Trigeminal neuralgia — ORE Part 1 MCQ

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ModerateOral Medicine and Oral PathologyTrigeminal neuralgiaORE Part 1

A 68-year-old patient reports brief electric-shock pains on the right side of the face triggered by shaving and touching the upper lip. Each episode lasts seconds, neurological examination is normal, and dental examination with radiographs shows no odontogenic cause. What is the most likely diagnosis?

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Correct answer: D — Trigeminal neuralgia

Trigeminal neuralgia (D) is the correct answer. The clinical presentation—brief (seconds), severe, electric shock-like pain triggered by light touch (innocent stimuli) on the face in a unilateral distribution—is pathognomonic for TN according to IHS ICHD-3 criteria. At age 68, the patient is in the typical age range for TN onset. Normal neurological examination and exclusion of odontogenic pathology further support the diagnosis. Option E (acute apical periodontitis) is excluded by normal dental findings. Option B (temporomandibular disorder) typically presents with jaw pain and functional limitations, not shock-like triggered pain. Option A (burning mouth syndrome) involves continuous burning rather than paroxysmal electric shocks. Option C (post-herpetic neuralgia) requires prior herpes zoster with vesicular rash and presents with continuous dysesthetic pain, not brief shocks.

Reference: Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461413/ and NICE Guidance IPG715 Chapter 2: The condition, current treatments and procedure. https://www.nice.org.uk/guidance/ipg715/chapter/2-The-condition-current-treatments-and-procedure