Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200035
Brazilian Journal of Pain
Relato de Caso

The challenge of diagnosing atypical odontalgia. Case report

O desafio para o diagnóstico da odontalgia atípica. Relato de caso

André Hayato Saguchi; Adriana Lira Ortega; Ângela Toshie Araki

http://dx.doi.org/10.5935/2595-0118.20200035 BrJP, vol.3, n2, p.185-188, 2020
PDF English
PDF Português
SciELO
Downloads: 0
Views: 597

Abstract

BACKGROUND AND OBJECTIVES: Atypical odontalgia is characterized by continuous pain that persists for more than three months in one or more teeth or in the socket after extraction, without apparent dental and neurological causes, with transient pain relief and worsening within a few days or even weeks in patients undergoing extensive dental treatment. These patients are at risk of going through unnecessary dental/surgical procedures, which would worsen their pain. This article aims to report a difficult case of atypical odontalgia diagnosis of a patient that underwent extensive dental treatment accompanied by severe pain.

CASE REPORT: A 57-year-old female patient with severe and excruciating pain in the right maxillary region of no identified source. After an endodontic retreatment on teeth 14 and 16, the pain worsened suggesting traumatic pericementitis or reaction to the intracanal drug used. Since the pain did not improve, a pulpectomy on 13 was performed. However, the pain increased significantly, and after an evaluation by volumetric computed tomography, a paraendodontic surgery was performed, but the pain irradiated to the ocular fundus and the maxillary region. The absence of neurological, ophthalmological, and otorhinolaryngological alterations led to the diagnosis of atypical odontalgia.

CONCLUSION: The diagnosis of atypical odontalgia is difficult, requiring a multidisciplinary approach listening to the patient’s complaint, and, in case of doubt, avoid any procedures not to worsen pain and turn it chronic.

Keywords

Diagnosis, Endodontics, Toothache

Resumo

JUSTIFICATIVA E OBJETIVOS: A odontalgia atípica caracteriza-se por dor contínua que persiste por mais de três meses em um ou mais dentes ou no alvéolo após extração, sem causas dentárias e neurológicas aparentes, com alívio transitório, e piora da dor dentro de poucos dias ou até semanas, em pacientes com amplo tratamento odontológico. A dificuldade para o diagnóstico pode levar a procedimentos odontológicos desnecessários e mutiladores, com piora e/ou cronificação da dor. Este artigo tem como objetivo relatar um caso de difícil diagnóstico de odontalgia atípica em paciente submetida a extenso tratamento odontológico.

RELATO DO CASO: Paciente do sexo feminino, 57 anos, apresentava queixa de dor lancinante em região maxilar direita cuja origem não identificava. Após retratamento endodôntico dos dentes 14 e 16, houve piora da dor sugerindo pericementite traumática ou reação a fármaco intracanal. Como a dor não melhorou foi realizada uma pulpectomia no dente 13. Entretanto, a dor aumentou e após tomografia computadorizada volumétrica foi realizada cirurgia parendodôntica, porém a dor irradiou para fundo do olho direito e região maxilar. A ausência de alterações neurológicas, oftalmológicas e otorrinolaringológicas permitiram diagnosticar a odontalgia atípica.

CONCLUSÃO: O diagnóstico é difícil, sendo recomendada a abordagem multidisciplinar, valorizar a queixa do paciente e, em casos de dúvida, evitar quaisquer procedimentos para não piorar e cronificar a dor.

Palavras-chave

Diagnóstico, Endodontia, Odontalgia

Referências

The International Classification of Headache Disorders. 2018;38(1):1-211.

Marbach JJ. Phantom tooth pain. J Endod. 1978;4(12):362-72.

Rees RT, Harris M. Atypical odontalgia. Br J Oral Surg. 1979;16(3):212-8.

Malacarne A, Spierings ELH, Lu C, Maloney GE. Persistent dentoalveolar pain disorder: a comprehensive review. J Endod. 2018;44(2):206-11.

Forssell H, Jääskeläinen S, List T, Svensson P, Baad-Hansen L. An update on pathophysiological mechanisms related to idiopathic oro-facial pain conditions with implications for management. J Oral Rehabil. 2015;42(4):300-22.

Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Duarte MA, Conti PC. Diagnostic accuracy of quantitative sensory testing to discriminate inflammatory toothache and intraoral Neuropathic Pain. J Endod. 2015;41(10):1606-13.

Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Conti PC. Effect of topical anaesthesia in patients with persistent dentoalveolar pain disorders: a quantitative sensory testing evaluation. Arch Oral Biol. 2015;60(7):973-81.

Porporatti AL, Costa YM, Stuginski-Barbosa J, Bonjardim LR, Conti PC, Svensson P. Quantitative methods for somatosensory evaluation in atypical odontalgia. Braz Oral Res. 2015;29.

Baad-Hansen L, Pigg M, Ivanovic SE, Faris H, List T, Drangsholt M. Intraoral somatosensory abnormalities in patients with atypical odontalgia--a controlled multicenter quantitative sensory testing study. Pain. 2013;154(8):1287-94.

Rafael B, Sorin T, Eli E. Painful traumatic trigeminal neuropathy. Oral Maxillofac Surg Clin North Am. 2016;28(3):371-80.

List T, Leijon G, Svensson P. Somatosensory abnormalities in atypical odontalgia: a case-control study. Pain. 2008;139(2):333-41.

Tarce M, Barbieri C, Sardella A. Atypical odontalgia: an up-to-date view. Minerva Stomatol. 2013;62(5):163-81.

Tinastepe N, Oral K. Neuropathic pain after dental treatment. Agri. 2013;25(1):1-6.

Baad-Hansen L, Benoliel R. Neuropathic orofacial pain: facts and fiction. Cephalalgia. 2017;37(7):670-9.

Tait RC, Ferguson M, Herndon CM. Chronic orofacial pain: burning mouth syndrome and other neuropathic disorders. J Pain Manag Med. 2017;3(1).

Bosch-Aranda ML, Vázquez-Delgado E, Gay-Escoda C. Atypical odontalgia: a systematic review following the evidence-based principles of dentistry. Cranio. 2011;29(3):219-26.

Thorburn DN, Polonowita AD. Atypical odontalgia--a diagnostic dilemma. N Z Dent J. 2012;108(2):62-7.

Baad-Hansen L. Atypical odontalgia - pathophysiology and clinical management. J Oral Rehabil. 2008;35(1):1-11.

Abiko Y, Matsuoka H, Chiba I, Toyofuku A. Current evidence on atypical odontalgia: diagnosis and clinical management. Int J Dent. 2012;2012:518548.

García-Sáez R, Gutiérrez-Viedma Á, González-García N, Gómez-Mayordomo V, Porta-Etessam J, Cuadrado ML. OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients. J Pain Res. 2018;11:1583-8.

Cuadrado ML, García-Moreno H, Arias JA, Pareja JA. Botulinum neurotoxin type-A for the treatment of atypical odontalgia. Pain Med. 2016;17(9):1717-21.

Yatani H, Komiyama O, Matsuka Y, Wajima K, Muraoka W, Ikawa M. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil. 2014;41(11):843-52.

Arias A. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J. 2013;46(8):784-93.

Durham J, Stone SJ, Robinson LJ, Ohrbach R, Nixdorf DR. Developing and preliminary evaluation of a new screening instrument for atypical odontalgia and persistent dentoalveolar pain disorder. Int Endod J. 2019;52(3):279-87.

Pigg M, List T, Petersson K, Lindh C, Petersson A. Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia. Int Endod J. 2011;44(12):1092-101.

Pigg M, Svensson P, Drangsholt M, List T. Seven-year follow-up of patients diagnosed with atypical odontalgia: a prospective study. J Orofac Pain. 2013;27(2):151-64.

Schnurr RF, Brooke RI. Atypical odontalgia: Update and comment on long-term follow-up. Oral Surg Oral Med Oral Pathol. 1992;73(4):445-8.

Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017;37(7):680-91.

Zakrzewska JM. Facial pain: an update. Curr Opin Support Palliat Care. 2009;3(2):125.

Saguchi AH, Yamamoto AT, Cardoso CA, Ortega AO. Odontalgia ati´pica: fisiopatologia, diagno´stico e tratamento. BrJP. 2019;2(4):368-73.

Submetido em:
21/11/2019

Aceito em:
25/03/2020

5f287c2d0e882547290e4938 brjp Articles
2595-3192 (Eletrônico) 2595-0118 (Impresso)
BrJP ©2024 Todos os direitos reservados.

BrJP

Share this page
Page Sections