Atypical Odontalgia
(Idiopathic or Phantom Tooth Pain)
What is Atypical Odontalgia?

Atypical Odontalgia (AO) is a condition in which a tooth is
very painful but nothing can be found wrong with the tooth.  
The pain is continuous, usually burning, aching and
sometimes throbbing and most often occurs in upper
premolars (bicuspids) or molars.

Since symptoms are very similar to those caused by a
"toothache", often numerous dental procedures are done.

To complicate matters, these treatments (such as
, root-tip surgery or tooth extraction) may offer
temporary relief from pain, only to have the pain return.

What are the Signs & Symptoms of Atypical Odontalgia?

The typical clinical presentation of AO involves pain in a tooth
in the absence of any sign of pathology; the pain may spread
to areas of the face, neck, and shoulder.

Symptoms include a continuous burning, aching pain in a
tooth or in the bone / gum surrounding a tooth.

Often there in increased sensitivity to pressure over the
painful region.  Often nothing shows up on diagnostic tests,
no abnormalities are found on X-rays and no obvious cause
for the “tooth pain” can be found.

Patients often have difficulty localising the pain.

All ages can be affected except for children.  
AO seems to
be more common in women in their mid - 40’s.

Diagnosis is based primarily on symptoms and on elimination
of other possible disorders.  Tests may include diagnostic
dental X-rays, CT scans and possibly MRI scans.  If a nerve
block does not result in pain reduction or if the results are
ambiguous then a diagnosis of
AO should be considered.

How is it treated?

Medications such as painkillers and sedatives are not
effective in AO.  Surgery and other dental interventions rarely
provide relief.

Anti-depressants medications can reduce AO pain which is
probably due to their
analgesic effects (Anti-depressants
have the ability to produce low-grade pain relief at lower
strengths) and not to their
anti-depressant effects.  AO
patients are generally not depressed.

Topical application of
capsaicin (the ‘heat’-producing
component of chilli) to painful tissue has also been
investigated as a treatment for

The outcome is usually fair, with many patients obtaining
complete relief from pain.

Especially in the absence of overt pathology, particular
attention should be paid to avoiding any unnecessary and
potentially dangerous dental intervention on the teeth.

AO is surprisingly common, of uncertain origin and potentially

Useful Websites:

Facial Neuralgia Resources

European Association of Oral Medicine

Useful Articles:

Dental Update 1999.  Orofacial Pain

British Medical Journal 2000.  ABC of Oral Health - Oro-
facial Soreness and Pain

J Canadian Dent Assoc 2004.  Diagnostic Challenges of
Neuropathic Tooth Pain

British Dental Journal 2006.  Oral Medicine, Update for the
GDP - Oro-Facial Pain

J Contemporary Dent Practice 2007.  Diagnosis and
Treatment of Atypical Odontalgia: A Review of the Literature
and Two Case Report.
Last Updated 22nd November 2010