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Neuropathic orofacial pain part 1--prevalence and pathophysiology
1Department of Anaesthesia and Pain Management, University of Sydney, Royal North Shore Hospital. rvickers@med.usyd.edu.au
Summary
Neuropathic orofacial pain, previously called atypical odontalgia, causes severe persistent pain without clear abnormalities. This condition, affecting many, often follows dental procedures, highlighting a need for better understanding and diagnosis.
Area of Science:
- Neurology
- Dentistry
- Pain Medicine
Background:
- Neuropathic orofacial pain is defined as pain from nervous system dysfunction, previously termed atypical odontalgia or phantom tooth pain.
- Patients experience severe, persistent pain often without identifiable clinical or radiographic abnormalities, leading to unnecessary endodontic procedures.
- The condition's prevalence is significant, with estimates suggesting 125,000 individuals in the USA alone, and up to 50% of patients reporting persistent pain after endodontic treatment.
Purpose of the Study:
- To define neuropathic orofacial pain and differentiate it from other pain conditions.
- To review the clinical features, potential predisposing factors, and pathophysiology of neuropathic orofacial pain.
- To highlight the diagnostic challenges and the impact of endodontic treatment on patients with this condition.
Main Methods:
- Literature review of existing studies on neuropathic orofacial pain, atypical odontalgia, and phantom tooth pain.
- Analysis of retrospective studies reporting the incidence of persistent pain after endodontic treatment.
- Synthesis of clinical features, diagnostic criteria, and proposed pathophysiological mechanisms.
Main Results:
- Neuropathic orofacial pain is characterized by severe, persistent pain often lacking clear physical or radiographic findings.
- Incidence of persistent pain post-endodontic treatment ranges from 3-6% and 5% in retrospective studies.
- Clinical features include dysesthesias, burning pain, and sensory deficits, with potential triggers like trauma or infection, and delayed onset.
Conclusions:
- Neuropathic orofacial pain presents a diagnostic challenge in dentistry, often mimicking dental pain but originating from nervous system dysfunction.
- Understanding the complex neurobiology and clinical presentation is crucial for accurate diagnosis and appropriate management, avoiding invasive procedures.
- Further research is needed to elucidate the aberrant neurobiology and develop targeted treatments for this debilitating pain condition.