Clinical features of atypical odontalgia; three cases and literature reviews

Abstract

BackgroundAtypical odontalgia (AO) is a disease characterized by continuous pain affecting the teeth or tooth sockets after extraction in the absence of any identifiable cause on clinical or radiographic examination. Antidepressants, such as amitriptyline, are reported to be effective in the treatment of AO; however, their efficacy varies depending on the case. In this article, we report three types of AO and discuss its heterogeneity and management.Case presentationIn the first case, a 58-year-old woman presented with a heavy, splitting pain in the four maxillary front post-crown teeth, as if they were being pressed from the side. Her symptoms abated with 20 mg of amitriptyline. In the second case, a 39-year-old woman presented with a feeling of heaviness pain on the right side of maxillary and mandibular molar teeth, face, whole palate, and throat. She was unable to function because of her pain. Her symptoms drastically subsided with 3 mg of aripiprazole. In the third case, a 54-year-old woman presented with a tingling sensation on the left mandibular second premolar and first molar, and an uncomfortable feeling on her provisional prosthesis that made it unbearable to keep the caps on. Her symptoms diminished with 2 mg of aripiprazole added to 30 mg of mirtazapine.ConclusionsAO shows various features and responses to drugs. It is considered not only a purely sensory problem, but also a considerably complex psychological problem, such as rumination about the pain. Investigating the difference in pharmacotherapeutic responses might help to advance the treatment of AO.

Atypical odontalgia: pathophysiology, diagnosis and management

“…Recent studies do not point to psychiatric comorbidity as a determining cause for triggering AO 15 , but professionals should be aware of this condition 36 and cannot disregard it 22 . A high incidence of AO patients presents these comorbidities 22,33 , reaching 50% in another study 16 . "Neurotic and stressed" 16 and "resentful and depressed" 15 were striking characteristics described in individuals with AO.…”

“…Takenoshita et al 33 AO is not purely a sensory problem, but it has psychological involvement. It has a variable response to drug use, and it is necessary to investigate the different pharmacological responses to advance the treatment of AO.…”

“…Interesting to note that in 1982, Kreisberg 17 already suggested referral to the neurologist; 7) Consider psychological aspects: Although psychogenic and psychiatric factors have no determining relationship in the development of AO 16 , there was a high incidence of these patients with psychiatric comorbidities [14][15][16]22,32,36 . The professional should be aware of these comorbidities, giving AO a multifactorial etiology 31,33 . Thus, a biopsychosocial 31 and interdisciplinary 36 and no less priority 39 approach are necessary 39 ; 8) A more holistic, psychosocial, and not purely mechanical approach is important.…”

A case of an elderly patient with persistent idiopathic facial pain related to dental implants successfully treated with mirtazapine

“…4 However, not all patients respond to TCA. 5 In addition, the risk of side-effects increases in elderly patients treated with TCA because of their anticholinergic profile and patients' age-related declining metabolism and polypharmacy. Among the side-effects of TCA, fall and cognitive impairment should be of particular concern in elderly patients.…”

An interdisciplinary approach to evaluation of the results of dental implantation and prosthetic treatment

“…Ïðè òàêèõ íåâðîïàòè÷íèõ áîëüîâèõ ñòàíàõ, ÿê íåâðàëã³ÿ òð³é÷àñòîãî íåðâà, àòèïîâà îäîíòàëã³ÿ, ñèíäðîì ïàëàþ÷îãî ðîòà, òðàâìàòè÷íà íåéðîïàò³ÿ, ïîñòãåðïåòè÷íà íåâ-ðàëã³ÿ, ïîºäíàíèé áîëüîâèé ñèíäðîì ùåëåïíî-ëèöåâî¿ ä³ëÿíêè ïîìèëêîâà ä³à´íîñòèêà ³íêîëè çóìîâëþº åíäîäîíòè÷íå ë³êóâàííÿ ÷è âèäàëåííÿ çóá³â áåç íåîáõ³äíîñò³ [25,30,35,43,54]. Îêð³ì òîãî, îñîáèñò³ñíî âðàçëèâ³ ïà-ö³ºíòè ç äîñâ³äîì òðàâìàòè÷íèõ ñòîìàòîëî´³÷íèõ âòðó÷àíü, à òèì á³ëüøå -âèÿâàìè "ñòðàõó ïåðåä ñòîìàòîëî´îì" àáî äåïðåñ³¿, íåîõî÷å çâåðòàþòüñÿ äî ïñèõ³àòð³â ³ ââàaeàþòü òàê³ ñêåðóâàííÿ íåäîðå÷íèìè [13,32,57].…”