The fundamental cause of trifacial neuralgia lies in some structural change. The really painful tic usually occurs about the period of middle life or later and is generally caused by a lesion or lesions within the teeth. All strain, whether mental or physical (and this comprises that common to all diseases and conditions), which a normal amount of sleep cannot relieve or during which the tissue consumed cannot be restored, these abnormal conditions are the foundations for an earlier degeneration of the nerve structure. No injury to the teeth from external causes, and no injury to the dental pulp from constitutional causes ever repairs itself. That is, should a tooth be broken or decayed it can never be restored by natural means, or should a pulp nodule or dentinal tumor form within the pulp from constitutional causes it will never be absorbed. A normal life should be led more on
SHIELDS NT. THE ETIOLOGY OF TRIFACIAL NEURALGIA OR TIC DOULOUREUX AND CLINICAL TREATMENT. JAMA. 1913;61(21):1892–1893. doi:10.1001/jama.1913.04350220036011
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