CRANIAL NERVE 5, TRIGEMINAL PAIN

Facial pain can be really frustrating detective work to figure out for both patients and doctors alike. I was reminded of that recently with a patient that had been doctoring in multiple places for 18 months, with some unexplained tooth pain, to no avail. In this blog I would like to explore one source of facial pain that is often overlooked and that is trigeminal referred nerve pain from the cervical spine.

I still recall during human dissection in my first year of chiropractic school discovering that unlike most nerves, which were pretty small and elusive, the trigeminal nerve and its node were surprisingly large and easy to find. The trigeminal nerve is part of the 12 cranial nerves which exits through various openings in the skull, unlike the spinal nerves that exit at the level of the vertebral column below. It's a very large nerve with many sensory and motor functions. It affects a huge area over the lateral part of the face from the ear forward. In particular, the trigeminal nerve provides sensation to the upper and lower jaw and the base of the teeth.

What makes the trigeminal nerve unique from a chiropractic perspective is the following anatomical fact: the nerve cell that sends out its long nerve endings to the side of the face starts in the brainstem and dips all the way down in the spinal cord of the upper cervical spine, all the way down to the level of the second cervical vertebrae. As a result, any irritation to the upper cervical spinal cord has the potential to refer sensation to the side of the face. And very often this will localize over the jaw, and the lower teeth.

I'm certainly not suggesting that your first call when experiencing tooth pain should be to the chiropractor, but after a dental checkup, if you still have unexplained pain in the lower teeth especially, diffusely in the corner of the jaw or ear, it's certainly worth having a chiropractic evaluation. Not all upper cervical benign misalignments are likely to cause that, but functional lesions associated with enough torsion and extension can create some irritation of the upper cervical spinal cord and get the trigeminal nerve cells to misfire. This would result in vague unexplained pain in the above areas.