The challenge of diagnosing atypical odontalgia. Case report

Abstract

BACKGROUND AND OBJECTIVES: Atypical odontalgia is characterized by continuous pain that persists for more than three months in one or more teeth or in the socket after extraction, without apparent dental and neurological causes, with transient pain relief and worsening within a few days or even weeks in patients undergoing extensive dental treatment. These patients are at risk of going through unnecessary dental/surgical procedures, which would worsen their pain. This article aims to report a difficult case of atypical odontalgia diagnosis of a patient that underwent extensive dental treatment accompanied by severe pain. CASE REPORT: A 57-year-old female patient with severe and excruciating pain in the right maxillary region of no identified source. After an endodontic retreatment on teeth 14 and 16, the pain worsened suggesting traumatic pericementitis or reaction to the intracanal drug used. Since the pain did not improve, a pulpectomy on 13 was performed. However, the pain increased significantly, and after an evaluation by volumetric computed tomography, a paraendodontic surgery was performed, but the pain irradiated to the ocular fundus and the maxillary region. The absence of neurological, ophthalmological, and otorhinolaryngological alterations led to the diagnosis of atypical odontalgia. CONCLUSION: The diagnosis of atypical odontalgia is difficult, requiring a multidisciplinary approach listening to the patient's complaint, and, in case of doubt, avoid any procedures not to worsen pain and turn it chronic.