Atypical Odontalgia

Atypical odontalgia means toothache of unknown cause. It is a continuous pain felt in the dentoalveolar structures. Most patients who suffer with this condition have had multiple dental treatments completed. Frustration increases for both the patient and the clinician with each failed treatment. The prevalence of atypical odontalgia is not known. However, studies suggest that between 3-7% of endodontically treated teeth may experience persistent pain. In addition, postimplant neurosensory disturbances range from 0.6% to 36%.

Cause

The cause of atypical odontalgia is not known, although it may share a common cause as other chronic pain conditions in medical population. The clinical characteristics of this pain disorder resemble deafferentation pain with a strong central component. Removal of pulpal tissue or extraction of teeth represents deafferentation procedures.

Symptoms

Atypical odontalgia affects more females than males. The most common affected teeth are maxillary premolars and molars. Patient can usually locate the exact tooth or area that is responsible for the pain. Pain can be dull, aching and persistent for months or even years with no significant change. Patient usually has no other associated symptoms.

Diagnosis

It is important to differentiate atypical odontalgia from toothache of pulpal source. Compared to toothache of pulpal source, atypical odontalgia presents with the following:

No local pathology
Local provocation of the tooth does not alter the pain consistently
Toothache is stable over weeks or months
Failed repeated dental therapies
Local anesthetics cannot completely block the pain
History of trauma

Treatment

Like many continuous neuropathic pain, atypical odontalgia can be difficult to manage. Medications that used to manage atypical odontalgia include

Tricyclic antidepressants
Gabapentin, pregabalin
Tramadol
Topical lidocaine delivered through neurosensory stent
Topical capsaicin

References