Persistent Dentoalveolar Pain Research Articles

Evaluating the Influence of Acute and Chronic Orofacial Pains on the Overall Comprehensive Quality of Life.

Background Orofacial discomfort refers to various disorders that affect the mouth, jaws, and face. These conditions may substantially influence a person's quality of life (QoL). This kind of pain may be categorised into two primary classifications: acute and chronic. Acute orofacial pain (OFP) usually occurs suddenly and lasts for a short period. It is commonly caused by specific factors such as dental treatments, traumas, or infections. Hence, this study aimed to assess the influence of acute and chronic orofacial discomfort on the overall QoL. Methodology This research used a convenience sample to gather data from the five groups. It was conducted as a cross-sectional study. Four categories of OFP syndromes were utilised: temporomandibular disorders (TMDs), atypical dental pain (ADP), trigeminal neuralgia (TN), and persistent dentoalveolar pain disorder (PDAP). In addition, a control group consisting of individuals who did not experience any discomfort was also included in the study. Participants received a standardised explanation of the questionnaires utilised, and in most instances, they completed them at the clinic under the supervision of one of the investigators. Results The correlations between each version of the Oral Health Impact Profile (OHIP) were statistically significant (p < 0.001), with correlation values ranging from 0.92 to 0.97. When comparing the occurrence of OHIP items across the four pain types, we identified 18 variations that exceeded the 35% prevalence threshold we established for identifying important items that frequently occur out of the 315 comparisons. The question "Have you had a painful aching in your mouth?" showed a low frequency in patients with TN, TMD, and ADP but a significant prevalence in patients with PDAP (90%). This difference in prevalence across pain types was the biggest seen. The question that seemed to distinguish between the pain categories most effectively was "Have you experienced a toothache?" This question had a high occurrence in PDAP (65%) and ADP (60%), perhaps allowing for differentiating these two diseases from TN and TMD. The highest prevalence differences, over 30%, were most often seen when PDAP was included as one of the disorders being compared. ADP had the fewest variances, over 30%, occurring just seven times. Conclusion Both acute and chronic OFPs have a major negative influence on QoL, but they affect it differently and to differing extents. Injury-related acute pain obviously poses rapid and severe restrictions on physical function and causes temporary psychological distress and temporary social exclusion. On the other hand, chronic pain for the patient always implies being locked in a physical world that does not allow him or her to bypass physical limitations, psychological disorders remain constant, and isolation from other people persists for life.

Post-traumatic Trigeminal Neuropathy Associated With Endodontic Therapy: A Systematic Review.

A painful or non-painful trigeminal nerve lesion brought on by trauma that exhibits symptoms and/or clinical evidence of trigeminal nerve dysfunction is known as painful post-traumatic trigeminal neuropathy (PTTN). In relation to this, the term post-traumatic persistent dentoalveolar pain (PDAP) is an idiopathic condition of chronic neuropathic origin that manifests as a diagnostic challenge for dental practitioners. Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." PDAP is located primarily in the teeth and jaws. This study systematically reviews how likely it is to get painful PTTNif the patient receivedendodontic therapy and the duration between doing root canal therapy (RCT) and getting PTTN. A systematic review was carried out using key search terms from PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) with English as the only permitted language. There were strict inclusion requirements. The 10 articles that were included showed a prevalence of an endodontic procedure anywhere from three to 48 months following post-endodontic treatment, and it mainly affects females in their mid-40s with no variation regarding the areas, whether it is in the maxilla or mandible. The lack of information about the association between RCT and PTTN led practitioners to make wrong diagnoses, which made the patient unwilling to seek further help. So, in this review, we identified some visible characteristics that can help in that process.

Persistent dentoalveolar pain disorder: A putative intraoral chronic overlapping pain condition.

Chronic overlapping pain conditions (COPCs) are conditions that share several clinical characteristics and symptomatology, are usually considered idiopathic in nature, and are frequently comorbid. Currently, there are no established inclusion criteria to determine which conditions should be included under this umbrella term despite different systems proposed. Persistent dentoalveolar pain disorder (PDAP), also referred to as atypical odontalgia and thought to be a component of persistent idiopathic facial pain, is a chronic pain condition that manifests as a persistent tooth pain or pain over a dentoalveolar site formerly occupied by a tooth in the absence of detectable pathology during clinical or radiological examination. PDAP is considered idiopathic in nature, and its pathophysiological mechanisms are not fully understood. Our objective was to investigate whether PDAP fits the conceptual paradigm of COPC given its characteristics and commonalities with other COPC, based on published literature identified through a scoping review. We found that PDAP fits 16 out of 18 common characteristics among COPCs, and based on this finding, we discuss the implications of PDAP being considered a COPC.

Diagnostic delay and suboptimal management in persistent idiopathic facial pain and persistent dentoalveolar pain; a cross-sectional study

The aim of this study was to explore the diagnostic and therapeutic challenges encountered by patients with persistent idiopathic facial pain (PIFP) and to investigate factors influencing its delayed diagnosis. In this cross-sectional study, 34 patients with newly diagnosed PIFP were interviewed. Data about diagnostic delay, number and nature of previous consultations, and previous medical and surgical interventions were recorded. Pearson's correlation and Student t test were used to examine the differences among the variables in relation to diagnostic delay. The average time between the onset of symptoms to correct diagnosis was 19.3 ± 11.1 months. Diagnostic delay was significantly longer in patient with pain localized to intraoral sites (22.6 ± 7.4) compared with patients with extraoral pain (16.1 ± 9.3). The average number of health care professionals consulted before correct diagnosis was 3.7 ± 2.3. General dental practitioners were the most commonly consulted health care professionals (n = 27; 79.4%). On average, patients were given 2.3 ± 0.24 misdiagnoses before the correct diagnosis was determined and were prescribed 3.5 ± 2.4 classes of drugs. Twenty-five patients (73.5%) underwent unnecessary surgical/dental interventions. Patients with PIFP are frequently misdiagnosed, leading to prescription of ineffective medications and unnecessary investigations and surgical interventions. Educational efforts should emphasize on improving knowledge and awareness of this condition.

Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain.

Objective To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

Psychological Interventions for Persistent Orofacial Pain

Persistent pain has been defined as pain lasting beyond the normal time of healing (up to six months), often in the absence of observable tissue pathology. it includes a range of conditions which are likely to present in the dental setting including temporomandibular disorders, burning mouth syndrome, persistent dentoalveolar pain, trigeminal nerve injury, trigeminal neuralgia and atypical facial pain.<br/> This article reviews psychological interventions for pain. this includes interventions that have been researched in a range of persistent pain settings, including but not limited to those that have been directly applied to persistent orofacial pain (POFP).<br/> All current psychological interventions for persistent pain are underpinned by a biopsychosocial understanding of the complex and multifactorial nature of pain. the main currently applied interventions are described, along with their rationale and selected relevant research. To date, psychological treatments which have been shown to persistent pain demonstrate small but consistent improvements in pain, disability and quality of life compared to standard care.<br/> A stepped care approach to service provision is outlined, with practical ideas for administering routine psychological measures to help stratify patients towards the appropriate care pathway.

Initial accuracy assessment of the modified S-LANSS for the detection of neuropathic orofacial pain conditions.

To evaluate the accuracy of a questionnaire modified for the identification of intraoral pain with neuropathic characteristics in a clinical orofacial pain sample population. 136 participants with at least one of four orofacial pain diagnoses (temporomandibular disorders [TMD, n = 41], acute dental pain [ADP, n = 41], trigeminal neuralgia [TN, n = 19], persistent dentoalveolar pain disorder [PDAP, n = 14]) and a group of pain-free controls (n = 21) completed the modified S-LANSS, a previously adapted version of the original questionnaire devised to detected patients suffering from intraoral pain with neuropathic characteristics. Psychometric properties (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) were calculated in two analyses with two different thresholds: (1) Detection of pain with neuropathic characteristics: PDAP + TN were considered positive, and TMD + ADP + controls were considered negative per gold standard (expert opinion). (2) Detection of PDAP: PDAP was considered positive and TMD + ADP were considered negative per gold standard. For both analyses, target values for adequate sensitivity and specificity were defined as ≥ 80%. For detection of orofacial pain with neuropathic characteristics (PDAP + TN), the modified S-LANSS presented with the most optimistic threshold sensitivity of 52% (95% confidence interval [CI], 34-69), specificity of 70% (95% CI, 60-79), PPV of 35% (95% CI, 22-51), and NPV of 82% (95% CI, 72-89). For detection of PDAP only, with the most optimistic threshold sensitivity was 64% (95% CI, 35-87), specificity 63% (95% CI, 52-74), PPV 23% (95% CI, 11-39) and NPV 91% (95% CI, 81-97). Based on a priori defined criteria, the modified S-LANSS did not show adequate accuracy to detect intraoral pain with neuropathic characteristics in a clinical orofacial pain sample.

Persistent Dento-Alveolar Pain Disorder: The Patient You Will Never Forget…

The Persistent Dento-Alveolar Pain Disorder (PDAP) is a neuropathic pain with a nonodontogenic etiology, difficult to diagnose and its usually accompanied by a growing anxiety from both the patient and also the dentist because of the multiple unsuccessful treatments performed attempting to relieve the pain. A thorough medical history, including complete clinical and radiographic examination and other relevant diagnostic tests, should aid the dentist to diagnose as early as possible, in order to start the indicated treatment for each case. The interdisciplinary management is recommended, as this condition usually involves psychosocial aspects of the patient, affecting his quality of life. Before performing any invasive clinical treatment, a responsible dentist should obtain a clear diagnosis of the etiology of the pain, and if in any doubt, always suspect of a nonodontogenic pain, such as the PDAP.

What is the impact of acute and chronic orofacial pain on quality of life?

ObjectivesOrofacial pain (OFP) is thought to substantially reduce oral health-related quality of life (OHRQoL). Little has been reported about the impact of acute dental pain and persistent (chronic) orofacial pain conditions, other than temporomandibular disorders (TMD), on OHRQoL. The aim of this study was to examine and compare OHRQoL impairment among four OFP conditions: TMD, acute dental pain (ADP), trigeminal neuralgia (TN) and persistent dentoalveolar pain disorder (PDAP). MethodsOHRQoL was measured using the OHIP-49 in a convenience sample of subjects with four OFP conditions (TMD (n=41), ADP (n=41), TN (n=21), PDAP (n=22) and a pain-free control group (n=21)). The mean OHIP-49 summary score described the level of impact and inferential and descriptive statistics were used to examine any differences inter-condition. The mean of the OHIP-14 and 5 were also measured by extracting the corresponding items from the OHIP-49. ResultsAll pain conditions presented with statistically significant (P<0.001) and clinically relevant (measured by effect sizes and the OHIP's minimal important difference) impairment when compared to the control group (P<0.001). The OHRQoL for the four OFP conditions had similar levels of impairment (TMD=62.3, ADP=55.5, TN=58.1 and PDAP=69.8). ConclusionTMD, ADP, TN and PDAP have substantial impact on OHRQoL as measured by the OHIP-49 and the extracted items for the OHIP-14 and 5. Differences among the four groups of orofacial pain conditions are likely not to be substantial.

Effect of topical anaesthesia in patients with persistent dentoalveolar pain disorders: A quantitative sensory testing evaluation

ObjectiveThe aim of this study was to test the hypothesis that patients with persistent dentoalveolar pain disorder (PDAP) expresses somatosensory abnormalities through quantitative sensory testing (QST), when compared to healthy controls; and that individuals with PDAP do not have somatosensory alterations after application of a topical anaesthetic gel. DesignQST was performed in 25 subjects with PDAP (19 women and 6 men), at baseline and after topical application of benzocaine 2% (Benzotop 200mg/g, DFL) and compared to 25 matched healthy controls. After “Z” score transformation, results were analyzed using the paired “t” test and “t” test with significance level of 5%. ResultsPDAP subjects have lower pain detection thresholds confirmed through mechanical tests; and higher pain intensity report through thermal stimuli tests (heat and cold) when compared to healthy subjects. Topical anaesthesia partially reduces in 60% pain intensity of PDAP patients; and anaesthetic gel increases mechanical detection thresholds and reduces pain intensity report in dynamical mechanical allodynia tests. ConclusionsPDAP patients had abnormal thermal sensory and mechanical allodynia, which is indicative of central sensitization. Moreover, topical anaesthetic incited a significant reduction in pain intensity, and an increase in mechanical and pain detection thresholds, which could be also suggestive of a peripheral disorder.

Differential Diagnoses for Persistent Pain after Root Canal Treatment: A Study in the National Dental Practice-based Research Network

IntroductionPain present 6 months after root canal treatment (RCT) may be of odontogenic or nonodontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT. MethodsWe enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1 of 10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomographic radiographs, to determine diagnoses. ResultsThirty-eight of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth and 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder pain and 1 from persistent dentoalveolar pain disorder). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, whereas 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation. ConclusionsPatients reporting “tooth” pain 6 months after RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with temporomandibular disorder being the most frequent nonodontogenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients.

Persistent dento-alveolar pain disorder (PDAP)

Dento-alveolar pain is common in the orofacial area. Persistent dento-alveolar pain could be experienced without an identifiable etiology with poor response to existing treatments. Confusion about the diagnosis and classification of persistent dento-alveolar pain (PDAP) disorders could explain the difficulties in treatment and unfavorable prognosis. Recently, initial steps were made to improve the taxonomy and diagnostic criteria for PDAP in order to improve clinical research and care.

Cooperative Intervention by Multidisciplinary Pain Center and Dental Clinic for a Patient with Persistent Dentoalveolar Pain

Cooperative Intervention by Multidisciplinary Pain Center and Dental Clinic for a Patient with Persistent Dentoalveolar Pain

Effects of Kamishoyosan, a Traditional Japanese Kampo Medicine, on Pain Conditions in Patients with Intractable Persistent Dentoalveolar Pain Disorder.

There are patients who suffer from persistent dentoalveolar pain disorder (PDAP) which is a pain of the teeth, either dentoalveolar pain or nonodontogenic toothache, and its cause has not yet been identified. An effective intervention for PDAP has not yet been established. Interventions for patients with PDAP are generally pharmacological treatments such as antidepressants, anticonvulsants, and pregabalin. However, these medicines are not always effective for patients. The pain disorder in the orofacial region including temporomandibular disorder (TMD) and PDAP was effectively treated with our original exercise therapy. However, we did observe some intractable cases of PDAP even when our original exercise therapy was used. This paper presents our findings in which Kamishoyosan improved the pain intensity in 14 out of 15 PDAP patients refractory to our original exercise therapy.

Healthcare pathway and biopsychosocial impact of persistent dentoalveolar pain disorder: a qualitative study

To examine persistent dentoalveolar pain disorder (PDAP) patients' reported experiences of the biopsychosocial impacts of the condition and its healthcare pathway. Qualitative semi-structured interviews were conducted with a university-based cohort of PDAP patients. One interviewer used an open-ended, evolving, topic guide, and all interviews were recorded and transcribed verbatim. Data collection and analysis continued until saturation (n=20). The principles of the constant comparative method were followed, and frameworks were used to help organize and analyse the data. PDAP exerts significant biopsychosocial impacts on the individual. These impacts occur across a wide variety of everyday activities including employment, personal relationships and social activities. The conceptualization and acceptance of PDAP are difficult for patients given the reinforcement of multiple ineffective dental treatments perceived as targeting the source of their pain. There is an urgent need for earlier identification of PDAP cases in order to minimize the negative biopsychosocial effects of multiple dental interventions incorrectly applied to treat the symptom of pain.

Persistent Dentoalveolar Pain: The Patient’s Experience

To build an understanding of the patient's experience and from this identify recurring themes that could form part of an item pool for further testing of persistent dentoalveolar pain disorder (PDAP). Proven cases of PDAP were identified from a clinical database, and a purposive maximum variation sample was drawn. Semi-structured interviews were conducted with the sample by a single trained interviewer. Interviews were digitally recorded and transcribed verbatim. Data collection and analysis occurred until data saturation (n = 20), with no new themes emerging. Analysis of the data was an iterative and inductive process broadly following the principles of the constant comparative method. Recurrent themes emerging from the data were: difficulty in responding to history taking; duration and magnitude of pain; complex and confounding descriptors; common exacerbating factor; well-localized pain; deep pain; pressurized or pressure feeling. Several common experiences that can be considered items were identified in the data. These items will add to the limited pre-existing item pool in the literature and allow testing of this item pool to determine those items best suited to form an adjunctive self-report diagnostic instrument for PDAP.

Current Evidence on Atypical Odontalgia: Diagnosis and Clinical Management

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.

Orofacial Pain: Part Two.

This issue of Reviews in Pain explores some of the (putative) neurovascular and neuropathic pains that can affect the craniofacial region: Migraine, Burning Mouth Syndrome, and Persistent Dentoalveolar pain (PDAP, previously classified as phantom tooth pain, or atypical odontalgia). Mostly these pain entities have a typical presentation that makes diagnosis for the health professional relatively straightforward, but at other times they can present atypically, with other painful co-morbidities, or masquerade as another type of headache or as pathology associated with the dentition (1–7). Compounding this is the possibility that the pain may be secondary to an intracranial pathology. The articles in this issue helpfully illustrate the main presenting features for those readers who are less familiar with these trigeminally mediated pains. They also highlight that in more difficult cases and in the absence of definitive biomarkers, or investigations, more than one discipline may be needed to help establish a diagnosis. What is clear from the papers is that advances in the understanding of the genomics and pathophysiology of conditions such as Migraine, may help further our understanding of the aetiology of some of the less well understood pains affecting the Trigeminal system. These advances in understanding are likely to translate into better management strategies either through more targeted, or more efficacious, treatment modalities. Such cross-condition and cross-discipline translational advances are clearly urgently needed in conditions such as PDAP, which can have significant psychosocial and economic impacts on the individual.

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

• New terminology, persistent dento-alveolar pain disorder (PDAP), and diagnostic criteria have been put forward to address the shortcomings of existing nomenclature, which are associated with unclear criteria. • Arriving at an accurate diagnosis of PDAP is based on excluding other possible aetiologies, and may involve different care providers. • Synthesis of published data suggests that PDAP has a frequency of occurrence following root canal therapy of around 1.6%. • The putative risk factors involved in PDAP are largely unknown, but seem to be similar to those being identified with other post-surgical chronic pain disorders. • The underlying mechanisms involved in the development of and/or perpetuating PDAP are unknown and the approach to treatment remains empiric in nature.

Classifying orofacial pains: a new proposal of taxonomy based on ontology

We propose a new taxonomy model based on ontological principles for disorders that manifest themselves through the symptom of persistent orofacial pain and are commonly seen in clinical practice and difficult to manage. Consensus meeting of eight experts from various geographic areas representing different perspectives (orofacial pain, headache, oral medicine and ontology) as an initial step towards improving the taxonomy. Ontological principles were introduced, reviewed and applied during the consensus building process. Diagnostic criteria for persistent dento-alveolar pain disorder (PDAP) were formulated as an example to be used to model the taxonomical structure of all orofacial pain conditions. These criteria have the advantage of being (i) anatomically defined, (ii) in accordance with other classification systems for the provision of clinical care, (iii) descriptive and succinct, (iv) easy to adapt for applications in varying settings, (v) scalable and (vi) transferable for the description of pain disorders in other orofacial regions of interest. Limitations are that the criteria introduce new terminology, do not have widespread acceptance and have yet to be tested. These results were presented to the greater conference membership and were unanimously accepted. Consensus for the diagnostic criteria of PDAP was established within this working group. This is an initial first step towards developing a coherent taxonomy for orofacial pain disorders, which is needed to improve clinical research and care.