Atypical Odontalgia

What is Atypical Odontalgia?

Atypical Odontalgia (AO) is a condition in which a tooth is very painful but nothing can be found wrong with the tooth. The pain is continuous, usually burning, aching and sometimes throbbing and most often occurs in upper premolars (bicuspids) or molars.

Since symptoms are very similar to those caused by a “toothache”, often numerous dental procedures are done.

To complicate matters, these treatments (such as pulp extirpation, root-tip surgery or tooth extraction) may offer temporary relief from pain, only to have the pain return.

What are the Signs & Symptoms of Atypical Odontalgia?

The typical clinical presentation of AO involves pain in a tooth in the absence of any sign of pathology; the pain may spread to areas of the face, neck, and shoulder.

Symptoms include a continuous burning, aching pain in a tooth or in the bone / gum surrounding a tooth.

Often there in increased sensitivity to pressure over the painful region. Often nothing shows up on diagnostic tests, no abnormalities are found on X-rays and no obvious cause for the “tooth pain” can be found.

Patients often have difficulty localising the pain.

All ages can be affected except for children. AO seems to be more common in women in their mid – 40’s.

Diagnosis is based primarily on symptoms and on elimination of other possible disorders. Tests may include diagnostic dental X-rays, CT scans and possibly MRI scans. If a nerve block does not result in pain reduction or if the results are ambiguous then a diagnosis of AO should be considered.

How is it treated?

Medications such as painkillers and sedatives are not effective in AO. Surgery and other dental interventions rarely provide relief.

Anti-depressants medications can reduce AO pain which is probably due to their analgesic effects (Anti-depressants have the ability to produce low-grade pain relief at lower strengths) and not to their anti-depressant effects. AO patients are generally not depressed.

Topical application of capsaicin (the ‘heat’-producing component of chilli) to painful tissue has also been investigated as a treatment for AO.

The outcome is usually fair, with many patients obtaining complete relief from pain.

Especially in the absence of overt pathology, particular attention should be paid to avoiding any unnecessary and potentially dangerous dental intervention on the teeth.

AO is surprisingly common, of uncertain origin and potentially treatable.