Atypical Odontalgia: A Review of the Literature

Marcello Melis, DDS, RPharm; Silvia Lobo Lobo, DDS, MS; Caroline Ceneviz, DDS; Khalid Zawawi, BDS; Emad Al-Badawi, BDS, MS; George Maloney, DMD; Noshir Mehta, DMD, MDS, MS


Headache. 2003;43(10) 

In This Article

Abstract and Introduction

Objective: To review previous reports of cases of atypical odontalgia to examine its epidemiological and clinical characteristics and to explore the etiology and pathophysiology of the disease.
Background: Atypical odontalgia is one of many painful conditions that affect the oral cavity and is often overlooked in the differential diagnosis.
Methods: A search of the literature was performed for all cases of atypical odontalgia reported from 1966 to the present.
Results. The typical clinical presentation of atypical odontalgia that has been reported 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. The existing literature suggests that this condition occurs in 3% to 6% of the patients who undergo endodontic treatment, with high female preponderance and a concentration of cases in the fourth decade of life. Deafferentation seems to be the most likely mechanism to initiate the pain, but psychological factors, alteration of neural mechanisms, and even an idiopathic mechanism have been implicated. Not all reported cases were preceded by trauma to the teeth or gums.
The treatment of choice is a tricyclic antidepressant, alone or in combination with a phenothiazine. 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.
Conclusion. Atypical odontalgia is surprisingly common, of uncertain origin, and potentially treatable.

Atypical odontalgia (AO) is probably one of the most frustrating conditions that challenge dental clinicians. It was reported for the first time by McElin and Horton in 1947, and since then there have been many clinical reports in the literature, especially in relation to endodontic treatment.[1]

It presents as tooth pain or pain in a site where a tooth was extracted, in absence of clinical and radiographic evidence of tooth pathology. Unfortunately, the occurrence of AO is common; it occurs in 3% to 6% of patients who undergo endodontic treatment.[2,3] There is a female preponderance with a concentration of cases of women in their mid 40s.[2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18] Except for children (no reports have been found in the literature), all ages can be affected. Molars and premolars are more frequently involved,[10,15,1821] with the maxilla being affected more often than the mandible.[10,15,18,19]