8th Edition of International Conference on Dentistry
and Oral Health

August 24-26, 2023 | Virtual Event

August 24-26, 2023 | Online Event
ICDO 2023

Manveer Singh Chhina

Manveer Singh Chhina, Speaker at Oral Health Conferences
Glasgow Dental Hospital & School, United Kingdom
Title: Trigeminal neuropathy as a manifestation of systemic sclerosis.

Abstract:

Introduction/Aims
Trigeminal neuropathy (TNO) is a condition characterised by numbness in the skin and mucous membranes, caused by a trigeminal sensory alteration of one or more branches of the trigeminal nerve. It may also lead to motor disturbance in the muscles of mastication. TNO should be distinguished from trigeminal neuralgia (TNA) which is typified by stabbing, shooting or ‘electric-shock-like’ pain which is often described by sufferers as ‘excruciating’. In the latter condition, there is no sensory impairment or motor weakness.
The nature of TNO is complex as many disease processes are capable of producing them. These aetiologies vary from being idiopathic, inflammatory, connective tissue, vascular malformations, neoplastic, degenerative, or congenital in origin. As these disorders progress, surrounding neurons are destroyed and cause altered sensation and weakness. Interestingly, TNO can also occur as a peripheral manifestation of systemic sclerosis (SSc).

Materials and Methods
A 44-year-old, very tearful female patient presented to the Oral Medicine department with a history of pain initially affecting the left side of her face for more than one year. She reported an excruciating pain initially in the mid-face extending into the eye and teeth. She then developed numbness in this area. Her symptoms had been mainly unilateral, however, she subsequently developed some mid-face paraesthesia on the right side. The pain was described as a ‘squashing or squeezing’ sensation, with the severity being around 8-9/10, and the electric shocks at around 10/10. 

Results/Statistics
Blood tests showed an ANA positivity of 1/2560 with SCL >240. Her Biochemistry profile was unremarkable. Our colleagues in Neurology had carried out an MRI which displayed no demyelination or space-occupying lesion. An OPG showed large pocketing and widespread periodontal disease for which she was referred to the Periodontal department. She was later seen by Rheumatology who provided her a diagnosis of Systemic Sclerosis (SSc), diffuse variant, after finding mucocutaneous grade 2/3 skin involvement over the face and perioral region. Raynaud’s phenomenon was present and had been limiting her functional capacity. She reported no gastrointestinal symptoms, but she did have a transient right-sided pleural effusion with no evidence of interstitial lung disease (ILD). Mycophenolate and Nortriptyline were prescribed to help manage her SSc and TNO with excellent effect.

Conclusions/Clinical Relevance
Trigeminal neuropathy can be a consequence of medical conditions such as SSc, representing a sign of active inflammation and needs to be carefully managed to prevent further deterioration in a patient’s quality of life.

Audience Takeaway Notes:

  • The audience will be able to identify clinical signs and symptoms related to TNO and SSc.
  • The audience will learn why SSc can lead to a patient developing TNO.
  • The audience will learn which investigations are required to conclude a diagnosis of TNO and SSc.
  • The audience will learn about consequences of TNO and SSc on a sufferer’s oral health and wellbeing.
  • The audience will become aware of other medical conditions which may increase the risk of a patient developing TNO.

Biography:

Dr. Chhina studied Dentistry at the University of Plymouth, England and graduated with a BDS in 2019. He then went on to complete Dental Foundation Training (DFT) in the Berkshire, Thames Valley and Wessex Scheme. Following this he carried out senior house officer roles within hospital settings, initially at Kings College Dental Hospital, London in the Oral Surgery, Acute Dental Care, Restorative and Paediatric Dentistry departments from 2020-21. He then obtained a position in the Oral and Maxillofacial Department at Queen Elizabeth Hospital, Birmingham from 2021-22. He currently works in the Glasgow Dental Hospital’s Oral Surgery & Oral Medicine departments.

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