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The Shocking Tooth
About Trigeminal Neuralgia |
The
New England Journal of Medicine
June 29, 2000, Vol. 342, No. 26 |
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To the Editor:
A 66-year-old woman with a two-year history of right-sided
Trigeminal neuralgia (involving the second Trigeminal division)
presented with severe exacerbation of her typical sharp pain after
a root-canal procedure in a right upper incisor. The procedure had
slightly repositioned a mercury-amalgam restoration, nudging it
closer to the adjacent tooth, which bore a gold-alloy crown.
Thereafter, and until the mercury amalgam was replaced by a porcelain
restoration, tomatoes or certain other acidic foods would produce
intense jolts, described as being like those of an "electrical
battery," in the right palate, boosting the pain in the
same division of the Trigeminal nerve to an excruciating level.
Lightly touching the right cheek also triggered paroxysms of neuralgia,
which subsequently resolved with use of gabapentin.
Adjacent dental amalgams that are composed of dissimilar
metals in contact with saliva can :
1
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Form a galvanic cell that generates
localized electrical currents with potentials as high as
several hundred millivolts
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2
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Such currents usually cause
no symptoms
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3
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Some patients report
a metallic or battery-like taste
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Many patients with Trigeminal
neuralgia describe their pain in terms of electricity. This
patient's oral galvanism produced genuine electrical currents
that potentially triggered the neuralgia. |
William P. Cheshire, Jr., M.D.
Mayo Clinic Jacksonville
Jacksonville, FL 32224
References
- Certosimo AJ, O'Connor RP. Oral electricity. Gen Dent 1996;44:324-6.
(8957826)
- Bergman M, Ginstrup O, Nilsson B. Potentials of and currents
between dental metallic restorations. Scand J Dent Res 1982;90:404-8
(6758103)
- Muller AW, Van Loon LA, Davidson CL. Electrical potentials of
restorations in subjects without oral complaints. J Oral Rehabil
1990;17:419-24. (2231160)
- Hugoson A. Results obtained from patients referred for the investigation
of complaints related to oral galvanism. Swed Dent J 1986;10:15-28.
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