Abstract
Patients with atypical odontalgia (AO) complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i) What is the prevalence of AO in the community? (ii) What psychological problems are experienced by patients with AO? (iii) Are there any comorbidities of AO? (iv) Is local anesthesia effective for the relief of pain in AO? (v) Are there any characteristic symptoms of AO other than spontaneous pain? (vi) Are antidepressants effective for treatment of AO? (vii) Are anticonvulsants effective for treatment of AO? Our literature search provided answers for these questions; however, there is insufficient evidence-based data to establish guidelines for the diagnosis and treatment of AO. Overall, some diagnostic criteria for neuropathic pain and persistent dentoalveolar pain disorder may be applied to AO patients. The patient's psychogenic background should always be considered in the treatment and/or management of AO. The clinicians may need to treat AO patients using Patient-Oriented Evidence that Matters approach.
Highlights
Patients with atypical odontalgia (AO) complain of medically unexplained toothache
Baad-Hansen et al [42] examined 46 AO patients and showed that episodic tension-type headache (TTH), chronic TTH, and myofascial temporomandibular disorder occurred in 46%, 18%, and 50% of AO patients, respectively
In addition to being linked with temporomandibular disorder (TMD) or TTH, AO has been reported in patients with burning mouth syndrome (BMS) [11, 46,47,48]
Summary
Symptoms include pain without any pathological changes and/or stronger pain than would be expected from the clinical findings. The persistent nature of the pain prompts dentists to treat the teeth in the absence of any pathological findings. Possible pathophysiological mechanisms for AO include those with neuropathic, vascular, and psychogenic origins. Since the clinical course of AO varies among patients, and each case may stem from a different origin, a universal treatment method may not be effective for all AO patients, and it may be difficult to establish an evidence base for clinical management. We formulated seven questions based on our clinical experience in the Japanese Society of Psychosomatic Dentistry. These questions will be reviewed based on current knowledge in the literature, and diagnostic criteria and guidelines for treatment and management will be discussed
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