(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
Since symptoms are very similar to those caused by a
"toothache", often numerous dental procedures are done.
To complicate matters, these treatments (such as pulp
extirpation, root-tip surgery or tooth extraction) may offer
temporary relief from pain, only to have the pain return.
|Last Updated 26th February 2015
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 AO.
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.