the condition. They may lose efficacy over time and cause possible side effects like dizziness, drowsiness or brain fog,” he notes.
For more severe cases, or when medication no longer provides enough relief, other procedural options may be considered, says Dr Kon. These treatments may need to be repeated if symptoms return.
One option is gamma knife radiosurgery, a non-invasive outpatient procedure that uses targeted radiation on the nerve root, with pain relief developing gradually over several weeks. Another is radiofrequency ablation, which uses controlled heat delivered through a fine needle to deactivate the part of the nerve causing pain.
Microvascular decompression treats the root cause of trigeminal neuralgia by relieving pressure on the nerve, allowing it to stop sending pain signals.
INFOGRAPHIC: NEURO ASIA CARE
A third procedure is microvascular decompression
Says Dr Kon: “MVD directly addresses the underlying root cause of trigeminal neuralgia and is associated with long-term, medication-free recovery.”
Performed under general anaesthesia, MVD involves a small incision behind the ear. Using a keyhole approach, the neurosurgeon places a small pad between the nerve and the blood vessel pressing on it.
“Although every surgical procedure carries risks, MVD is well established and generally safe,” says Dr Kon. He notes possible post-surgery side effects such as temporary facial numbness or mild balance problems but they usually resolve with time.
“By removing the pressure, the nerve can stop sending abnormal pain signals. For most patients, relief is almost immediate,” says Dr Kon.
“For the small group of people who do not experience full relief immediately, the pain is often much milder and easier to manage than before, sometimes requiring only minimal medication.”
According to Dr Kon, MVD is most suitable for patients with classic TN and clear MRI evidence of a blood vessel compressing the nerve. It may not be ideal for those with medical conditions that make general anaesthesia risky or patients with atypical symptoms.
“Patients should discuss their personal risk factors with their neurosurgeon to find the safest and most effective path forward,” he says.
To learn more about trigeminal neuralgia or book a consultation with Dr Nicolas Kon, visit Neuro Asia Care
