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

Case Reports

A MEDLINE search was performed for all AO cases reported and described in the literature since 1966. We found that descriptions of the cases ( Table 6 ) generally confirm the clinical and epidemiological characteristics of AO as they have been reported in the literature.

As previously mentioned, all ages (except children) may be affected. In the literature, ages ranged from 13 to 82 years. The prevalence of females was high (4.6:1) confirming previous reports.[2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17] The major clinical symptom reported was usually tooth pain, frequently spread to involve other areas of the head and neck, including entire quadrants of the mouth, cheeks, temple, temporomandibular joint, eye, ear, neck, and shoulder. The quality of the pain is aching and dull, or burning and continuous, at times exacerbated by cold, touch, talking, eating, chewing, menses, or stress. Even though many cases occurred after dental treatment (endodontic treatment, tooth preparation, placement of crowns and bridges, tooth extraction, periodontal surgery), in other cases apparently there was not a precipitating factor. This fact is puzzling if we accept only deafferentation as the cause of symptoms.

Most of the patients were treated at first by dental therapy (root canal treatment, apicoectomy, tooth extraction, surgery, oral appliance) with no or minor results. Only after a diagnosis of AO was made and medical treatment was prescribed, did the patients receive relief from the pain. The most effective medications were tricyclic antidepressants and phenothiazines; however, good results were obtained using other medications such as injections of dexamethasone and lidocaine, anti-inflammatories, sphenopalatine blocks with cocaine hydrochloride, ethyl chloride vapocoolant sprays, trazodone, methysergide, isometheptene, MAO inhibitors, topical application of EMLA, phentolamine infusion, and topical application of capsaicin. Prognosis seems to be fair in most cases with many patients completely pain-free after treatment and some reporting only partial relief. Only a few did not obtain satisfactory results.