Acupuncture in the treatment of dentogenic trigeminal neuralgia – molecular mechanisms and safe treatment strategies

Abstract

Dentogenic trigeminal neuralgia usually occurs as a complication of nerve injuries induced by invasive dental interventions, and its sudden onset of violent pain and tolerance to carbamazepine (the first-line drug) represent a major challenge in clinical practice. As a minimally invasive neuromodulation technique, acupuncture has demonstrated remarkable efficacy and safety in improving this condition. This article represents a systemic analysis of the biological mechanisms of acupuncture in the treatment of dentogenic trigeminal neuralgia, indicating that acupuncture effectively inhibits peripheral voltage-dependent sodium channels and P2X3 receptors, reduces microglia-mediated neuroinflammation in the spinal trigeminal nucleus, and activates the endogenous descending inhibitory system to reset pain gain. In clinical practice, deep acupuncture of the Xiaguan point (ST7), combined with low-dose carbamazepine, not only produces an excellent synergistic analgesic effect, but also significantly reduces the adverse effects of the drug and accelerates myelin repair. In conclusion, acupuncture should be considered an important intervention method in the multidisciplinary management of dentogenic trigeminal neuralgia; early intervention and individualized selection of acupuncture points are essential for optimal prognosis. Future research should validate the therapeutic targets of acupuncture, applying a multifactorial and multidisciplinary approach (genomics, proteomics, metabolomics, functional brain imaging and others).