What are the common causes of odontalgia. How can you find relief from tooth pain. When should you seek professional dental care for odontalgia. What treatments are available for different types of toothaches.

Decoding Odontalgia: The Medical Term for Toothache

Odontalgia, the medical term for toothache, encompasses a wide range of dental discomfort. This condition can manifest as anything from a mild, persistent ache to sharp, debilitating pain. Understanding odontalgia is crucial for maintaining optimal oral health and seeking timely treatment.

Odontalgia occurs when the nerve endings in and around a tooth become irritated or inflamed. This irritation can stem from various factors, including tooth decay, gum disease, dental trauma, or even referred pain from other areas of the head and neck.

Key Symptoms of Odontalgia

• Sharp, shooting pains in teeth or jaw
• Dull, throbbing sensation
• Pain that intensifies with pressure or temperature changes
• Discomfort that radiates to the head, ear, or neck
• Difficulty eating or drinking
• Swelling around the affected tooth
• Fever or general malaise
• Unpleasant taste in the mouth

Is odontalgia always a sign of a serious dental problem. While not all instances of tooth pain indicate severe issues, persistent or intense odontalgia should never be ignored. It often signals an underlying condition that requires professional evaluation and treatment.

Common Causes of Odontalgia: From Decay to Trauma

Odontalgia can arise from a multitude of factors, ranging from common dental issues to more complex systemic conditions. Identifying the root cause is essential for effective treatment and long-term oral health management.

Dental Decay and Cavities

Tooth decay remains the most prevalent cause of odontalgia. When bacteria in the mouth produce acid that erodes tooth enamel, it can lead to cavities. As decay progresses, it can reach the sensitive inner layers of the tooth, resulting in pain and discomfort.

Dental Infections and Abscesses

Bacterial infections in the tooth pulp or surrounding tissues can cause severe odontalgia. Dental abscesses, characterized by pus-filled pockets, often result in intense, throbbing pain and require immediate attention.

Gum Disease and Periodontal Issues

Gingivitis and periodontitis can lead to odontalgia by affecting the tissues supporting the teeth. As these conditions progress, they can cause tooth sensitivity, pain, and even tooth loss if left untreated.

Dental Trauma and Injuries

Accidents, sports injuries, or even habitual teeth grinding (bruxism) can cause dental trauma, leading to odontalgia. Cracked, chipped, or fractured teeth are common culprits of tooth pain following an injury.

Sinus Infections and Referred Pain

Sometimes, odontalgia may not originate from the teeth themselves. Sinus infections can cause pressure and pain that mimics a toothache, particularly in the upper teeth. This phenomenon, known as referred pain, can also occur with conditions affecting the ears, jaw joints, or even the heart.

Can odontalgia be a symptom of a more serious health condition. In some cases, tooth pain can be indicative of broader health issues. Conditions such as trigeminal neuralgia, certain types of headaches, or even cardiovascular problems can manifest as dental pain. This underscores the importance of comprehensive evaluation when experiencing persistent odontalgia.

Diagnosing Odontalgia: The Path to Proper Treatment

Accurate diagnosis of odontalgia is crucial for determining the most effective treatment approach. Dental professionals employ various diagnostic tools and techniques to pinpoint the cause of tooth pain.

Clinical Examination

A thorough visual inspection of the oral cavity is the first step in diagnosing odontalgia. Dentists look for signs of decay, infection, trauma, or other visible abnormalities that could be causing the pain.

Dental X-rays

Radiographic imaging plays a vital role in identifying hidden dental issues. X-rays can reveal cavities between teeth, abscesses, bone loss, and other problems not visible to the naked eye.

Percussion and Temperature Tests

Gently tapping on teeth or applying hot and cold stimuli can help locate the source of pain and determine the condition of the tooth pulp.

Periodontal Probing

This technique involves measuring the depth of gum pockets around teeth to assess gum health and detect signs of periodontal disease.

How does the diagnostic process for odontalgia differ from other medical conditions. Unlike many medical diagnoses that rely heavily on blood tests or imaging studies, dental diagnoses often combine clinical examination with targeted tests specific to oral health. This multi-faceted approach allows for precise identification of the pain source and tailored treatment planning.

Treatment Options for Odontalgia: From Conservative to Surgical Approaches

The treatment of odontalgia varies depending on its underlying cause. Dental professionals offer a range of interventions, from simple conservative measures to more complex surgical procedures.

Conservative Treatments

• Dental fillings for cavities
• Dental bonding for minor chips or cracks
• Desensitizing agents for sensitive teeth
• Nightguards for bruxism-related pain

Endodontic Procedures

Root canal therapy is a common endodontic treatment for odontalgia caused by deep decay or infection. This procedure involves removing the infected pulp, cleaning the root canals, and sealing them to prevent further infection.

Periodontal Treatments

For odontalgia stemming from gum disease, treatments may include scaling and root planing, antibiotic therapy, or in severe cases, gum surgery to restore periodontal health.

Surgical Interventions

In cases of severe infection or trauma, tooth extraction may be necessary. Following extraction, dental implants, bridges, or dentures can be used to restore function and aesthetics.

Are there any natural remedies that can effectively treat odontalgia. While some home remedies like saltwater rinses or clove oil may provide temporary relief, they should not replace professional dental care. Natural approaches can complement, but not substitute, proper dental treatment for odontalgia.

Preventing Odontalgia: Strategies for Maintaining Optimal Oral Health

Prevention is always preferable to treatment when it comes to odontalgia. Implementing a robust oral hygiene routine and making lifestyle changes can significantly reduce the risk of developing tooth pain.

Daily Oral Hygiene Practices

• Brushing teeth at least twice daily with fluoride toothpaste
• Flossing or using interdental cleaners once a day
• Using an antiseptic mouthwash to reduce bacterial buildup

Regular Dental Check-ups

Scheduling biannual dental visits for professional cleanings and examinations can help detect and address potential issues before they cause odontalgia.

Dietary Considerations

Limiting sugary and acidic foods and beverages can help prevent tooth decay and erosion, common precursors to odontalgia.

Protective Measures

Wearing mouthguards during sports activities and using night guards for teeth grinding can prevent dental trauma and associated pain.

How often should one visit the dentist to prevent odontalgia. While the general recommendation is twice a year, individual needs may vary. Factors such as overall health, risk of dental disease, and history of dental problems may necessitate more frequent visits.

The Impact of Odontalgia on Overall Health and Quality of Life

Odontalgia extends beyond mere dental discomfort; it can significantly affect an individual’s overall well-being and daily functioning. Understanding these broader implications underscores the importance of prompt treatment and prevention.

Physical Health Implications

Chronic odontalgia can lead to difficulty eating, potentially resulting in nutritional deficiencies. It may also disrupt sleep patterns, leading to fatigue and decreased immune function.

Mental Health Considerations

Persistent tooth pain can contribute to anxiety, irritability, and even depression. The constant discomfort can affect mood, social interactions, and overall quality of life.

Work and Productivity

Severe odontalgia can impact work performance and lead to lost productivity. The distraction of pain can decrease concentration and efficiency in both professional and personal tasks.

Systemic Health Connections

Research has shown links between oral health issues, including those causing odontalgia, and systemic conditions such as cardiovascular disease and diabetes. Addressing dental problems promptly may have far-reaching health benefits.

Can chronic odontalgia lead to more serious health complications. Untreated dental infections causing persistent odontalgia can potentially spread to other parts of the body, leading to more severe health issues. This underscores the importance of timely dental intervention for any persistent tooth pain.

Emerging Technologies and Future Directions in Odontalgia Management

The field of dentistry is continuously evolving, with new technologies and treatment approaches emerging to better manage odontalgia and improve overall oral health care.

Advanced Diagnostic Tools

Innovations like 3D imaging and AI-assisted diagnosis are enhancing the accuracy and efficiency of odontalgia diagnosis, allowing for more targeted treatments.

Minimally Invasive Treatments

Laser dentistry and other minimally invasive techniques are revolutionizing the treatment of conditions causing odontalgia, offering reduced pain and faster recovery times.

Regenerative Therapies

Research into dental stem cells and bioengineered tooth structures offers promising avenues for repairing damaged teeth and potentially eliminating certain causes of odontalgia.

Smart Dental Devices

The development of smart toothbrushes and monitoring devices may help in early detection of dental issues, potentially preventing odontalgia before it starts.

How might future advancements change the landscape of odontalgia treatment. As technology progresses, we may see a shift towards more personalized, preventive approaches to dental care. This could include tailored treatment plans based on genetic profiles and real-time monitoring of oral health status, potentially reducing the incidence of odontalgia significantly.

In conclusion, odontalgia, while a common dental complaint, should never be ignored or underestimated. Its causes are diverse, its impacts far-reaching, and its treatment options ever-evolving. By understanding the nature of tooth pain, seeking prompt professional care, and maintaining good oral hygiene practices, individuals can effectively manage and prevent odontalgia, ensuring better overall health and quality of life. As dental science continues to advance, the future holds promising developments in the diagnosis, treatment, and prevention of this all-too-common ailment, offering hope for a future where debilitating tooth pain becomes increasingly rare.

What Is Odontalgia? | Toothache Treatment

Are you experiencing an intense shooting pain in your teeth or face making it hard to talk, eat, or even breathe normally? If so, you may be experiencing odontalgia. Odontalgia is the medical term for toothache and can range from mild discomfort to severe pain. It’s typically caused by a problem with one or more of the teeth, including infection, trauma, or decay. It can also be caused by an issue with the jaw, such as a malocclusion (misalignment of teeth).

Whatever the reason for odontalgia, it’s important to seek dental treatment right away. A qualified dentist can diagnose the reason for your odontalgia and provide appropriate care. Whether you need a filling, a root canal, periodontal treatment services, or another type of dental care, a dentist can help relieve your odontalgia and restore your oral health.

The team at Columbia Smiles, led by Dr. Parisa Parizadeh and Dr. Michael Hsu, is dedicated to providing gentle, comprehensive dental care that helps patients find relief from odontalgia. Call us today at 410.690.4855 to schedule an appointment.

An Overview of Odontalgia

Toothaches of any kind can be categorized as odontalgia, but they can vary in intensity and duration. It’s important to recognize the signs of odontalgia so that you can seek help right away. Common symptoms include:

• Sharp, shooting pains
• Dull ache or throbbing sensation
• Pain that worsens when pressure is applied
• Pain that radiates to other areas, such as the head or face
• Difficulty eating or drinking fluids
• Swelling of the gums around the painful tooth
• Fever or chills
• Unpleasant taste in the mouth

If you’re experiencing any of these odontalgia symptoms, contact a dentist right away to get an accurate diagnosis and appropriate treatment.

Common Causes of Odontalgia

The most common cause of odontalgia is tooth decay, or cavities. When bacteria accumulate on the enamel of your teeth, they can create holes in the surface and eventually reach the root, leading to odontalgia. Other causes include:

• Infection or abscessed tooth
• Deep filling
• Loose dental crown or fractured tooth
• Broken filling
• Sinus infection
• Injury to the head, face, or jaw
• Referred pain from the temporomandibular joint (TMJ) or other areas of the mouth
• Grinding your teeth at night
• Gum disease
• Hot or cold foods and beverages

Finding Relief from Odontalgia

At Columbia Smiles, we understand the pain odontalgia can cause. Depending on what’s causing your tooth pain, your dentist may recommend a variety of services, including:

• Cleanings and checkups  – Regularly scheduled cleanings and checkups can help identify odontalgia-causing problems early on, so they can be treated before becoming severe.
• Fillings – If tooth decay is the cause of your odontalgia, a filling may be used to fill in the decayed area and prevent further damage.
• Root canal – If odontalgia is caused by an infection or abscessed tooth, a root canal may be necessary to remove the affected pulp and prevent further decay.
• Crowns – Damaged teeth that are causing odontalgia may require a dental crown to protect them from further harm.
• Periodontal treatment – If odontalgia is due to gum disease, periodontal treatment may be needed to restore the health of your gums.
• Surgery – In some cases, odontalgia may require surgery to repair jaw or face injuries.

No matter what the cause of odontalgia is, treatment is available to help.

Schedule an Appointment at Columbia Smiles Today for Pain Relief

Don’t let odontalgia take over your life. Seek help from the experienced team at Columbia Smiles and experience relief as soon as possible. Call us today at 410.690.4855 or reach out online to book an appointment.

Toothaches: MedlinePlus Medical Encyclopedia

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A toothache is pain in or around a tooth.

A toothache is often the result of dental cavities (tooth decay) or an infection or irritation of the tooth. Tooth decay is often caused by poor dental hygiene. It may also be partly inherited. In some cases, toothache may be caused due to grinding teeth or other dental trauma.

Sometimes, pain that is felt in the tooth is actually due to pain in other parts of the body. This is called referred pain. For example, an earache may sometimes cause tooth pain.

A toothache may occur because of:

• Abscessed tooth
• Earache
• Injury to the jaw or mouth
• Heart attack (can include jaw pain, neck pain, or toothache)
• Sinus infection
• Tooth decay
• Tooth trauma such as wear, injury, or fracture

You can use over-the-counter pain medicine if you can’t see your dentist or primary health care provider right away.

Your dentist will first diagnose the source of the pain and recommend treatment. You may be prescribed antibiotics, pain medicines, or other drugs.

Use good oral hygiene to prevent tooth decay. A low-sugar diet is recommended along with regular flossing, brushing with fluoride toothpaste, and regular professional cleaning. Sealants and fluoride applications by the dentist are important for preventing tooth decay. Also, tell your dentist if you think you might grind your teeth.

Seek medical care if:

• You have a severe toothache
• You have a toothache that lasts longer than a day or two
• You have fever, earache, or pain when opening your mouth wide

Note: The dentist is an appropriate person to see for most causes of toothaches. However, if the problem is referred pain from another location, you may need to see your primary provider.

Your dentist will examine your mouth, teeth, gums, tongue, throat, ears, nose, and neck. You may need dental x-rays. Your dentist may recommend other tests, depending on the suspected cause.

Your dentist will ask questions about your medical history and symptoms, including:

• When did the pain start?
• Where is the pain located, and how bad is it?
• Does the pain wake you up at night?
• Are there things that make the pain worse or better?
• What medicines are you taking?
• Do you have any other symptoms, such as fever?
• Have you had any injuries?
• When was your last dental checkup?

Treatment will depend on the source of the pain. They may include removing and filling cavities, root canal therapy, or extraction of the tooth. If the toothache is related to trauma, such as grinding, your dentist may recommend a special appliance to protect the teeth from wear.

Pain – tooth or teeth

• Tooth anatomy

Benko KR. Emergency dental procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 64.

Page C, Pitchford S. Drug use in dentistry. In: Page C, Pitchford S, eds. Dale’s Pharmacology Condensed. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 28.

Updated by: Michael Kapner, DDS, General Dentistry, Norwalk Medical Center, Norwalk CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Teeth hurt. Why? | Blog Dental Designer

Almost everyone has suffered from a toothache at least once in their life. This is a very common pathology, since caries, pulpitis and other dental diseases are also very common. Toothache can have different strength and duration, and it depends on what the dental treatment will be in each case.

Causes of pain

Tooth pain can occur for a variety of reasons.

Caries. This is the most common cause of toothache. Caries is an infection that first affects the enamel, and then the dentin and deeper tissues of the tooth. As it progresses, it can cause pain of varying intensity. They can disturb both constantly and from time to time, for example, while eating too hot or cold food. That is why even minimal pain is a reason to go to the dentist. Dentistry in St. Petersburg or any other city is a service available to everyone, so do not neglect your health and endure pain.

Pulpitis. This term refers to inflammation of the nerve of the pulp or, in other words, the root of the tooth. Pulpitis often occurs as a complication of caries. The pain is quite intense and annoys the person both day and night. In this case, you should immediately make an appointment with a doctor.

Periodontitis. In this case, inflammation affects the tissues around the root. The pain is sharp and very strong. In this case, immediate medical attention is needed, as the infection can penetrate deep into the bone.

Pericoronitis. This is the pain that occurs when wisdom teeth erupt. Very often, this process is accompanied by inflammation of the soft tissues and, as a result, pain sensations of varying intensity. Often this ends with the removal of the tooth surgically.

Gingivitis. If you think you have a toothache, take a close look at your gums. Their inflammation can also cause discomfort. With gingivitis, the gums turn red and swell, and in addition to pain, a person is also worried about bad breath.

What should I do if I have a toothache?

Toothache is a reason to consult a dentist. However, sometimes it is not possible to get to the doctor on the same day. In this case, you can relieve pain at home. It is best to use non-steroidal painkillers for this. Usually we are talking about medicines containing nimesulide, ibuprofen, paracetamol. You can also alleviate the condition with the help of folk recipes. For example, ordinary unsalted lard, which must be applied to an aching tooth, helps well. Rinsing also gives good results. Usually, sage is brewed for this purpose or a few tablespoons of soda are diluted in water.

Indications for treatment

Specialist examination and treatment is necessary for different types of toothache:

Acute. It often comes on suddenly and increases in intensity over several hours.

Aching. In this case, it is not as intense as aching, but it constantly worries. The tooth can whine both during the day and at night, almost without stopping.

Pulsating. Such pain is quite penetrating and feels like a throbbing.

Short term. As a rule, it occurs as a response to some kind of stimulus. Often we are talking about sweet foods, as well as cold or hot foods.

Pain when pressed. Sometimes pain occurs only when you press on the tooth, for example, when biting or chewing.

Contraindications

If you have a toothache, you should definitely consult a doctor. He determines the cause of the pathology and prescribes the necessary treatment. But unfortunately, some therapies may not be suitable for a particular person. These are the following states:

• allergic to anesthesia, filling material or other substances used during treatment;
• epilepsy and severe mental disorders;
• problems with blood clotting;
• severe pathologies of the cardiovascular and respiratory systems;
• oncological diseases;
• pregnancy and lactation in women.

The listed contraindications are not absolute. If a particular treatment is not suitable for a person, then the doctor selects an individual scheme for him. In any case, consultation with a specialist and detailed diagnostics is necessary.

Prevention

Toothache is the body’s signal that something is wrong with your teeth. For this reason, regular visits to the dental clinic can be called the main prevention of discomfort. During the examination, the specialist will be able to identify the problem in time and carry out the necessary treatment. You also need to have it professionally cleaned regularly. Removal of plaque and tartar helps in the prevention of diseases of the teeth and gums, and therefore is the best prevention of toothache.

To avoid discomfort in the oral cavity, it is recommended to follow the rules of hygiene at home as well. Don’t forget to brush your teeth in the morning and in the evening, and additionally use dental floss, special brushes and an irrigator.

Diet plays an important role in oral health. The abundance of sugar-containing foods in the diet most negatively affects the condition of the teeth and is one of the main causes of caries. That is why it is recommended to limit sweets. But dairy products, fresh vegetables and fruits, on the contrary, help to cleanse and strengthen the enamel, so they should be consumed regularly.

Atypical odontalgia – diagnostic and therapeutic dilemma | Parkhomenko E.V., Nartov S.E., Karpov D.Yu.

The article presents data on the prevalence, classification, pathogenesis, clinical features, diagnosis and treatment of atypical odontalgia

Introduction

Atypical odontalgia (AO) is an unusual, difficult-to-treat chronic pain syndrome in the orofacial region. Often, clinicians of various specialties (dentists, neurologists, maxillofacial surgeons) have difficulties in diagnosing this disorder. This is due to the absence of objective clinical and radiological signs of pathology
from the side of the teeth. Common dental procedures such as root canal treatment and tooth extraction have become known to pose a potential risk for developing AO. Persistent pain that persists afterwards often prompts dentists to treat teeth despite the absence of any pathological findings. Such therapy often paradoxically exacerbates pain rather than relieves it. The diagnosis of AO itself can be extremely difficult to make and is usually a diagnosis of exclusion. Patients find it difficult to accept such a conclusion and prescribed treatment, they often change doctors, they use various invasive methods of treatment. This often leads to an exacerbation of pain, and the extraction of teeth is inconclusive.
The term “atypical odontalgia” is used to refer to prolonged pain in the teeth or socket after tooth extraction in the absence of any objective pathology on the part of the teeth [1, 2]. In the literature, this disorder is also known under other names, such as “persistent dentoalveolar pain” [3] and “phantom toothache” [4].
The terminology and diagnostic criteria for AO have long been a subject of discussion among specialists [5]. There is an opinion that this name is not appropriate, since it does not provide information about the mechanisms of pain [6, 7].
The International Association for the Study of Pain (IASP) has defined AO as “intense throbbing pain” in a tooth without serious pathology [8].

AO classification

According to the 3rd edition of the International Classification of Headache (ICHD-3, 2018), this condition is currently considered a subtype of persistent idiopathic pain (13.11 Persistent idiopathic facial pain ), belonging to the section “Pain disorders of the cranial nerves and other facial pain.” However, it should be noted that there are no clearly defined diagnostic criteria in ICHD-3 [9].
J. Marbach and K. Raphael in 2000 developed diagnostic criteria for AO [10]:
The pain is localized in the face or is described by the patient as a toothache.
The pain is described as constant, dull, deep. Less than 10% of patients describe episodes of spontaneous acute pain that are superimposed on the dull pain described above. The presence of such episodes is not a mandatory diagnostic criterion.
After awakening, there is a short (from seconds to minutes) period of absence of pain. There are no other pain-free periods.
Pain develops (or continues) within a month after endodontic treatment or extraction of teeth, other medical procedures, or trauma to the face.
In the area of ​​​​stomatological (or other) intervention (usually on the skin of the face, but sometimes in the oral cavity), the threshold of pain sensitivity (hyperalgesia) is significantly reduced. In the surrounding (larger area) zone, less pronounced hyperalgesia is often noted.
Pain and paresthesia do not interfere with sleep.
X-ray or laboratory studies do not reveal other possible sources of pain.
Note: there are no sex-related differences in frequency of occurrence. The loss of milk teeth does not lead to phantom toothaches.
The International Consortium of Temporomandibular Disorders (TMD) has proposed diagnostic criteria for persistent dentoalveolar pain disorder [3]. According to Y. Abiko et al., these criteria can be adaptive for AO [11].
Diagnostic criteria for persistent dentoalveolar pain disorder:
Persistent intense pain for at least 8 hours per day ≥15 days per month for ≥3 months.
Pain is defined according to IASP criteria (including dysesthesia).
The maximum pain is localized in a certain dentoalveolar region.
The results of other research methods (dental, neurological examination), CT and/or MRI do not provide additional information.
In the presence of an identified traumatic lesion of the trigeminal nerve, according to ICGB-3, this condition can also be considered a subform of “13.1.2.3. Painful post-traumatic trigeminal neuropathy, previously used term – Anaesthesia dolorosa” [9]. This is unilateral facial or oral pain following a trigeminal nerve injury in association with other symptoms and/or clinical signs of trigeminal dysfunction.
Diagnostic criteria for pain post-traumatic trigeminal neuropathy:
History of surgical interventions on the ipsilateral side of the face and / or in the oral cavity, in combination with criterion C.
There is an identified traumatic effect on the trigeminal nerve, with clinically significant positive (hyperalgesia, allodynia) and/or negative (hypesthesia, hypoalgesia) signs of trigeminal dysfunction.
Association with trauma is confirmed by the following criteria:
Pain is localized in the area of ​​distribution of the same
trigeminal nerve.
Pain develops within 3-6 months. after a traumatic event.
There is no better match for another ICHD-3 diagnosis.

Epidemiology

AO occurs in women and men of various age groups, but there are epidemiological data on the predominance of women aged 40 years among patients [1, 4, 12–15]. The literature does not describe cases of AO in children [1].
AO may result from dedifferentiation of trigeminal nerve fibers following dental procedures or may be of idiopathic origin.
Many patients have a history of dental procedures, which are now considered triggers and risk factors for the development of this condition. According to available data, the prevalence of AO among patients who underwent dental treatment is 3-6% [1, 16]. Root canal treatments and tooth extractions are common invasive procedures that can damage the terminal branches of the trigeminal nerve. The literature describes cases of AO after facial trauma or blockade of the inferior alveolar nerve [17]. However, the development of the disease was not preceded by dental procedures in all cases.
Patients who associate the debut of pain with surgical dental interventions seek help from specialists in various fields in medical institutions, often persistently seek a repeated in-depth examination and surgical intervention, which, however, does not bring relief. Missing or late diagnosis of atypical AO leads to unjustified extraction of one or more teeth, unreasonable operations, and inadequate medical treatment.

Pathophysiology

One of the main reasons for the difficulties in the diagnosis and treatment of AO is the lack of understanding of the underlying pathophysiological mechanisms of this disorder. At the same time, the most substantiated of the existing hypotheses suggests that AO is neuropathic pain caused by deafferentation.
It is assumed that during the instrumental removal of the pulp, nerve fibers are damaged at the apex of the tooth root, leading to a violation or interruption of peripheral afferent impulses. In this case, deafferentation is a somatosensory deficit caused by insufficient afferent impulses. Another possible cause of AO may be the formation of a traumatic neuroma in the apical periodontium.
There are also some psychological factors that determine a person’s predisposition to develop chronic pain after treatment and tooth extraction. These aspects may be related to changes in somatosensory perception of the trigeminal stimulus, and often patients with AO report traumatic events associated with dental procedures in time.
According to available data, several mechanisms may be involved in the pathophysiology of AO:
Increased expression of sodium channels in regenerating nerve fibers leads to increased generation of action potentials and epaptic (without the participation of a mediator) transmission of nerve impulses to the nuclei of the trigeminal nerve.
The high frequency of action potentials and increased release of neurotransmitters lead to central sensitization in the CNS.
The lack of endogenous antinociceptive modulation contributes to the intensification and chronicity of pain.
Various somatosensory anomalies, such as allodynia, hyperalgesia, and increased pain with thermal, mechanical, and/or chemical stimulation, are clinical manifestations of the described processes [18].

Clinical manifestations

The main complaint of patients is pain in the area of ​​one or more teeth or tooth socket that occurs after tooth extraction. As a rule, pain is localized in the neuroanatomical region where the tooth is located, but an unpleasant sensation can spread to other areas of the trigeminal innervation. Patients often have difficulty describing the location of pain.
Pain can vary from mild to intense, often changing over time, sometimes capturing the entire upper or lower jaw. Usually, AO is noted in molars and premolars, more often in the upper jaw than in the lower (8:2 ratio) [11, 19, 20]. The pain can be polymorphic in character, but in most cases it is described as dull, aching, pressing, throbbing, deep and non-paroxysmal [21]. Against the background of constant pain, attacks are noted that last from several minutes to several hours and days (this is in contrast to short-term attacks of shooting pain in trigeminal neuralgia). Increased pain is possible under the influence of emotions, meteorological factors or physical activity. When examining sensitivity, hypo- or hyperesthesia, hypo- or hyperalgesia, allodynia, secondary hyperalgesia (pain in the tissues adjacent to the injury site) can be detected. Some patients with AO also complain of a burning, burning nature of pain and taste disturbance in the mouth. Some patients may notice a feeling of swelling of the gums, but this is usually not confirmed by an objective examination.
The course of the disease is usually long, and the anamnesis can span several years. Diagnostic difficulties are sometimes caused by patients in whom AO at the onset resembled trigeminal neuralgia, and the characteristic clinical pattern appeared late.
Due to the lack of organic causes, AO is often regarded as a psychogenic illness, but the relationship between this illness and psychological factors has not been properly established at present. Some experts, on the contrary, believe that psychological problems are secondary to chronic pain [8]. At the same time, many studies confirm the association of AO with depression [22], somatoform pain disorder [23], anxiety disorder [19], hypochondria [8].
In a recent study by A. Miura et al. it was shown that about half of patients with AO had concomitant mental disorders (46.2%). The most common were depressive (15.4%) and anxiety disorders (10.1%), bipolar disorder (3.0%), schizophrenia (1.8%). Dental interventions as a trigger for AO were reported in 56.7% of patients [24].

Differential

Differential diagnosis of AO should be carried out with other diseases, the manifestations of which are localized in the dentoalveolar region.
Diseases with which it is important to differentiate AO include: odontogenic pain, trigeminal neuralgia, postherpetic neuralgia, facial myofascial pain syndrome, temporomandibular joint dysfunction, and sinusitis (Tables 1, 2) [10, 25, 26]. AO is often mistaken for the normal course of the postoperative period or the consequences of maxillofacial trauma.

Treatment

AO therapy is a difficult task for the doctor and sometimes becomes a test for the patient. Practice shows that the patient often finds it difficult to accept the diagnosis of AO, which leads to a numerous search for alternative “organic” causes of pain, and the use of invasive dental treatments only exacerbates the problem.
Given the lack of a clear understanding of the pathophysiology of AO, treatment is based on the proposed concepts of post-traumatic dentoalveolar neuropathy in conditions of dysfunction of the antinociceptive system associated with mental disorders – anxiety and depression. A multidisciplinary approach to the management of this category of patients seems to be the most rational [24].
All available information on the treatment of AO is based on the results of single randomized controlled trials (RCTs), descriptions of individual clinical cases, the consensus of experts, and the treatment uses drugs used to treat neuropathic pain [27].
After diagnosing AO, it is important to provide the patient with information about the disease, preventing invasive treatment methods, including tooth extraction, since such procedures are ineffective in most cases and aggravate the pain syndrome. Keeping a pain diary by a patient is considered useful, as it allows a more detailed assessment of the dynamics of symptoms during treatment, as well as identifying pain triggers, which is especially important when changing therapy [27, 28].
Topical (local) anesthesia . The use of a mixture of lidocaine 6% + prilocaine, especially in combination with local application (application) of capsaicin 0.025% (not registered in the Russian Federation) 2 times a day for 3 minutes for 4 weeks, showed its effectiveness for the treatment of AO [29, 30].
Local anesthesia with lidocaine showed significant but incomplete pain relief in patients with AO, the effect was observed 15-125 minutes after drug administration and was short-lived [31]. A clinically significant result was observed in patients with more pronounced manifestations of peripheral neuropathy, the presence of allodynia, which may indicate the variability of the pathogenetic reaction of AO [11]. According to some data, drug blockade of the cervical sympathetic ganglia with phentolamine (not registered in the Russian Federation) was effective in neuropathic orofacial pain, and this may indicate the contribution of the autonomic nervous system to the pathogenesis of pain [27, 32].
Botulinum toxin type A (BTA) as reported by M.L. Cuadrado et al. have been used to treat refractory AO. Four patients (two women and two men) received injections into the soft tissues of the gums, and some into the hard palate and upper lip. The total dose was 15-30 IU per procedure, all patients received significant relief with complete or almost complete reduction in pain. The analgesic effect appeared after a latent period of 3 to 14 days and persisted for 2–6 months. No significant side effects have been reported [33].
In a recent open-label study, 9 patients also benefited from onabotulinumtoxin A, all patients in the study group experienced a 50% reduction in pain, with a median post-treatment reduction in maximum pain on the Numerical Pain Rating Scale of 6 points. A delayed onset of a therapeutic effect lasting 2–15 days was noted, the duration of the effect was, as in the previous study, from 2 to 6 months. No significant adverse effects were also noted [34].
Tricyclic antidepressants (TCA) were effective in AO, as well as in some other orofacial pain, while the effect was potentiated by antipsychotics – phenothiazines (perphenazine or trifluoperazine). The most commonly used dose was amitriptyline at a dose of 25–100 mg/day [17, 35, 36]. Other TCAs describe the effective use of imipramine, nortriptyline (not registered in the Russian Federation) [36].
Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) . The mechanism of analgesic action is similar to that of TCAs, but SNRIs have a better safety profile. The efficacy of milnacipran was demonstrated in a study by M. Ito et al. (2010) in 36 patients with chronic orofacial pain (burning mouth syndrome (SGR) and AO). The dose of milnacipran was titrated from 15 mg to 100 mg/day. Pain was assessed using a visual analog scale and depressive symptoms were assessed using the Hamilton Depression Rating Scale at baseline and at 1, 2, 4, 6, 8, 10, and 12 weeks. treatment. Treatment with milnacipran resulted in a significant reduction in chronic orofacial pain, regardless of concurrent symptoms of depression [37]. Similar results were obtained for duloxetine in patients with chronic orofacial pain (AO and SGR), while the analgesic effect was also not associated with a depressive effect [38, 39].
Anticonvulsants (anticonvulsants) are widely used in many neuropathic orofacial pain syndromes [28]. According to a systematic review of the effectiveness of anticonvulsants for the treatment of orofacial pain, gabapentin had a positive effect in chronic pain syndrome involving the masticatory muscles [40, 41]. Topical clonazepam has been effective in treating GHR [42], lamotrigine has been shown to reduce pain in refractory trigeminal neuralgia [43], and carbamazepine has established itself as a first-line drug in trigeminal neuralgia [28, 44].
With regard to AO, there is currently insufficient data on the effectiveness of anticonvulsants in this disorder, despite the proposed mechanism of neuropathy. Some experts argue that a better response to therapy in AO should be expected from antidepressants rather than anticonvulsants [11]. Opioid narcotic analgesics such as oxycodone, meperidine, controlled release morphine, and methadone (not registered in the RF) have shown only modest effects in AO and should therefore only be used when other agents have failed [27].
One randomized, placebo-controlled, cross-over study showed pain relief in patients with AO with intravenous administration of S-ketamine and fentanyl [45].

Conclusion

Thus, AO remains a diagnosis of exclusion, allowing the establishment only after a thorough examination and exclusion of other diseases localized in the orofacial region.