A 7-year follow-up of patients with atypical odontalgia (AO)

Background and Aim: Atypical odontalgia (AO) is a severe chronic dentoalveolar pain condition with a prevalence of about 3% after endodontic treatment. The etiology is suggested to involve neuropathic pain mechanisms, possibly deafferentation of primary sensory neurons in dental pulp. Prior to correct diagnosis, patients with AO frequently undergo multiple and repeated endodontic treatments because of unresolved pain. The aim of this prospective study was to examine the long-term prognosis of AO. Methods: The study included 43 patients diagnosed with AO. Baseline (2002) and follow-up (2009) data were collected by means of validated questionnaires and instruments including pain frequency, characteristic pain intensity (CPI 0—100 score), average pain intensity (0—100 numerical rating scale), graded chronic pain severity (GCPS), psychological status (depression and non-specific physical symptoms scores of the SCL-90R according to the RDC/TMD) and a global improvement rating (PGIC). Baseline and follow-up data were compared using paired samples t-test at 5% significance level. Results: 37 patients (86%) responded; 31 women and 6 men (mean age 63, range 38—81 years). 62% reported continuous pain at baseline and 27% at follow-up (p=.001); 0% at baseline and 16% at follow-up had occasional pain (p=.012). CPI scores decreased from baseline 61±19 to follow-up 39±25 (p<.001). Average pain also decreased, from 5.7±2.0 to 3.5±2.4 (p<.001). 11% had GCPS scores indicating high disability at follow-up compared to 32% at baseline (p=.003). 14% at follow-up and 0% at baseline reported no disability (p=.023). SCL-90R depression scores and non-specific physical symptoms scores showed no significant differences between baseline and follow-up, but remained high. 54% of the patients rated their global status as improved, 41% as unchanged and 5% as worse at follow-up. Conclusion: We conclude that a majority of AO patients experience pain reduction of some degree over time. Psychological status does not change accordingly