Abstract
Diseases that may involve nociplastic pain mechanisms in dentistry include burning mouth syndrome （BMS）, persistent idiopathic facial pain （PIFP）, and persistent idiopathic dentoalveolar pain （PIDAP）, which are classified as idiopathic orofacial pain in the International Classification of Orofacial Pain, 1st edition （ICOP-1）.
Both of these diseases were conventionally thought to be caused by peripheral neuropathic pain, and most of the recommended medical treatments are topically administered, but their efficacy has been inadequate. This paper describes the characteristics of these diseases and the currently recommended treatment methods, with a literature review of our own case studies, followed by a description of the pharmacological therapies, involving tricyclic antidepressants, used by the authors.
The authors used amitriptyline as their first choice. In our case-study of 195 patients （71 with BMS and 124 with PIDAP）, 63.4％ of BMS and 63.7％ of PIDAP patients achieved pain resolution in approximately 4 months and 4.5 months, respectively, at a mean dose of 59.2mg and 78.9mg/day, respectively. The mean dose of amitriptyline used was 59.2 and 78.9mg/day, respectively. If amitriptyline alone is not effective, the cure rate can be further increased by switching to another antidepressant within the same tricyclic antidepressant class or by newly adding an antipsychotic.
The authors believe that idiopathic orofacial pain disorders respond well to antidepressants, and that early diagnosis and initiation of treatment can lead to cure without chronicity.
