Abstract
AimTo assess whether persistent idiopathic dentoalveolar pain (PIDAP), a diagnosis of exclusion, exhibits common features that can facilitate its diagnosis. PIDAP is defined by the International Classification of Orofacial Pain (ICOP 6.3.) as ‘Persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 h per day for more than 3 months, in the absence of any preceding causative event’.MethodologyIn this observational study, participants fulfilling the new ICOP diagnostic criteria of PIDAP were included, covering 16 years of consecutive data. A systematic, retrospective assessment of patients utilizing the new PIDAP criteria on complaints of chronic tooth pain in a referral‐based endodontic practice was undertaken. Non‐idiopathic cases were excluded on the basis of clinical and radiologic findings. A modified neuropathic pain questionnaire was used to describe the painful sensations. Furthermore, allodynia in the periodontal space and sensory changes in the oral mucosa were assessed using a periodontal probe.ResultsAmongst the 160 patients assessed, 78 (63 women) fulfilled the strict PIDAP criteria. Pain history of PIDAP included no nocturnal awakening (85%) and a ‘pulling/dragging’ pain quality (59%). In 69% of the patients with PIDAP, pain was associated with a root filled tooth at the same site. In 14% of the cases, no endodontic treatment was performed in the affected quadrant. Mechanical allodynia in the gingival sulcus was observed in 91% of patients with painful teeth or implants.ConclusionsIn this observational study, PIDAP mainly affected females and was associated with undisturbed sleep and periodontal allodynia.
Highlights
Dental pain is a relatively common condition with a significant socioeconomic impact (Constante et al, 2012).The main reason for this pain is usually endodontic infection (Zehnder & Belibasakis, 2015)
persistent idiopathic dentoalveolar pain (PIDAP) is defined by the International Classification of Orofacial Pain (ICOP 6.3.) as ‘Persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 h per day for more than 3 months, in the absence of any preceding causative event’
Sixty-four of these were excluded since odontogenic pain, facial headache variants, referred pain and other non-idiopathic pain sources could not be ruled out or signs of gingivitis were present (Figure 1)
Summary
The main reason for this pain is usually endodontic infection (Zehnder & Belibasakis, 2015). Whilst toothaches from endodontically involved, i.e. infected teeth can be excruciatingly intense, they do not normally. PIDAP DENTAL SIGNS AND SYMPTOMS last long before the patient seeks dental care (Rechenberg et al, 2016). This form of ‘typical’ tooth pain usually resolves after endodontic intervention (Law et al, 2015). Patients with persistent toothache require dentists to differentiate between odontogenic, non-odontogenic and mixed pain. The pathophysiology (Vickers & Cousins, 2000), classification (ICOP, 2020), risk factors (Aggarwal et al, 2010), diagnosis, prognosis and therapy for persistent dentoalveolar pain have been discussed extensively (Malacarne et al, 2018). Despite newer classifications being published, many open questions remain
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