Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

Abstract

BackgroundBurning mouth syndrome (BMS) and atypical odontalgia (AO) are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities.ObjectiveTo analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities.Study designPsychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision.ResultsThe proportion of F4 classification (neurotic, stress-related, and somatoform disorders) in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders). However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses.ConclusionAlthough BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ substantially.

Diagnostic challenges of nonodontogenic toothache

“…In recent study, Nixdorf et al reported the frequency of nonodontogenic pain in patients who had undergone endodontic procedures was approximately 3.4%, that is, nonodontogenic pain is not an uncommon outcome after root canal treatment 19. In other recent study, Takenoshita et al reported that for burning mouth syndrome, the complaints occurred after dental treatment in 38.9%, after other medical treatment in 10.3%, after stressful or emotional events in 10.3%, and spontaneously in 36.5%, that is, more than on third of patients of Burning mouth syndrome relate time of onset to a dental procedures 20. The patient can misunderstand the pain which is actually nonodontogenic pain, occurs because of the dental procedures.…”

Amplified Brain Processing of Dentoalveolar Pressure Stimulus in Persistent Dentoalveolar Pain Disorder Patients

“…10 Although preclinical data in cats 52,53 and rats 54 support functional alterations in trigeminal brainstem neurons following tooth pulp extirpation, evidence from primates, including humans, is lacking. Dental procedures preceding PDAP onset have been anecdotally described, with reported occurrence of 54% 55 up to 83%. 21 By contrast, other studies have reported that 24% 55 to 64% 56 of the patients with pain did not have a preceding dental procedure.…”

“…Dental procedures preceding PDAP onset have been anecdotally described, with reported occurrence of 54% 55 up to 83%. 21 By contrast, other studies have reported that 24% 55 to 64% 56 of the patients with pain did not have a preceding dental procedure. The evidence of increased brain activation in areas associated with sensory-discriminative and cognitive aspects of pain processing (eg, thalamus, SI, SII, insula, prefrontal cortex) as well as an integrative cortical area related to somatosensation (IPL) 38,57,58 support the hypothesis of altered central neural mechanisms in PDAP pain.…”

Persistent Dento-Alveolar Pain Disorder (PDAP): Working towards a Better Understanding

“…In the last decade there have been three articles published that assessed psychosocial factors in patients with PDAP, all employing a case-control study design (28,37,38). The first study used the SCL-90 questionnaire to assess this domain for ten cases plus ten matched controls.…”

“…The third study was restricted to patients being referred from psychiatric facilities and compared patients with PDAP to those with burning mouth syndrome (BMS), but with no pain-free controls (38). Of the 36 patients with PDAP and pre-existing records, the referring clinic had given the following diagnoses: 19 (53%) had a somatoform disorder, 8 (22%) a mood disorder, and 14 (39%) had no psychiatric diagnosis.…”