Intraoral neuropathy

Abstract

Chronic nonodontogenic toothache has been reported in the literature since the 1700s. This problem has followed a similar scenario since those first reports. The patient typically is misdiagnosed and then subjected to multiple unnecessary procedures, ultimately resulting in tooth extractions because of dentists and physicians being unaware of the existence of atypical odontalgia and other types of intraoral neuropathic pain that are treatable without sacrificing the teeth. This paper reviews the medications and procedures used to treat nonodontogenic toothache.

Peripheral painful traumatic trigeminal neuropathies

“…Peripheral painful traumatic trigeminal neuropathy may be a result of nerve injury from repeated dental interventions aimed at pain relief in misdiagnosed entities. This theory is supported by findings that chronic craniofacial pain patients undergo extensive but often-misguided surgical interventions (Israel et al, 2003;Merrill, 2004). Surgical intervention clearly exacerbated pain in 55% of surgically treated patients -possibly they had superimposed PPTTN.…”

Clinical characteristics and diagnosis of atypical odontalgia

“…n recent years, investigators have recognized atypical odontalgia (AO) as a chronic trigeminal neuropathy affecting the maxillary or mandibular divisions of the trigeminal nerve. 1,2 Alternative terms for AO are "persistent orodental pain" and, if the patient has had teeth extracted, "phantom tooth pain." Patients with AO often have continuous pain located in a tooth, the gingiva or an extraction site, and it often can involve other areas of the face.…”

Dental Note: Drug treatment of neuropathic pain

“…The presentation of neuropathic pain in and around the mouth has been extensively reviewed. 1,2,3 If neuropathic pain is suspected a thorough clinical evaluation is necessary to assess this type of pain and its mechanism. Dental treatments that are irreversible and potentially harmful to the underlying dentoalveolar structures must be avoided when the diagnosis is uncertain.…”