Lymphoma masquerading as jaw pain, headache, and syncope: A case report.

BACKGROUND: Lymphomas of parapharyngeal space often have complex manifestations, posing a diagnostic dilemma for clinicians. CASE DESCRIPTION: A 64-year-old man sought treatment for a 4-month history of unresolving right-sided headache and jaw pain associated with syncope, all of which started with a toothache. Since the onset of pain, the patient had undergone multiple diagnostic tests with various specialists, with no pain relief. A detailed clinical and radiologic examination by an orofacial pain specialist revealed diffuse large B-cell lymphoma in the parapharynx. PRACTICAL IMPLICATIONS: A thorough knowledge of the head and neck anatomy helps in identifying the pathophysiology of complex orofacial pain manifestations, which assists in early diagnosis and treatment.

Serum 3-Hydroxybutyrate is Expected to Serve as One of the Supportive Diagnostic Markers of Persistent Idiopathic Dentoalveolar Pain (PDAP).

Background: Persistent idiopathic dentoalveolar pain (PDAP), previously referred to as atypical odontalgia, is a chronic dental pain that occurs without signs of pathology. PDAP is considered a diagnosis of exclusion, and its definition is currently under refinement and remains ambiguous. The metabolite known as 3-hydroxybutyrate (3HB) has garnered significant interest as a potential indicator for both depression and chronic psychogenic pain. We investigated the characteristics of patients with PDAP and hypothesized that serum 3HB could support the diagnosis of PDAP. Subjects and Methods: Forty-one patients with PDAP and 167 patients with odontogenic toothache were investigated regarding depression and anxiety scales in addition to the general dental evaluation. Blood tests including high-sensitivity CRP, HbA1c, and 3HB were performed for all patients. Associations between PDAP and patients' varying characteristics were investigated using hierarchical multivariate logistic regression analyses. Results: There were more females, current smokers, patients with orofacial pain (such as temporomandibular joint pain, glossalgia, and headache), and people with elevated 3HB levels among patients with PDAP than among control participants. Multivariate logistic regression analyses predicting patients with PDAP identified the female sex (odds ratio [OR]: 4.16), current smoking (OR: 14.9), glossalgia (OR: 19.8) a high CES-D score (≥16) (OR: 5.98), and elevated serum 3HB (≥80 µmol/L) (OR: 18.4) factors significantly associated with PDAP. Conclusion: Our results demonstrated that serum 3HB levels could be elevated in patients with PDAP compared to other types of odontogenic pain, although 3HB was not specific to PDAP. Based on our findings, five factors - female sex, current smoking, depressive tendencies, chronic orofacial pains, and high serum 3HB levels - could be useful for diagnosing PDAP.

Persistent Idiopathic Dentoalveolar Pain: Is It a Central Pain Disorder?

The International Classification of Orofacial Pain (ICOP) describes idiopathic pain as "unilateral or bilateral intraoral or facial pain in the distribution(s) of one or more branches of the trigeminal nerve(s) for which the etiology is unknown. Pain is usually persistent, of moderate intensity, poorly localized and described as dull, pressing or of burning character." Several diagnoses are included in the ICOP Idiopathic pain section, burning mouth syndrome and persistent idiopathic facial and dentoalveolar pain. This article, with a representative case presentation, briefly discusses common features that may lead to a common central cause for a variety of peripheral complaints.

Case report: Treatment of persistent atypical odontalgia with attention deficit hyperactivity disorder and autism spectrum disorder with risperidone and atomoxetine.

Chronic pain has recently been associated with developmental disorders [autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)]. Regarding chronic pain in adulthood, fibromyalgia, migraine, and chronic low back pain have been associated with ADHD. The ICD-11 disease classification categorizes these pain diseases as chronic primary pain, suggesting high comorbidity with developmental disorders in chronic primary pain. Atypical odontalgia (AO) is a persistent tooth pain that occurs in the absence of any of the usual dental causes, most of which are triggered by dental treatment. Conditions characterized by tooth pain with no apparent cause are also classified as chronic primary pain. Approximately half the patients with AO are diagnosed with psychiatric disorders; the most common are depression (15.4%) and anxiety disorders (10.1%). However, there are no reports on neurodevelopmental disorders comorbid with AO. In the present study, we report a case of a 46-year-old man with numerous complaints (e.g., occlusal instability, difficulty eating, difficulty speaking), who took work leave due to worsening of his symptoms after periodontal scaling ("gingival recession" and "aggressive periodontal treatment") and frequently expressed dissatisfaction and anger at the hospital, making the dental treatment difficult. After a referral to a psychiatrist specializing in chronic pain, AO and previously undiagnosed comorbidity of ASD and ADHD were confirmed. Atypical antipsychotic risperidone for ASD irritability and an ADHD medication, atomoxetine dramatically reduced anger, pain, anxiety, depression, and pain catastrophizing thoughts, leading to reduced obsession with his symptoms and less frequent complaints. After risperidone (1 mg/day) + atomoxetine (120 mg/day) were ultimately prescribed after adjustment, he was able to return to work 226 days after initiation of psychiatric treatment. Recent studies show that comorbidity of developmental disorders in patients with chronic pain is likely to be undetected. Clinicians should include screening for ASD and ADHD not only in cases of fibromyalgia, migraine, and chronic low back pain, but also in orofacial pain such as AO and other treatments for chronic primary pain. For patients diagnosed with ASD or ADHD, an effective drug therapy for ASD and ADHD should be considered.

Case Report: Auditory Hallucination Induced by Amitriptyline for the Treatment of Atypical Odontalgia.

Auditory hallucination is usually associated with psychiatric diseases and organic brain illness. It was rarely found as adverse events of antidepressants. Amitriptyline is considered as one of the first line medications for the psychopharmacotherapy of chronic pain including atypical odontalgia (AO) which shows chronic tooth pain without corresponding abnormalities. Anticholinergic adverse events induced by amitriptyline are usually bearable and not critical since the prescription dose is very low for the patients with AO. This is a first case report about the AO patients who showed auditory hallucination by the low dose of amitriptyline. A 43-years-old female, housewife, complained chronic toothache following dental procedures and was diagnosed as AO. Amitriptyline was initially prescribed 25 mg and gradually increased up to 60 mg with the improvement of AO symptoms in 7 months. Although the temporary recurrence was observed following to the retreatment of prosthodontic dental procedures, it improved in a few weeks. Therefore, the dose of amitriptyline was decreased, and the continuation dose was set 30 mg. In 24 months, the AO symptoms were very much improved; however, she reported that she had been heard the voices at midnight for a year. The voices were neighborhoods' and talking about the noise troubles she had claimed before. She had not realized that the voices were auditory hallucination since they were heard only at midnight infrequent and not bothering her daily life. At the time she reported auditory hallucination, she worried whether organic brain diseases are hiding because the frequency of voices was increased and sometimes occurred in daytime. The adverse event of amitriptyline was suspected since she had never had psychotic symptoms before. Amitriptyline was decreased and continued with the dose of 25 mg. Magnetic resonance imaging and psychiatric consultation revealed no abnormality of brain and in psychiatric aspects. After final prosthodontic treatment, the amitriptyline was discontinued in 30 months. Two months after the discontinuation, auditory hallucination was almost disappeared with no recurrence of AO. The present case report suggests that amitriptyline has possibility to induce auditory hallucination even in conventional dose throughout the treatment of chronic pain including AO.

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 PTTN if the patient received endodontic 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.

Duloxetine attenuates pain in association with downregulation of platelet serotonin transporter in patients with burning mouth syndrome and atypical odontalgia.

OBJECTIVE: The aim of this study was evaluation of the association between severity of pain and expression of total or ubiquitinated serotonin transporter (SERT) protein in patients with burning mouth syndrome and atypical odontalgia (BMS/AO), who were treated by duloxetine. METHODS: Patients with BMS/AO were assessed for severity of pain using the visual analog scale (VAS), and expression of total and ubiquitinated SERT protein in platelets before (baseline) and 12 weeks after duloxetine-treatment. RESULTS: The expression of total and ubiquitinated SERT protein at baseline in all patients (n = 33) were higher and lower, respectively, compared to those in healthy controls. 12 weeks after duloxetine-treatment, there was no difference in the total SERT protein levels between patients (n = 21) and healthy controls. In the 16 patients who could be measured, mean VAS scores and total SERT protein levels were significantly decreased after the treatment, compared to those at baseline. There was tendency for a positive correlation between total SERT protein levels and VAS scores in these patients. CONCLUSIONS: Our findings indicate that duloxetine relieves pain in association with downregulation of platelet SERT expression in patients with BMS/AO.

Atypical odontalgia and trigeminal neuralgia: psychological, behavioral and psychopharmacological approach in a dental clinic - an overview of pathologies related to the challenging differential diagnosis in orofacial pain.

Orofacial pain represents a challenge for dentists, especially if with a non-odontogenic basis. Orofacial neuropathic pain is chronic, arduous to localize and develops without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect the condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacologic tailored and adapted therapies, after conventional medications had failed.  In addition, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given, since current data are insufficient.   A 68-year-old male complained of chronic throbbing, burning pain in a maxillary tooth, worsening upon digital pressure. Symptoms did not abate after conventional amitriptyline therapy; psychological intervention and antianxiety drug were supplemented and antidepressant agent dosage incremented; the patient revealed improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old male lamented chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while conventional carbamazepine therapy had not been sufficient to control pain. Due to concern with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favourably changing the clinical outcome.  Comorbid psychiatric disorders have a negative impact on orofacial pain and dentists should consider adopting tailored therapies, such as psychological counselling and behavioural and psychopharmacologic strategies, besides conventional treatments. They also need to be familiar with the signs and symptoms of orofacial pain, recollecting a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis prevents pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims.

Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation.

PURPOSE: To explore the challenges faced in the diagnosis and treatment of atypical odontalgia (AO) and other persistent idiopathic facial pain (PIFP). PATIENTS AND METHODS: This retrospective multi-centric cross-sectional study utilized clinical information (eg, clinical manifestations, history of consultations and treatments prior to correct diagnoses) from patients' medical records. Their economic parameters were also extracted from medical insurance databases. Each variable collected was statistically analyzed. Differences of variables between AO and other PIFP were statistically tested. RESULTS: A total of 394 patients were included in this study. On average, the diagnostic delay was 34.8±14.2 months, a median of 7 consultations were performed prior to a correct diagnosis, and 5 ineffective prescriptions were issued. Patients with AO suffered from longer diagnostic delays than patients with other PIFP (38.4±14.3 months vs 31.6±13.4 months) and were more likely to receive invasive dental treatments (73.3% vs 4.3%). The median total cost of treatment for a single patient before correct diagnosis was 8506.3 yuan. Patients with AO spent more than patients with other PIFP (10,146.5 Yuan vs 3864.0 Yuan). CONCLUSION: Patients with PIFP were frequently misdiagnosed and the length of diagnostic delay was observed to be long. Ineffective medications, unwarranted procedures, and unnecessary economic burden were imposed on the patients. Patients with AO are in a worse situation than patients with other PIFP. As significantly urgent and unsatisfactory results of misdiagnosis of PIFP have been reported in our study, more attention should be paid on the research and education in this field.

Differences in the Clinical Characteristics of Persistent Idiopathic Facial Pain (Atypical Odontalgia) Patients with or Without Neurovascular Compression of the Trigeminal Nerve.

BACKGROUND: Persistent idiopathic facial pain (PIFP) is the unexplained pain along the territory of the trigeminal nerve, including nonorganic tooth pain called atypical odontalgia (AO). Though PIFP is debilitating to patients' livelihood and well-being, its pathophysiology remains poorly understood. Although neurovascular compression (NVC) of the trigeminal nerve is known to be associated with trigeminal neuralgia (TN), the relationship between NVC and other orofacial pains has not been fully elucidated. METHODS: In this study, we investigated the differences in the characteristics of PIFP (primarily AO) patients in the presence or absence of NVC. A retrospective analysis was performed on data from 121 consecutive patients who had been diagnosed with unilateral PIFP according to the criteria of the International Classification of Headache Disorders (ICHD)-3 and underwent magnetic resonance imaging scans of the head. RESULTS: In the group without NVC, characteristic findings were significant for psychiatric morbidity, somatization, and pain disability, when compared with the group with NVC. Furthermore, the group without NVC exhibited significant headache, noncardiac chest pain, shortness of breath, and pain catastrophizing. CONCLUSIONS: These results suggest that PIFP patients can be divided into two groups: one consistent with a neuropathic pain phenotype when NVC is present and a functional somatic symptom phenotype when presenting without NVC. Our findings may enable a more precise understanding of pathophysiology of PIFP and lead to better treatment strategies.

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.

Atypical odontalgia: pathophysiology, diagnosis and management / Odontalgia atípica: fisiopatologia, diagnóstico e tratamento

ABSTRACT BACKGROUND AND OBJECTIVES: Atypical odontalgia, a subtype of persistent idiopathic facial pain, is characterized by continuous pain in one tooth or more, or inside the alveolus after exodontia, with no apparent clinical causes. These patients run the risk of going through unnecessary dental/surgical procedures which would worsen their pain. Since the pathophysiology, diagnosis, and management of atypical odontalgia are not clear, this article aims to present an integrative literature review about these aspects. CONTENTS: A review of articles related to the topic was conducted on the Pubmed database using the keywords "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Applying the inclusion criteria (publications in the last ten years, in English, as clinical trials, multicenter studies, case reports, reviews, integrative and systematic reviews, 114 articles were found, and 39 were selected after the application of the exclusion criteria (articles with no relation to the topic). CONCLUSION: Although studies suggest the involvement of strong neuropathic mechanism, the psychological/psychiatric aspects might be considered not as a primary cause, but as an aggravator of the patient´s pain. Knowledge of other pathologies is recommended in order to determine the differential diagnosis. Also, complementary image tests, qualitative somatosensorial test, and reference to an orofacial pain specialist should be considered. In case of uncertain diagnosis, it is recommended to avoid any dental procedures because the pain can get worse.

RESUMO JUSTIFICATIVA E OBJETIVOS: A odontalgia atípica, um subtipo da dor facial idiopática persistente, se caracteriza por dor contínua em um ou mais dentes, ou no alvéolo, após exodontia sem qualquer causa aparente e é um desafio para o dentista. O desconhecimento por parte do profissional pode levar a procedimentos odontológicos desnecessários e mutiladores, piorando e/ou cronificando a dor do paciente. Diante desse panorama, o objetivo deste estudo foi apresentar informações referentes à fisiopatologia, diagnóstico e tratamento da odontalgia atípica através de uma revisão integrativa da literatura. CONTEÚDO: A busca na base de dados Pubmed foi realizada com os termos: "atypical odontalgia" OR "phantom tooth pain" OR "idiopathic tooth pain" OR "odontalgia" OR "odontalgias" OR "atypical toothache". Aplicando-se critérios de inclusão (publicações nos últimos 10 anos, de língua inglesa, tipo ensaio clínico, estudo multicêntrico, relato de caso, revisão, revisão integrativa científica e sistemática) foram encontrados 114 artigos, dos quais 39 foram selecionados após aplicação do critério de exclusão (trabalhos sem relação com o tema). CONCLUSÃO: Embora os estudos apontem forte envolvimento de mecanismos neuropáticos, aspectos psicogênicos/psiquiátricos devem ser levados em consideração como agravante do estado de dor do paciente. Sugere-se conhecimento sobre as outras doenças existentes para se realizar um diagnóstico diferencial, exames complementares de imagem, realização do teste somatossensorial qualitativo, encaminhamento a um especialista em dor orofacial e neurologista, e em casos de dúvida, não realizar nenhum procedimento a fim de não piorar a sua dor.

Effect of antidepressant treatment on plasma levels of neuroinflammation-associated molecules in patients with somatic symptom disorder with predominant pain around the orofacial region.

OBJECTIVE: Burning mouth syndrome (BMS) and atypical odontalgia (AO) are examples of somatic symptom disorders with predominant pain around the orofacial region. Neuroinflammation is thought to play a role in the mechanisms, but few studies have been conducted. We aimed to better understand the role of neuroinflammation in the pathophysiology and treatment of BMS/AO. METHODS: Plasma levels of 28 neuroinflammation-related molecules were determined in 44 controls and 48 BMS/AO patients both pretreatment and 12-week post-treatment with duloxetine. RESULTS: Baseline plasma levels of interleukin (IL)-1ß (p < .0001), IL-1 receptor antagonist (p < .001), IL-6 (p < .0001), macrophage inflammatory protein-1ß (p < .0001), and platelet-derived growth factor-bb (.04) were significantly higher in patients than in controls. Plasma levels of granulocyte macrophage colony stimulating factor were significantly higher in patients than in controls (p < .001) and decreased with treatment (.009). Plasma levels of eotaxin, monocyte chemoattractant protein-1, and vascular endothelial growth factor decreased significantly with treatment (p < .001, .022, and .029, respectively). CONCLUSIONS: Inflammatory mechanisms may be involved in the pathophysiology and/or treatment response of somatic symptom disorders with predominant pain around the orofacial region.

Pharmacotherapeutic outcomes in atypical odontalgia: determinants of pain relief.

OBJECTIVES: There has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as "idiopathic toothache", and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO. PATIENTS AND METHODS: Data for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients' sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging. RESULTS: A 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant (P<0.001). Four elements, that is, patient sex, depression score at baseline, pain score at 4 weeks, and change in the catastrophizing score, explained 52.5% of the variation in final outcome between individual patients. CONCLUSION: Our findings confirm the efficacy of tricyclic antidepressants (TCAs) as a treatment for AO and indicate that other medications, especially aripiprazole used in combination with a TCA, may be useful. A considerable number of patients, especially women, those with lower levels of depression at baseline, and those who responded to 4 weeks of treatment, achieved pain relief.

Development and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder.

AIM: To develop and preliminarily evaluate a new screening instrument for atypical odontalgia (AO) or persistent dentoalveolar pain disorder (PDAP). To evaluate the instrument's performance in detecting AO/PDAP amongst a heterogeneous group of orofacial pain conditions and pain-free controls and empirically compare its performance with an established neuropathic screening instrument (S-LANSS), which is the best available standard. METHODS: The study design was cross-sectional; subjects recruited included a convenience sample of pain-free controls (n = 21) and four groups of orofacial pain conditions: AO/PDAP (n = 22); trigeminal neuralgia (n = 21); temporomandibular disorder (n = 41); and acute dental pain (n = 41). The instrument's internal reliability and factor structure were examined alongside its sensitivity and specificity and ROC-determined threshold score. RESULTS: The 9 AO/PDAP-specific items were found to moderately correlate with the S-LANSS (r = 0.58; P < 0.01). The 14-items of the full instrument were examined using exploratory factor analysis and reduced to ten items in a two-factor structure that explained 96% of the variance. This 10-item final instrument had a ROC area of 0.77 (95% CI: 0.67; 0.88), sensitivity of 77% (95% CI: 55; 92%), and specificity of 69% (95% CI: 60; 77%) with an intentionally higher false-positive rate than false-negative rate. In contrast, the S-LANSS exhibited sensitivity of 32% (95% CI: 14;55%) and specificity of 78% (95% CI: 70;85%) with less optimal false-positive versus false-negative rates. CONCLUSION: This preliminary study confirms the new screening instrument for AO/PDAP merits progression to field testing.

Psychiatric comorbidities in patients with Atypical Odontalgia.

OBJECTIVE: Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause. Although psychiatric comorbidity seems to be very common, it has rarely been studied. To clarify the influence of psychiatric comorbidity on the clinical features in patients with AO, we retrospectively evaluated their examination records. METHODS: Clinical features and psychiatric diagnoses of 383 patients with AO were investigated by reviewing patients' medical records and referral letters. Psychiatric diagnoses were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We also analyzed visual analogue scale (VAS), self-rating depression scale (SDS), and the short-form McGill pain questionnaire (SF-MPQ) scores. RESULTS: Of the 383 patients with AO, 177 (46.2%) had comorbid psychiatric disorders. The most common were depressive disorders (15.4%) and anxiety disorders (10.1%). Serious psychotic disorders such as bipolar disorder (3.0%) and schizophrenia (1.8%) were rare. Dental trigger of AO was reported in 217 (56.7%) patients. There were no significant correlations between psychiatric comorbidities and most of the demographic features. Higher VAS and SDS scores, higher frequency of sleep disturbance, and higher ratings of "Fearful" and "Punishing-cruel" descriptors of the SF-MPQ were found in patients with psychiatric comorbidity. CONCLUSIONS: About half of AO patients had comorbid psychiatric disorders. Dental procedures are not necessarily causative factors of AO. In AO patients with comorbid psychiatric disorders, pain might have a larger emotional component than a sensory one. VAS, SDS, and SF-MPQ scores might aid in the noticing of underlying comorbid psychiatric disorders in AO patients.

Persistent Dentoalveolar Pain Disorder: A Comprehensive Review.

INTRODUCTION: Persistent dentoalveolar pain of idiopathic origin represents a diagnostic challenge for the dentist and physician alike. Disagreement on taxonomy and diagnostic criteria presents a significant limit to the advancement of research in the field. Patients struggle with a lack of knowledge by dental and medical professionals, diagnostic delays, and unnecessary treatments. METHODS: A PubMed search was performed as of January 1, 2017 by using the terms atypical odontalgia, phantom tooth pain, persistent idiopathic facial pain, painful posttraumatic trigeminal neuropathy, idiopathic toothache, persistent dentoalveolar pain disorder, nonodontogenic tooth pain, and continuous neuropathic orofacial pain. Three hundred forty-five abstracts were screened, and 128 articles that were pertinent to the topic went through full-text reading. RESULTS: Case reports and narrative reviews constitute the majority of available literature. Several retrospective case-control studies investigated the clinical characteristics, pathophysiology, and diagnostic processes. Treatment strategies were evaluated in only 7 open-label and 2 randomized controlled trials. CONCLUSIONS: Persistent dentoalveolar pain disorder is likely neuropathic in origin, but pathophysiological mechanisms to explain the onset and persistence of the pain are still far from understood. A correct diagnosis should be established before treatments are performed. Researchers should reach an agreement on the diagnostic criteria to enable a coherent research path to better understand the condition and reduce patient suffering.

Evaluating Burning Mouth Syndrome as a Comorbidity of Atypical Odontalgia: The Impact on Pain Experiences.

OBJECTIVE: This study aimed (1) to investigate the differences in clinical characteristics of patients between 2 groups, those who have atypical odontalgia (AO) only and those who have AO with burning mouth syndrome (BMS), and (2) to assess the influence of psychiatric comorbidity factors on patients' experiences. METHOD: Medical records and psychiatric referral forms of patients visiting the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between 2013 and 2016 were reviewed. The final sample included 2 groups of 355 patients: those who have AO only (n = 272) and those who have AO with BMS (AO-BMS; n = 83). Clinicodemographic variables (gender, age, comorbid psychiatric disorders, and history of headache or sleep disturbances) and pain variables (duration of illness, pain intensity, and severity of accompanying depression) were collected. Initial pain assessment was done using the Short-Form McGill Pain Questionnaire, and depressive state was determined using the Zung Self-Rating Depression Scale. RESULTS: The average age, female ratio, and sleep disturbance prevalence in the AO-only group were significantly lower than those in AO-BMS group. AO-BMS patients rated overall pain score and present pain intensity significantly higher than did the AO-only patients (P = 0.033 and P = 0.034, respectively), emphasizing sharp (P = 0.049), hot-burning (P = 0.000), and splitting (P = 0.003) characteristics of pain. Patients having comorbid psychiatric disorders had a higher proportion of sleep disturbance in both groups and a higher proportion of depressive state in the AO-only group. CONCLUSIONS: AO-BMS patients have different epidemiological characteristics, sleep quality, and pain experiences compared to AO-only patients. The presence of psychiatric comorbidities in both groups may exacerbate sleep quality. We suggest that BMS as a comorbid oral disorder in AO patients contributes to a more intensively painful experience.

Clinical features of atypical odontalgia; three cases and literature reviews.

BACKGROUND: Atypical odontalgia (AO) is a disease characterized by continuous pain affecting the teeth or tooth sockets after extraction in the absence of any identifiable cause on clinical or radiographic examination. Antidepressants, such as amitriptyline, are reported to be effective in the treatment of AO; however, their efficacy varies depending on the case. In this article, we report three types of AO and discuss its heterogeneity and management. CASE PRESENTATION: In the first case, a 58-year-old woman presented with a heavy, splitting pain in the four maxillary front post-crown teeth, as if they were being pressed from the side. Her symptoms abated with 20 mg of amitriptyline. In the second case, a 39-year-old woman presented with a feeling of heaviness pain on the right side of maxillary and mandibular molar teeth, face, whole palate, and throat. She was unable to function because of her pain. Her symptoms drastically subsided with 3 mg of aripiprazole. In the third case, a 54-year-old woman presented with a tingling sensation on the left mandibular second premolar and first molar, and an uncomfortable feeling on her provisional prosthesis that made it unbearable to keep the caps on. Her symptoms diminished with 2 mg of aripiprazole added to 30 mg of mirtazapine. CONCLUSIONS: AO shows various features and responses to drugs. It is considered not only a purely sensory problem, but also a considerably complex psychological problem, such as rumination about the pain. Investigating the difference in pharmacotherapeutic responses might help to advance the treatment of AO.