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.
Last Updated 26th February 2015
Useful Websites:

Facial Neuralgia Resources

European Association of Oral Medicine

American Academy 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.

American Academy of Oral Medicine 2008. Patient Information Sheet.  Atypical

JADA 2009.  Clinical Characteristics & Diagnosis of Atypical Odontalgia.  
Implications for Dentists

J Headache & Pain 2013.  Review Article.  Multi-Dimensionality of Chronic Pain of
the Oral Cavity & Face

Br J Anaesth 2013.  Differential Diagnosis of Facial Pain & Guideleines for

Brain & Spine Foundation 2014.  Face Pain.  A Guide to Patients & Carers

Int J Contemp Dent & Med Rev 2015.  Atypical Facial Pain & Atypical Odontalgia -
A Concise Review
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 treatable.