Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause and hypersensitivity to stimuli in radiographically normal teeth. Patients complain of continuous pain even after extended endodontic treatment. This report presents two cases of AO in patients who visited our clinic in 2007 from the psychosomatic perspective. We examined their medical histories, treatment procedures and prescriptions as described in their medical records.
(Case 1)Female, 39 years old. Chief complaint: Pain on the right maxillary second premolar. The patient felt pain on the right maxillary first molar and the crown of the tooth was removed. She subsequently changed clinics and the tooth was extracted. Laser therapy and a pulpectomy were provided on account of the pain but she again changed clinics because of the constant toothache. She visited our clinic while receiving treatment at a pain clinic. SAIDs and milnacipran were ineffective. The pain was alleviated by amitriptyline.
(Case 2)Female, 38 years old. Chief complaint: Post extraction pain on the right maxillary molar and right orbital pain. The right maxillary molar was extracted after repeated root canal treatment (RCT) but the pain remained following tooth extraction and she next visited oral surgery. She was diagnosed as normal by the oral surgeon, and then visited our clinic. She refused to take antidepressants at first in spite of repeated counseling to do so, but did agree to take the medicines after three months. The pain was relieved by amitriptyline.
It is very difficult to diagnose AO due to the very nature of dental treatment. Despite the reports that some antidepressants are effective against AO, dentists often have difficulty in treating AO patients due to individual variations in the response to medicines. Further, as the patients themselves believe that their pain is caused by dental problems, they sometimes refuse antidepressants. Patients are inclined to become angry or distrustful because of their prolonged pain and repeated dental treatment, so it is important both to prescribe appropriate medications and to be receptive and listen attentively to what they say.