Development and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder

Durham, JA; Stone, Simon; Robinson, Linda; Ohrbach, Richard; Nixdorf, Donald R.

doi:10.1111/iej.13017

Cited by 7 publications

(13 citation statements)

References 29 publications

(38 reference statements)

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“…Table 2. Selected studies and relevant information Durham et al 5 The use of a questionnaire to diagnose neuropathic pain (S-LANSS) is desirable because it has sufficient sensitivity and specificity. However, clinical examination and investigation cannot be neglected.…”

Section: J the Characteristics Do Not Fall Into Any Other Diagnosticmentioning

confidence: 99%

“…2) Importance of the clinical examination: the odontogenic causes of toothache must be totally ruled out. For this, a thorough clinical examination is necessary 5,10,24,40 . One should not forget Rees and Harris's observations 7 emphasizing that all possibilities of caries, pulp disease and crack/fracture of the crown or root should be excluded;…”

Section: Diagnosismentioning

confidence: 99%

“…3) Complementary imaging tests: despite the limitations of periapical radiographs 54,55 they should be used to assess the periapical region. Volumetric computed tomography should be performed to rule out any possibility of periapical endodontic alteration 10,51 .…”

Section: Diagnosismentioning

confidence: 99%

“…Generally, when a patient complains of pain, its origin is odontogenic, and the professional can identify and treat its causefor example, a typical toothache due to pulpitis, caries or periodontal problem. But in some situations, pain continues in one or more teeth or in the socket after extraction without any apparent dental cause 2 , and the dentist faces the challenge of determining the true non-odontogenic origin of pain and properly diagnosing it 1,[3][4][5] . According to the 3 rd edition of the International Headache Society (ICHD-3) 2 , the diagnostic criterion of AO is described by continuous pain in one or more teeth or socket after extraction, without any apparent dental and neurological causes.…”

Section: Introductionmentioning

confidence: 99%

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Atypical odontalgia: pathophysiology, diagnosis and management

Saguchi

Araki

Cardoso

et al. 2019

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Atypical odontalgia, a subtype of persistent idiopathic facial pain, is characterized by continuous pain in one tooth or more, or inside the alveolus after exodontia, with no apparent clinical causes. These patients run the risk of going through unnecessary dental/surgical procedures which would worsen their pain. Since the pathophysiology, diagnosis, and management of atypical odontalgia are not clear, this article aims to present an integrative literature review about these aspects. CONTENTS: A review of articles related to the topic was conducted on the Pubmed database using the keywords "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Applying the inclusion criteria (publications in the last ten years, in English, as clinical trials, multicenter studies, case reports, reviews, integrative and systematic reviews, 114 articles were found, and 39 were selected after the application of the exclusion criteria (articles with no relation to the topic). CONCLUSION: Although studies suggest the involvement of strong neuropathic mechanism, the psychological/psychiatric aspects might be considered not as a primary cause, but as an aggravator of the patient´s pain. Knowledge of other pathologies is recommended in order to determine the differential diagnosis. Also, complementary image tests, qualitative somatosensorial test, and reference to an orofacial pain specialist should be considered. In case of uncertain diagnosis, it is recommended to avoid any dental procedures because the pain can get worse.

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Section: J the Characteristics Do Not Fall Into Any Other Diagnosticmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical odontalgia: pathophysiology, diagnosis and management

Saguchi

Araki

Cardoso

et al. 2019

Brazilian Journal of Pain

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“…10 Consequently, irreversible and ineffective dental treatments may be applied and cause worsening morbidity. 11,12 Therefore, patients with AO and other PIFP continue to suffer from the decline in quality of life associated with chronic pain and possible complications of ineffective treatments. [13][14][15] Moreover, repeated diagnoses and treatments might impose serious health-economic burden on patients, which could have been avoided with early accurate diagnosis.…”

Section: Introductionmentioning

confidence: 99%

<p>Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation</p>

Xiao

Jiang

Liu³

et al. 2020

JPR

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Purpose To explore the challenges faced in the diagnosis and treatment of atypical odontalgia (AO) and other persistent idiopathic facial pain (PIFP). Patients and Methods This retrospective multi-centric cross-sectional study utilized clinical information (eg, clinical manifestations, history of consultations and treatments prior to correct diagnoses) from patients’ medical records. Their economic parameters were also extracted from medical insurance databases. Each variable collected was statistically analyzed. Differences of variables between AO and other PIFP were statistically tested. Results A total of 394 patients were included in this study. On average, the diagnostic delay was 34.8±14.2 months, a median of 7 consultations were performed prior to a correct diagnosis, and 5 ineffective prescriptions were issued. Patients with AO suffered from longer diagnostic delays than patients with other PIFP (38.4±14.3 months vs 31.6±13.4 months) and were more likely to receive invasive dental treatments (73.3% vs 4.3%). The median total cost of treatment for a single patient before correct diagnosis was 8506.3 yuan. Patients with AO spent more than patients with other PIFP (10,146.5 Yuan vs 3864.0 Yuan). Conclusion Patients with PIFP were frequently misdiagnosed and the length of diagnostic delay was observed to be long. Ineffective medications, unwarranted procedures, and unnecessary economic burden were imposed on the patients. Patients with AO are in a worse situation than patients with other PIFP. As significantly urgent and unsatisfactory results of misdiagnosis of PIFP have been reported in our study, more attention should be paid on the research and education in this field.

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Clinical Features of the Persistent Idiopathic Dentoalveolar Pain Compared with Inflammatory Dental Pain

Jang

Chung

2022

J Oral Med Pain

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This study aimed to evaluate the differences between clinical and quantitative sensory testing (QST) results among persistent idiopathic dentoalveolar pain (PIDP), inflammatory dental pain, and control group subjects to identify discriminative clinical features for differential diagnosis.Methods: Methods: Thirty-three patients (5 PIDP-a without surgical procedures 10 PIDP-b with surgical procedures, 8 dental pain patients, and 10 controls) were evaluated for clinical features and QST results. Cold pain threshold, heat pain threshold, mechanical pain threshold (MPT), mechanical pain sensitivity, and pressure pain threshold (PPT) were performed. Psychological factors were assessed using Symptom Checklist-90-Revision (SCL-90-R) and a chart review was conducted to evaluate additional discriminative clinical features such as pain quality and treatment prognosis. Results: Results:The dental pain group had lower PPT than the PIDP-b and the control group. The PIDP-a group showed higher MPT and PPT than the PIDP-b and dental pain group but the difference was not statistically significant. Differences in SCL-90-R SOM (Somatization), O-C (obsessive-compulsive), ANX (anxiety), and PSY (Psychoticism) values were statistically significant among groups. PIDP-a and PIDP-b groups showed remaining symptoms after treatment and the pain tended to spread widely, whereas, in toothache patients, symptoms disappeared after treatment. However, factors that confound the diagnosis, such as an increase in pain during chewing and a decrease in the pain threshold at the affected site, could also be identified.Conclusions: Conclusions: PIDP and dental pain groups have distinct clinical symptoms, but there are also factors that cause confusing in diagnosis. Therefore, various clinical examination results should be carefully reviewed and comprehensively evaluated in the differential diagnosis process.

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Development and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder

Abstract: This preliminary study confirms the new screening instrument for AO/PDAP merits progression to field testing.

Cited by 7 publications

References 29 publications

Atypical odontalgia: pathophysiology, diagnosis and management

Atypical odontalgia: pathophysiology, diagnosis and management

<p>Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation</p>

Clinical Features of the Persistent Idiopathic Dentoalveolar Pain Compared with Inflammatory Dental Pain

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