From the Guidelines
Atypical odontalgia is characterized by a continuous, aching, dull, throbbing, or sometimes sharp pain localized to a tooth or tooth-bearing area, with mild to moderate severity, and is often exacerbated by touch. According to the study published in the British Journal of Anaesthesia 1, the symptoms of atypical odontalgia can be summarized as follows:
- Location: Localized to a tooth or tooth-bearing area
- Timing: Continuous
- Quality: Aching, dull, throbbing, or sometimes sharp
- Severity: Mild to moderate
- Aggravating factors: Sometimes touch
- Associated factors: May be hyperaesthesia in the area
- Examination: Intraoral X-rays to ensure no dental problems
- Management: Cognitive behaviour therapy
The pain associated with atypical odontalgia is often persistent and can last for more than 8 hours daily for over 3 months, despite the absence of any detectable pathology on clinical or radiographic examination. Patients may experience heightened sensitivity in the affected area, and some report altered sensations like numbness or tingling. The condition is believed to be neuropathic in nature, resulting from changes in pain processing pathways rather than actual tissue damage, as suggested by the study 1. This explains why traditional dental interventions fail to provide relief and why neuropathic pain medications or cognitive behaviour therapy are often more effective treatment options.
From the Research
Symptoms of Atypical Odontalgia
The symptoms of atypical odontalgia (AO) can vary, but common characteristics include:
- Continuous pain affecting the teeth or tooth sockets after extraction in the absence of any identifiable cause on clinical or radiographic examination 2, 3, 4, 5, 6
- Pain can be described as heavy, splitting, or a feeling of heaviness 2
- Pain can be localized to a specific area, such as the maxillary front post-crown teeth, or can be more widespread, affecting the face, palate, and throat 2
- Pain can be constant or intermittent, and can change in location 6
- Patients may experience a tingling sensation or uncomfortable feeling in the affected area 2
- Pain can be severe enough to interfere with daily functioning 2, 3
Pain Mechanisms
The pain mechanisms involved in AO are not fully understood, but it is thought to be a neuropathic pain condition caused by deafferentation 3, 4. This means that the pain is caused by damage to the nerves, rather than any identifiable problem with the teeth or surrounding tissues.
Differential Diagnosis
AO can be difficult to diagnose, as it shares symptoms with many other pathologies affecting the orofacial region 3, 4, 5, 6. A thorough knowledge of both odontogenic and nonodontogenic causes of orofacial pain is necessary to make an accurate diagnosis. Differential diagnoses to consider include:
- Odontogenic pain
- Sinusitis
- Trigeminal neuralgia
- Myofascial pain
- Pulpal pain