| Symptoms | Possible
Causes | Diagnosis | Treatment
Terminology | References |
Atypical Odontalgia (AO) is a condition in which a tooth is very painful
but nothing can be found wrong with it. The pain is continuous, usually
burning, aching and sometimes throbbing and most often occurs in a
maxillary (top) molar (back tooth) or in a tooth next to a molar. Since
symptoms are very similar to those caused by a "toothache",
often numerous dental procedures are done. To complicate matters, these
treatments may offer temporary relief from pain, only to have the pain
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. Diagnostic tests show no abnormality
on x-ray and no obvious cause of tooth pain can be found.
There is much speculation on possible causes, including psychological
disorders, deafferentation (some sort of nerve damage / pathology), and
problems have been posed as a cause mainly based on studies in
which no other physical cause for the pain could be found. A study
done by Graff-Radford and Stolberg using the Minnesota Multiphasic
Personality Inventory for facial pain patients found elevations of the
MMPI scales were within standards for other medical populations, thus
making it unlikely that psychological problems are a cause of AO or
other facial neuralgia problems.
A vascular cause for
AO similar to that described for migraine pain also seems unlikely
because AO pain is continuous rather than episodic like migraine
pain. However, one thermographic study of AO patients showed 100% of
them having asymmetric heat emission patterns, suggesting vascular
involvement of some sort causing some researchers to speculate that
vascular involvement is a result of some other process.
be a partial explanation. Many AO patients relate the onset of their
pain to a dental procedure or tooth trauma.
Diagnosis is based primarily on symptoms and on elimination of other
possible disorders. Tests may include diagnostic
dental x-rays, panorax, CAT scan and possibly MRI. If a nerve block does
not result in pain reduction or if the results are ambiguous, then a
diagnosis of AO should be considered.
Pain medications such as analgesics and sedatives are not effective for
AO. Surgery and other dental interventions rarely provide relief.
Antidepressants medications can reduce AO pain which is probably due to
their analgesic effects and not the antidepressant effects. AO patients
are generally not depressed (Graff-Radford) .
noted a 75% reduction in pain among 25 AO patients using an average dose
of 80mg of amitriptyline. He notes that a low dose of phenothiazine in
combination with amitriptyline may increase pain reduction but that the
potential serious side effects of phenothiazine may outweigh its
Atypical Odontalgia: A review of the literature
Headache. 2003 Nov-Dec;43(10):1060-74
of Terms for Non-Dentists
Dentists refer to each individual tooth by number. Knowing the tooth
number can be helpful when discussing your symptoms.
1. Orofacial Pain: An overview of Diagnosis and
Management - Steven Graff-Radford. Further source information
to be provided at a later date.