| García-Sáez et al.2525 García-Sáez R, Gutiérrez-Viedma A, González-García N, Gómez-Mayordomo V, Porta-Etessam J, Cuadrado ML. Onabotulinumtoxin A injections for atypical odontalgia: an open-label study on nine patients. J Pain Res. 2018;11:1583-8.
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The use of botulinum neurotoxin type A has been shown to reduce pain in patients with AO. However, randomized controlled trials (RCT) are suggested to prove their effectiveness. |
| Miura et al.1616 Miura A, Tu TTH, Shinohara Y, Mikuzuki L, Kawasaki K, Sugawara S, et al. Psychiatric comorbidities in patients with atypical odontalgia. J Psychosom Res. 2018;104:35-40.
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Attention to psychiatric comorbidity, common in patients with AO. There is no cause-effect relationship. |
| Malacarne et al.11 Malacarne A, Spierings EL, Lu C, Maloney GE. Persistent dentoalveolar pain disorder: a comprehensive review. J Endod. 2018;44(2):206-11.
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Persistent dentoalveolar pain is likely to be of neuropathic origin, but physiopathological mechanisms that explain the onset and maintenance of pain are not understood. A correct diagnosis must be established prior to any treatments. |
| Ghurye and McMillan3131 Ghurye S, McMillan R. Orofacial pain - an update on diagnosis and management. Br Dent J. 2017;223(9):639-47.
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The physiopathology of orofacial pain is complex, sometimes associated with psychological comorbidities. Chronic pain has an impact on quality of life. Early diagnosis and referral. Attention to the biopsychosocial approach, which confers a multifactorial etiology to chronic orofacial pain. It should be treated as neuropathy. |
| Tu et al.3232 Tu TTH, Miura A, Shinohara Y, Mikuzuki L, Kawasaki K, Sugawara S, et al. Evaluating burning mouth syndrome as a comorbidity of atypical odontalgia: the impact on pain experiences. Pain Pract. 2018;18(5):580-6.
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The presence of psychiatric comorbidities aggravated the quality of sleep but had little impact on pain experience. The presence of burning mouth syndrome in patients with AO contributes to more severe pain. |
| Takenoshita et al.3333 Takenoshita M, Miura A, Shinohara Y, Mikuzuki R, Sugawara S, Tu TTH, et al. Clinical features of atypical odontalgia; three cases and literature reviews. Biopsychosoc Med. 2017;11:21.
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AO is not purely a sensory problem, but it has psychological involvement. It has a variable response to drug use, and it is necessary to investigate the different pharmacological responses to advance the treatment of AO. |
| Tait, Ferguson and Herndon3434 Tait RC, Ferguson M, Herndon CM. Chronic orofacial pain: burning mouth syndrome and other neuropathic disorders. J Pain Manag Med. 2017;3(1). pii: 120.
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They consider AO, so the diagnosis occurs by exclusion. According to the authors, there is no diagnostic protocol with evidence. Treatments that are considered effective for orofacial pain are disappointing for AO. |
| Kobayashi et al.3535 Kobayashi Y, Nagashima W, Tokura T, Yoshida K, Umemura E, Miyauchi T, et al. Duloxetine plasma concentrations and its effectiveness in the treatment of nonorganic chronic pain in the orofacial region. Clin Neuropharmacol. 2017;40(4):163-8.
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The authors found no relationship between pain relief and duloxetine plasma concentration, which is used to treat AO. |
| Benoliel and Gaul3636 Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017;37(7):680-91.
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Enigmatic physiopathology. Neuropathic mechanisms are more relevant. Interdisciplinarity. Attention to psychiatric comorbidity. Careful interdisciplinary assessment is necessary to institute appropriate treatment. |
| Baad-Hansen and Benoliel2828 Baad-Hansen L, Benoliel R. Neuropathic orofacial pain: facts and fiction. Cephalalgia. 2017;37(7):670-9.
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There is no gold standard for diagnosis. A consensus on classification and taxonomy is needed. Prospective studies are necessary. Education and training for professionals are important to avoid iatrogenies. Careful interdisciplinary assessment is required to institute appropriate treatment. |
| Agbaje et al.3737 Agbaje J, De Laat A, Constantinus P, Svensson P, Baad-Hansen L. Agreement between quantitative and qualitative sensory testing of changes in orofacial somatosensory sensitivity. J Oral Rehabil. 2017;44(1):30-42.
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QualST can be used as a clinical diagnostic tool, as well as to investigate intraoral somatosensory function in patients with AO. QualST is a simple test to verify changes in somatosensory function. |
| Rafael, Sorin and Eli3838 Rafael B, Sorin T, Eli E. Painful traumatic trigeminal neuropathy. Oral Maxillofac Surg Clin North Am. 2016;28(3):371-80.
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It presents clinical characteristics and physiopathology of painful traumatic trigeminal neuropathy, and what to do to prevent it. |
| Toyofuku3939 Toyofuku A. Psychosomatic problems in dentistry. Biopsychosoc Med. 2016;10:14.
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The professional must be aware of the patient's psychosomatic aspect, which is a priority as well. |
| Cuadrado et al.2626 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.
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The positive response to the use of botulinum neurotoxin type A suggests that its use is effective and safe in the treatment of neuropathies, but RCT are necessary to prove its effectiveness. |
| Porporatti et al.4040 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. pii:S1806-83242015000100400.
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QST can help in the differential diagnosis between pulpitis and AO with substantial accuracy. QST limitations: patient gets tired, it is difficult to examine painful areas |
| Porporatti et al.4141 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.
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There is central sensitization involvement, and decreased pain with the anesthetic also suggests that there is peripheral involvement. |
| Porporatti et al.1010 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.
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It reinforces the role of the central nervous system sensitization. The most reliable method would be bilateral QST comparing pain threshold using a mechanical allodynia stimulus or heat pain threshold tests. |
| Baad-Hansen et al.4242 Baad-Hansen L, Pigg M, Yang G, List T, Svensson P, Drangsholt M. Reliability of intra-oral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls - a multicentre study. J Oral Rehabil. 2015;42(2):127-35.
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QST should be associated with neurophysiological tests or imaging examinations, where possible, to increase test sensitivity and specificity. |
| Forssell et al.2424 Forssell H, Jääskeläinen S, List T, Svensson P, Baad-Hansen L. An update on pathophysiological mechanisms related to idiopathic orofacial pain conditions with implications for management. J Oral Rehabil. 2015;42(4):300-22.
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There is increasing evidence of neuropathic mechanisms for orofacial pain - including AO. The authors suggest that the diagnosis be based on clinical examination, medical history, QST, neurophysiological tests, etc. |
| Pig et al.4343 Pigg M, List T, Abul-Kasim K, Maly P, Petersson A. A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia. J Oral Facial Pain Headache. 2014;28(3):233-42.
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MRI may be of great value as it excludes inflammation processes in the mandibular and maxillary regions. When the diagnosis is uncertain, MRI raises the argument to avoid dental treatments and consider noninvasive treatments. |
| Yatani et al.2727 Yatani H, Komiyama O, Matsuka Y, Wajima K, Muraoka W, Ikawa M, et al. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil. 2014;41(11):843-52.
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The authors present a guide for the treatment of non-odontogenic origin. The use of tricyclic antidepressants is the most commonly used but has no proven effectiveness. |
| Baad-Hansen et al.4444 Baad-Hansen L, Pigg M, Ivanovic SE, Faris H, List T, Drangsholt M, et al. Intraoral somatosensory abnormalities in patients with atypical odontalgia--a controlled multicenter quantitative sensory testing study. Pain. 2013;154(8):1287-94.
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The QST showed 87.3% abnormality in individuals with AO as an increase in mechanical and thermal stimuli and may be an appropriate tool for scanning patients with neuropathic pain. |
| Tarce, Barbieri and Sardella2323 Tarce M, Barbieri C, Sardella A. Atypical odontalgia: an up-to-date view. Minerva Stomatol. 2013;62(5):163-81.
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Diagnosis and treatment are challenging. Physiopathology is unclear. They suggest more RCT to prove the effectiveness of drugs used in the treatment of AO. |
| Baad-Hansen et al.4545 Baad-Hansen L, Pigg M, Ivanovic SE, Faris H, List T, Drangsholt M, et al. Chairside intraoral qualitative somatosensory testing: reliability and comparison between patients with atypical odontalgia and healthy controls. J Orofac Pain. 2013;27(2):165-70.
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QualST detect disturbances in individuals with AO, especially sensitivity to cold, touch, and bristle stimulation. |
| Zakrzewska4646 Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain. 2013;14:37.
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It reviews the literature on pain in the lower face and mouth. It addresses classification, epidemiology, and diagnosis. |
| Tınastepe and Oral 4747 Tinastepe N, Oral K. Neuropathic pain after dental treatment. Agri. 2013;25(1):1-6.
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Neuropathic pain has complex physiopathology and may start after dental treatment such as endodontic treatment, implant surgery, and trauma when anesthetizing. Trigeminal neuralgia, mouth burning syndrome, and postherpetic neuralgia and AO are neuropathic conditions |
| Ciaramella et al.1515 Ciaramella A, Paroli M, Lonia L, Bosco M, Poli P. Biopsychosocial aspects of atypical odontalgia. ISRN Neurosci. 2013;2013:413515.
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Some psychological factors determine predisposition to the development of chronic pain after extraction. Individuals with AO had high levels of resentment and depression. |
| Nagashima et al.4848 Nagashima W, Kimura H, Ito M, Tokura T, Arao M, Aleksic B, et al. Effectiveness of duloxetine for the treatment of chronic nonorganic orofacial pain. Clin Neuropharmacol. 2012;35(6):273-7.
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Duloxetine relieved the pain of patients with burning mouth syndrome and AO. |
| Patel, Boros and Kumar4949 Patel SB, Boros AL, Kumar SK. Atypical odontalgia--an update. J Calif Dent Assoc. 2012;40(9):739-47.
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In the absence of an accurate diagnosis, do not perform endodontic and surgical treatment. |
| Abiko et al.2222 Abiko Y, Matsuoka H, Chiba I, Toyofuku A. Current evidence on atypical odontalgia: diagnosis and clinical management. Int J Dent. 2012;2012:518548.
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They present diagnostic criteria and treatment and management protocols. There is insufficient information to establish a diagnosis and treatment protocol for AO. Psychological factors cannot be disregarded as there is a high incidence of related problems. |
| Thorburn e Polonowita5050 Thorburn DN, Polonowita AD. Atypical odontalgia--a diagnostic dilemma. N Z Dent J. 2012;108(2):62-7.
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The diagnosis occurs by exclusion. Clinical examination and history are important. With the advances in understanding the mechanisms of chronic neuropathic pain, there will be more focus on the diagnosis and treatment of AO. |
| Bosch-Aranda et al.2020 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.
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AO is difficult to diagnose because the physiopathological mechanisms are unclear. Still, the evidence is not enough to indicate treatments with analgesics and antidepressants. |
| Pigg et al.5151 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.
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Cone-beam computed tomography provides the identification of patients without periapical bone destruction, which facilitates the differentiation between symptomatic apical periodontitis and AO. |
| Zagury et al.5252 Zagury JG, Eliav E, Heir GM, Nasri-Heir C, Ananthan S, Pertes R, et al. Prolonged gingival cold allodynia: a novel finding in patients with atypical odontalgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(3):312-9.
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Sensory changes for post-cold sensation were identified in patients, suggesting the involvement of central neuropathic mechanisms. Pain extending to a broader region of the site of origin, and pain occurring on the contralateral side, reinforces the idea of central sensitization. Extraoral QST does not seem to be able to detect change. |
| Takenoshita et al.1414 Takenoshita M, Sato T, Kato Y, Katagiri A, Yoshikawa T, Sato Y, et al. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities. Neuropsychiatr Dis Treat. 2010;6:699-705.
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AO patients were most often diagnosed in the stressed F4 neurotic category. |
| Ito et al.5353 Ito M, Kimura H, Yoshida K, Kimura Y, Ozaki N, Kurita K. Effectiveness of milnacipran for the treatment of chronic pain in the orofacial region. Clin Neuropharmacol. 2010;33(2):79-83.
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Milnacipran was effective in reducing pain in AO patients, regardless of the degree of depression. |
| Ram et al.2929 Ram S, Teruel A, Kumar SK, Clark G. Clinical characteristics and diagnosis of atypical odontalgia: implications for dentists. J Am Dent Assoc. 2009;140(2):223-8.
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If the patient continues to have persistent pain after the treatment, with no apparent clinical and radiographic cause, the professional should consider AO as a differential diagnosis. Dentists should be able to identify this situation and refer to an orofacial pain specialist or neurologist. |
| List, Leijon and Svensson1919 List T, Leijon G, Svensson P. Somatosensory abnormalities in atypical odontalgia: a case-control study. Pain. 2008;139(2):333-41.
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Most patients with AO presented somatosensory alteration compared to few in the control group, which reflects in central and peripheral sensitization. |
