Statistical Analysis of Dental Consultation History and Inappropriate Dental Treatment in Patients with Trigeminal Neuralgia Undergoing Microvascular Decompression

Background Trigeminal neuralgia (TN) frequently presents with toothache-like symptoms and is often misdiagnosed as odontogenic pain, leading to unnecessary dental procedures. Although several studies have reported inappropriate dental interventions in patients with TN, the clinical characteristics associated with irreversible dental treatment in patients undergoing microvascular decompression (MVD) remain unclear. Methods We retrospectively reviewed 180 patients diagnosed with TN who underwent MVD at Fujita Health University Bantane Hospital between 2022 and 2024. Clinical variables including age, sex, body mass index (BMI), duration of symptoms, trigeminal nerve distribution, smoking and alcohol history, dental consultation history, referral pathway, toothache, and irreversible dental treatment were collected from medical records. Irreversible dental treatment was defined as composite resin restoration, root canal treatment, or tooth extraction. Postoperative outcomes were evaluated using the Barrow Neurological Institute (BNI) pain intensity score. Logistic regression analysis was performed to identify factors associated with irreversible dental treatment. Results Among the 180 patients, 126 (70.0%) had visited a dental clinic before diagnosis, whereas only 55 patients (43.6%) were referred to neurosurgery from dental clinics. Toothache was observed in 83 patients, of whom 60 (73.0%) underwent irreversible dental treatment before diagnosis. In contrast, only 5 of 97 patients (5.0%) without toothache received irreversible dental treatment (P < 0.001). Unnecessary tooth extraction was identified in 23 patients (12.8%). In univariate analysis, V3 involvement was significantly associated with irreversible dental treatment (P = 0.0097), whereas V1 involvement was negatively associated (P = 0.020). Multivariate logistic regression analysis identified toothache as the only independent risk factor for irreversible dental treatment (OR 33.4, 95% CI 12.0–93.0, P < 0.001). Postoperative BNI improvement rates did not differ according to the presence of toothache (84.1% vs 83.7%, P = 0.947). Conclusions Patients with TN frequently undergo dental consultations and unnecessary irreversible dental treatment before accurate diagnosis. Toothache was the strongest independent risk factor for inappropriate dental intervention. Strengthening collaboration between dental and medical departments may improve early diagnosis and prevent unnecessary dental procedures in patients with TN.