Quantitative methods for somatosensory evaluation in atypical odontalgia.

André Luís Porporatti,Leonardo Rigoldi Bonjardim,Yuri Martins Costa,Paulo César Rodrigues Conti,Peter Svensson,Juliana Stuginski-Barbosa

doi:10.1590/1807-3107bor-2015.vol29.0020

André Luís Porporatti, Leonardo Rigoldi Bonjardim + Show 4 more

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https://doi.org/10.1590/1807-3107bor-2015.vol29.0020

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Abstract

A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main databases (MEDLINE, EMBASE, and Cochrane Library). The studies included used the following quantitative sensory testing (QST) methods: mechanical detection threshold (MDT), mechanical pain threshold (MPT) (pinprick), pressure pain threshold (PPT), dynamic mechanical allodynia with a cotton swab (DMA1) or a brush (DMA2), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), cold pain detection (CPT), and/or wind-up ratio (WUR). The publications meeting the inclusion criteria revealed that only mechanical allodynia tests (DMA1, DMA2, and WUR) were significantly higher and pain threshold tests to heat stimulation (HPT) were significantly lower in the affected side, compared with the contralateral side, in AO patients; however, for MDT, MPT, PPT, CDT, and WDT, the results were not significant. These data support the presence of central sensitization features, such as allodynia and temporal summation. In contrast, considerable inconsistencies between studies were found when AO patients were compared with healthy subjects. In clinical settings, the most reliable evaluation method for AO in patients with persistent idiopathic facial pain would be intraindividual assessments using HPT or mechanical allodynia tests.

Highlights

Atypical odontalgia (AO) is a rare chronic orofacial condition that represents a real challenge for the dentists.[1]
This systematic review emphasizes the reliability of the dynamical mechanical tests DMA1, DMA2, and wind-up ratio (WUR), and the thermal test heat pain threshold (HPT), for the somatosensory evaluation of AO patients
Additional quantitative sensory testing (QST) appear to be helpful when the patients were compared to healthy controls, such as mechanical tests (DMA1, DMA2, mechanical detection threshold (MDT), mechanical pain threshold (MPT), and pressure pain threshold (PPT)) and thermal tests (HPT)

Summary

Introduction

Atypical odontalgia (AO) is a rare chronic orofacial condition that represents a real challenge for the dentists.[1] These patients feel continuous and severe pain in the tooth or in the dentoalveolar region, in the absence of identifiable odontogenic pathology.[2,3] As such, AO was classified as a type of persistent idiopathic facial pain by the International Headache Society (IHS).[4] The incidence of AO is 3%–6% among patients undergoing endodontic treatment.[5,6] Dental treatments like endodontics can damage or sever nerve fibers, leading to a perturbation or interruption of peripheral afferent impulses. The somatosensory deficit caused by deficient afferent impulses is known as deafferentation. AO was tentatively described as neuropathic pain because of the potential involvement of nerve damage.[7]

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