Atypical odontalgia — a diagnostic and therapeutic dilemma
E.V. Parkhomenko1, S.E. Nartov2, D.Yu. Karpov1,2
1 Altai State Medical University, Barnaul
2 LLC “Karpov Neuroclinic”, Barnaul
Life of a modern person is difficult to imagine without the intervention of a dentist, and oral hygiene and aesthetics of teeth have become an essential part of health and look. Atypical odontalgia — continuous pain in one or several teeth after canal treatment or tooth extraction in the absence of any dental reasons — can be a painful consequence of visiting this specialist. The development of such a complication leads to a significant reduction in the quality of patient’s life, even though the previous intervention could technically be performed correctly. Atypical odontalgia in clinical practice remains as the diagnosis of exclusion, which can be ascertained only after a thorough study and exclusion of other diseases of the maxillofacial area. Awareness of physicians of various specialties about this refractory chronic orofacial pain syndrome is crucial for the prevention of unreasonable endodontic treatment and vain teeth extraction. The article presents data on the prevalence, classification, pathogenesis, clinical features, diagnosis and treatment of atypical odontalgia. Particular attention is paid to the differential diagnosis of the described disease with odontogenic pain, trigeminal neuralgia, postherpetic neuralgia, myofascial pain syndrome of the face, and temporomandibular joint dysfunction. The article presents recommendations for the patient management with this disease in accordance with current data on the pathogenesis and treatment of this disease.
Key words: atypical odontalgia, persistent idiopathic pain, neuropathic pain, differential diagnosis, treatment.
For citation: Parkhomenko E.V., Nartov S.E., Karpov D.Yu. Atypical odontalgia — a diagnostic and therapeutic dilemma // RMJ. Medical Review. 2018. № 9. P. 14–18.
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35. Bates R.E., Stewart C.M. Atypical odontalgia: phantom tooth pain // Oral Surg Oral Med Oral Pathol. 1991. Vol. 72. P. 479-483. PMID: 1681488.
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41. Kimos P., Biggs C., Mah J. et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial // Pain. 2007. Vol. 127(1–2). P. 151–160. DOI: 10.1016/j.pain.2006.08.028.
42. Gremeau-Richard C., Woda A., Navez M.L. et al. Topical clonazepam in stomatodynia: a randomised placebo-controlled study // Pain. 2004. Vol. 108 (1-2). P. 51–57. DOI: 10.1016/j.pain.2003.12.002.
43. Zakrzewska J.M., Chaudhry Z., Nurmikko T.J. et al. Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial // Pain. 1997. Vol. 73 (2). P. 223–230. PMID: 9415509.
44. Killian J.M., Fromm G.H. Carbamazepine in the treatment of neuralgia // Use of side effects. Archives of Neurology. 1968. Vol. 19(2). P. 129–136. DOI: 10.1001/archneur.1968.00480020015001.
45. Baad-Hansen L., Juhl G.I., Jensen T.S. et al. Differential effect of intravenous S-ketamine and fentanyl on atypical odontalgia and capsaicin-evoked pain // Pain. 2007. Vol. 129. P. 46–54. PMID: 17088020. DOI: 10.1016/j.pain.2006.09.032.
2. Baad-Hansen L. Atypical odontalgia — pathophysiology and clinical management // J. Oral Rehabil. 2008. Vol. 35. P. 1–11. DOI: 10,1111 / j.1365-2842.2007.01813.x.
3. Nixdorf D., Drangsholt M., Ettlin D. et al. Classifying orofacial pains: a new proposal of taxonomy based on ontology // J Oral Rehabil. 2012. Vol. 39 (3) Р. 161–169. DOI: 10,1111/j.1365-2842.2011.02247.x.
4. Marbach J.J. Phantom tooth pain // J Endod. 1978. Vol. 4 (12). Р. 362–372. DOI: 10.1016/S0099-2399(78) 80211-8.
5. Woda A., Tubert-Jeannin S., Bouhassira D. et al. Towards a new taxonomy of idiopathic orofacial pain // Pain. 2005. Vol. 116 (3). P. 396–406. DOI: 10,1016/j.pain.2005.05.009.
6. Baad-Hansen L., Pigg M., Ivanovic S. et al. Intraoral somatosensory abnormalities in patients with atypical odontalgia — a controlled multicenter quantitative sensory testing study // Pain. 2013. Vol. 154 (8). P. 1287–1294. DOI: 0.1016/j.pain.2013.04.005.
7. Marbach J.J. Is phantom tooth pain a deafferentation (neuropathic) syndrome? (part 1): evidence derived from pathophysiology and treatment // Oral Surg Oral Med Oral Pathol. 1993. Vol. 75. P. 95–105. PMID:8419881.
8. Merskey H., Bogdūk N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms, 2nd edition. Seattle: IASP Press. 1994. http://www.iasp-pain.org/Education/content.aspx?ItemNumber=1698.
9. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders // Cephalalgia (3rd ed). 2018. Vol. 38(1). P. 1–21. DOI: 10,1177 / 0333102417738202.
10. Marbach J., Raphael K. Phantom tooth pain: a new look at an old dilemma // Pain Med. 2000. Vol. 1 (1). P. 68–77. DOI:10,1046/j.1526-4637.2000.00012.x.
11. Abiko Y., Matsuoka H., Chiba I., Toyofuku A. Current evidence on atypical odontalgia: diagnosis and clinical management // Int J Dent. 2012. P. 518548. DOI: 10.1155/2012/518548.
12. Brooke R.I. Atypical odontalgia. A report of twenty-two cases // Oral Surg Oral Med Oral Pathol. 1980. Vol. 49. P. 196–199. PMID: 6928299.
13. Woda A., Pionchon P. A unified concept of idiopathic orofacial pain: pathophysiologic features // J Orofac Pain. 2000. Vol. 14. P. 196–212. PMID: 11203755.
14. Takenoshita M., Sato T., Kato Y. et al. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities // Neuropsychiatr Dis Treat. 2010. Vol. 6. P. 699–705. DOI: 10,2147 / NDT.S12605.
15. Porporatti A., Costa Y. Stuginski-Barbosa J. et al. Quantitative methods for somatosensory evaluation in atypical odontalgia // Braz Oral Res. 2015. Vol. 29 (1). P. 1–7. DOI: 10.1590/1807-3107BOR- 2015 .vol29.0020.
16. Malacarne A., Spierings E., Lu C., Maloney G. Persistent dentoalveolar pain disorder: a comprehensive review // J Endod. 2018. Vol. 44(2). P. 206–211. DOI:10,1016/j.joen.2017.09.009.
17. Marbach J.J. Is phantom tooth pain a deafferentation (neuropathic) syndrome? Part II: Psychosocial considerations // Oral Surg Oral Med Oral Pathol. 1993. Vol. 75(2). P. 225–232. PMID: 8426723.
18. Porporatti A., Costa Y. Stuginski-Barbosa J. et al. Quantitative methods for somatosensory evaluation in atypical odontalgia // Braz Oral Res. 2015. Vol. 29(1). P. 1–7. DOI: 10.1590/1807-3107BOR-2015.vol29.0020.
19. Klausner J. Epidemiology of chronic facial pain: diagnostic usefulness in patient care // J Am Dent Assoc. 1994. Vol. 125 (12). P. 1604–1611. PMID: 7798480.
20. Graff-Radford S., Solberg W. Atypical odontalgia // J Craniomandib Disord. 1992. Vol. 6 (4). P. 260–265. PMID:1298761.
21. Rees R., Harris M. Atypical odontalgia // Br J Oral Surg. 1979. Vol. 16. P. 212–218. PMID: 285723.
22. Toyofuku A. Psychosomatic problems in dentistry // Biopsychosoc Med. 2016. Vol. 10. P. 14. DOI : 10,1186 / s13030-016-0068-2.
23. Marbach J. Phantom tooth pain: differential diagnosis and treatment // N Y State Dent J. 1993. Vol. 59. P. 28–33. PMID:8302511.
24. Miura A., Tu T., Shinohara Y. et al. Psychiatric comorbidities in patients with Atypical Odontalgia // J Psychosom Res. 2018. Vol. 104. P. 35–40. DOI : 10.1016/j. jpsychores.
25. Okeson J. Non-odontogenic toothache // Northwest Dent. 2000. Vol. 79(5). P. 37–44. PMID: 11413614.
26. Matwychuk М. Diagnostic Challenges of Neuropathic Tooth Pain // J Can Dent Assoc. 2004. Р. 70 (8). Р. 542–546. PMID: 15363215.
27. Tarce M., Barbieri C., Sardella A. Atypical odontalgia: an up-to-date view // Minerva Stomatol. 2013. Vol. 62(5). P. 163–181. PMID: 23715202.
28. Zakrzewska J. Medical management of trigeminal neuropathic pains // Expert Opin Pharmacother. 2010. Vol. 11(8). P. 1239–1254. DOI : 10.1517/14656561003767449.
29. Vickers E.R., Cousins M.J., Walker S., Chisholm K. Analysis of 50 patients with atypical odontalgia. A preliminary report on pharmacological procedures for diagnosis and treatment // Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998. Vol. 85 (1). P. 24–32. PubMed. PMID: 9474610.
30. Epstein J.B., Marcoe J.H. Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia // Oral Surg Oral Med Oral Pathol. 1994. Vol. 77. P. 135–140. PMID: 8139830.
31. List T., Leijon G., Helkimo M. et al. Effect of local anesthesia on atypical odontalgia—a randomized controlled trial // Pain. 2006. Vol. 122(3). P. 306–314. DOI: 10.1016/j.pain.2006.02.005.
32. Lynch M.E., Elgeneidy A.K. The role of sympathetic activity in neuropathic orofacial pain // J Orofacial Pain. 1996. Vol. 10. P. 297–305. PMID: 9161234.
33. Cuadrado M.L., García-Moreno H., Arias J.A., J. Pareja A., Botulinum Neurotoxin Type-A for the Treatment of Atypical Odontalgia // Pain Medicine. 2016. Vol. 17. P. 1717–1721. DOI: 10.1093/pm/pnw040.
34. Garcia-Saez R., Gutierrez-Viedma A., Gonzalez-Garcia N. et al. OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients // Journal of Pain Research. 2018. Vol. 11. P. 1583–1588. DOI: 10.2147/JPR.S169701.
35. Bates R.E., Stewart C.M. Atypical odontalgia: phantom tooth pain // Oral Surg Oral Med Oral Pathol. 1991. Vol. 72. P. 479-483. PMID: 1681488.
36. Pertes R.A., Bailey D.R., Milone A.S. Atypical odontalgia—a nondental toothache // J N J Dent Assoc. 1995. Vol. 66. P. 29-33. PMID: 9520703.
37. Ito M., Kimura H., Yoshida K. et al. Effectiveness of milnacipran for the treatment of chronic pain in the orofacial region // Clinical Neuropharmacology. 2010. Vol. 33 (2). P. 79–83. DOI: 10.1097/WNF.0b013e3181cb5793.
38. Nagashima W., Kimura H., Ito M. et al. Effectiveness of duloxetine for the treatment of chronic nonorganic orofacial pain // Send to Clin Neuropharmacol. 2012. Vol. 35 (6). P. 273–277. PMID: 23123692. DOI: 10.1097/WNF.0b013e31827453fa.
39. Kobayashi Y., Nagashima W., Tokura T. et al. Duloxetine Plasma Concentrations and Its Effectiveness in the Treatment of Nonorganic Chronic Pain in the Orofacial Region // Clin Neuropharmacol. 2017. Vol. 40 (4). P. 163–168. PMID: 28622208. DOI: 10.1097/WNF.0000000000000225.
40. Martin W., Forouzanfar T. The efficacy of anticonvulsants on orofacial pain: a systematic review // Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2011. Vol. 111(5). P. 627–633. DOI: 10.1016/j.tripleo.2011.01.033.
41. Kimos P., Biggs C., Mah J. et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial // Pain. 2007. Vol. 127(1–2). P. 151–160. DOI: 10.1016/j.pain.2006.08.028.
42. Gremeau-Richard C., Woda A., Navez M.L. et al. Topical clonazepam in stomatodynia: a randomised placebo-controlled study // Pain. 2004. Vol. 108 (1-2). P. 51–57. DOI: 10.1016/j.pain.2003.12.002.
43. Zakrzewska J.M., Chaudhry Z., Nurmikko T.J. et al. Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial // Pain. 1997. Vol. 73 (2). P. 223–230. PMID: 9415509.
44. Killian J.M., Fromm G.H. Carbamazepine in the treatment of neuralgia // Use of side effects. Archives of Neurology. 1968. Vol. 19(2). P. 129–136. DOI: 10.1001/archneur.1968.00480020015001.
45. Baad-Hansen L., Juhl G.I., Jensen T.S. et al. Differential effect of intravenous S-ketamine and fentanyl on atypical odontalgia and capsaicin-evoked pain // Pain. 2007. Vol. 129. P. 46–54. PMID: 17088020. DOI: 10.1016/j.pain.2006.09.032.
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