Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

Analysis of the Dental Hospital Patients with Atypical Odontalgia

비정형성 치통으로 여겨진 환자의 분석

Lee, Yong-Seung;Ryu, Ji-Won;Kim, Seong-Taek;Choi, Jong-Hoon
이용승;유지원;김성택;최종훈

  • Published : 20040600
⟨ Previous Next ⟩

Abstract

The purpose of this study is to looks into the clinical features of AO(Atypical odontalgia) patients. to find out relationship between AO and previous dental treatments. and to gain helpful information about the diagnosis and treatment of AO patients. The subjects chosen for this study were 42 patients who had visited the Department of Oral Medicine at Yonsei University Dental Hospital and diagnosed as AO. Previous clinical records review. questionnaires review. and diagnosis and treatment investigation were done for this study. The following results were obtained: 1. AO occurs more often to the female(69%) than to the male(31%). The average age is 45.2 years and the average pain duration is 40 months. 2. There were 40.5% without medical history.35.7% with GI troubles and 7.1 % with psychological diseases. And only few of them have smoking and drinking habits(7.1% each). 3. The most common site of AO is Molar area(83.3%). when the patients have more than two pain sites, unilateral case(70.8%) is more frequently shown than bilateral one. 4. Considering the departments referring to the department of oral medicine. treatment related to AO. previous dental treatment history, and visiting dental departments. AO is very closely related to the Endodontic treatments. 5. 90.5% of patients have visited more than 3 dental practitioners. 6. The number of patients who have referred pain and no referred pain were similar. 59.5% of patients have spontaneous pain. And the number of patients who have severe pain and who have moderate and light pain were similar. The average period of treatment was 7.2 months. 7. The main method of diagnosis was diagnostic anesthesia(57.1%), And it was diagnosed mainly as myofascial pain and chronic peripheral trigeminal neuropathy(28.6% each), 8. The used drugs were mainly anticonvulsants(69.0%) and antidepressants (59.5%), And the effectiveness of anticonvulsants(72.4%) is better than that of antidepressants(52%). Especially, one of the anticonvulsants, Gabapentin was used very frequently(64.3%), And topical Capsaicin has a limited effect. As a result. AO can be diagnosed from the detailed reviews of the clinical records and questionnaires when there's no abnormality in the clinical or radiographic examination but the patients appeal chronic pain which is not alleviated by dental treatments. And when the patients are considered to have AO. it's better to do a conservative treatments such as anticonvulsants or antidepressants therapy than to do an irreversible treatments like an Endodontic treatments or extractions.

Keywords

References

  1. Bates RE Jr. Steward CM : Atypical odontalgia: phantom tooth pain. Oral Surg Oral Med Oral Pathol 72 : 479-483, 1991.
  2. Bennett GJ, Xie YK : A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man. Pain 33 : 87- 108, 1988.
  3. Brooke RI : Periodic Migrainous Neuralgia : A cause of Dental Pain. Oral Medicine 46 : 511-516, 1978.
  4. Brooke RI : Atypical Odonta lgia. Oral Surg Oral Med Oral Pathol 49 : 196-199. 1980. .
  5. Campbell RL, Park s KW, Dodds RN : Chronic facial pain associated with endodontic therapy. Oral Surg Oral Med Oral Pathol 69 : 287-290, 1990.
  6. Dubner R : Topical capsaicin therapy for neuropat hic pain. Pain 47 : 247-248, 1991.
  7. Feinmann C, Harris 1\'1, Cawley R : Psychogenic facial pain, presentation and treatment. British Med, Journa l 288 : 436-438, 1984.
  8. Fordyce WE, Steger JC : Chronic pain. In: Pomerteau DF, Brady JP. eds. Behavior medicine theory and practice. Baltimore: Williams and Wilkins : 125-153, 1978.
  9. Frazier CH, Russell EC : Neuralgia of the face, Archives of neurology and psychiatry 11 : 557-563, 1924.
  10. Gobel S, Binck JM : Degenerat ive changes in primary trigeminal axons and in neurons in nucleus caudalis following tooth pulp extirpations in the cat. Brain Res 132 : 347- 354, 1977.
  11. Grabow TS, Dougherty PM : Gabapentin produces dose -dependent antinociception in the orofacial formalin test in the rat. Regional Anesthesia and ain Medicine 27(3) : 277- '2R1, 2002.
  12. Gra ff- Radford SB, Solberg 'VITI( : Atypical odontalgia. CDA Journal 14 : 27- 31, 1986.
  13. Graff- Radford SB, Solberg WK : Differential neura l blockade in atypical odontalgia. Cephalalgia 11(2) : 289-29 1, 1991.
  14. Graff- Hadford SB, Solberg WK : Atypical odontalgia. Journal of Craniomandibular Disorder Facial Oral Pain 6 : 260- 265, 1992.
  15. Graff- Hadford SB, Solberg WK : Is atypical odontalgia a psychological problem? Oral Surg Oral Med Oral Pathol 75 : 579-582, 1993.
  16. Gratt 13, Sickels EA, Graff-Radford SB Solberg WK : Electronic thermography in the diagnosis of Atypical Odontalgia. A pilot study. Oral Surg Oral l'vIed Oral Path 68(4) : 472, 1989.
  17. Harris I'vI : Psychosomatic disorders of the mouth and face. Practitioner 214 : 372, 1975.
  18. Hughes AM, Hunter S, Still D, et al. : Psychiatric disorders in a dental clinic. British Dental Journa l 166 : 16-19. 1989.
  19. Jensen TS : Anticonvulsant s in neuropathic pain : rationale and clinical evidence. European Journal of Pain 6(A) : 61-68, 2002.
  20. Keefe FJ, Beckham JC : Behavioral as sessment of chronic orofacial pain. Anesthesiology Prog 37 : 76-80, 1990.
  21. Kemppainen P, Avellan NL, Handwerker HO, Forster C : Differences between tooth stimulation and capsaicin-induced neurogenic vasodilatation In human gingiva. Journal of Dental Reserch 82(4) : :ID.1 -307. 2003.
  22. Kreisberg ;\IK : Atypical Odon talgia : Differential diagnosis and treatment. Journal of the American Dental As sociation 104 : x'S2-8,'J4. 1982 .
  23. Lascelles HC : Atypical Facial Pain and Depres sion. British Journal of Psychiatry 11 2 : 651-659. 1966.
  24. Lynch 1\ IE. Elgeneidy AK : The role of sympathetic activity in neuropathic orofacial pain . Journal of Orofacial Pain 10 : 297-:-lO5. 1996.
  25. Magni C;. Moreschi C. Riguu i-L uchini S. et al : Prospective study on the re lations hip between depressive symptoms and chronic muscu loskeletal pain. Pain 56 : 289-297 . Iffi'1.
  26. Marbach JJ : Phan tom tooth pain. j ourn al of Endodo nt ics 4 : 362-:m . 1978.
  27. Marbach JJ . l Iulbrock J. Holm C. Segal AC : Incidence of phantom tooth pain : An at ypical facial neuralgia. Oral Surg Ora l Med Oral I'athol S:~ : Isx)193. 1982.
  28. Melleg ers I\IA. Furlan AD. Mailis A : Gabapentin for neuropathic pain : sys tematic review of controlled and uncontro lled literature. Th e Clinical Journal of Pain 17 : 284-295. 2001.
  29. Okeson JP : Bell' s orofa cial pain s. 5th cd Chicago. Quintessence : 249- 2,')8. Hlli.
  30. Penes Hi\. Ileir ( ;;\1 : Chronic orofacial pain . A practical approach to differen tia l diagnosis. Dental Clinic 010I1h America :1') : 12:3- 140. 1991.
  31. Rasmus sen OC : Painful traumatic neuromas in the ora l cavi ty. Ora l Surg 49 : 191-1!J5. 1980
  32. Ree s 1rI'. Harri s, 1\1 : Atypica l Odontalgia : Differen tial diagn osis and Treatmen t. British Journal of Oral Surgery 16 : 212-2 18. 197K.
  33. Reik L : Atypical Odontalgia : a localized form of atypica l facial pain. Headache 24(2) : 222- 224. 1984.
  34. Reik L : Atypical facial pain . Headache 25 : 30 -:32. 19X,').
  35. Reisn er L. Pettengi ll CA : The use of anticonvulsant s in orofacial pain. Oral Sun; Oral Med Oral Pathol 91 : 2- 7. 2001.
  36. Sato J. Perl EH : Adrenergic exci ta tion of cutaneou s pain receptors induced by peripheral nerve injury. Science 251 : IG08- lGlO. 1991
  37. Simons CT. Dessirier Ji\!. Jinks SL. Carst ens E : An animal model to assess aversion to intra-oral ca psaicin : increased threshold in mice lacking subs tance P. Chem. Senses 26 : 491 -497. 2001.
  38. Smith DP. Pilling LF. Pearson JS. Hush Ion JG. Goldst ein NI'. Gibilisco JA : A psychiatric study of at ypical pain . Canadian Medical Associa tion Journal I I : 286-29 1. 1!XJ9.
  39. Solberg W : Atypical Odontalgia. The Journ al of Korean Academy of raniomandibular Disorders :~ : 28 :{~ . 1991.
  40. Vickers EH. Cous ins M], Walker S. Chisholm K : Ana lysis of 50 patient s wit h atypical ondontalgia. Ora l Surg Ora l Med Ora l Pat hol Ora l Radiol Endod x,') : 24-::l2. 1!*1~.
  41. Westrum LE. Canfi eld HC. Black nc; T ransganglionic degeneration in the spinal trigeminal nucleus follow ing removal of tooth pulps in adult cat s. Brain Res 101 : 1:~7 -140. 1976.
  42. Zakrzew ska Ji\l : Facial pain : neurol ogical and non -neurol ogic al. Journal of neurol neurosuru psychiatry 72(2) : 27-::l2. 2002.
  43. 고명연: 삼차신경통 환자의 임상양태와 치료에 관한 연구. 대한두개하악장애학회지 6(2) : 57-63, 1994.
  44. 김성택, 김일영, 강희석 : 임플란트 수술이나 발치후 지각이상 환자에서의 약물치료. 대한치과턱관절기능교합학회지 19(2) : 2-5, 2003.
  45. 김연중, 정성창 : 구강안면동통의 기전과 그 임상적 적용. 대한두개항가장애학회지 991) : 49-64, 1997.
  46. 김인정, 최종훈, 김종열 : 치과병원에 내원한 삼차신경통 환자의 치험예. 대한구강내과학회지 25(2) : 235-240, 2000.
  47. 이승우, 한송 : 비정형성 구강안면 동통 치험예. 대한구강내과학회지 20(1) : 127-130, 1995.
  48. 정성창 : 만성 구강안면 동통. 대한두개하악장애학회지 8(1) : 1-15, 1996.