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Atypical Facial Pain

Atypical Facial Pain

Atypical facial pain is unwarranted pain. It is often disabling, and no disease is found to cause it.

What is atypical facial pain?

It is persistent facial pain that does not have the characteristics of cranial neuralgias and cannot be attributed to a distinct disorder.

It is usually localized to teeth or sites of tooth extractions of teeth that have typically undergone various dental operative treatments and procedures.

It has no pattern. Nor does it present with momentary crises, it is usually more long-lasting, often continuous, and does not stick to the territory of any nerve branch (1).

In addition, sensory alterations other than pain are perceived, such as burning, tingling, swelling or numbness.

Types of pain

As modalities of this pain we have:

      1. Atypical odontalgia, which presents with pain in one or more teeth that do not suffer any lesion.
      2. Phantom tooth syndrome, which is pain in a tooth that does not exist in the mouth because it has been extracted.

Today we know that it is an alteration of the nociceptive system (set of neurons responsible for registering the sensation of pain).

The patient perceives pain in response to stimuli that are not normally painful, such as the rubbing of the tongue or the slightest pressure of food on the teeth or gums (2).

Treatment

In general, the prognosis is poor and the development of psychiatric pathologies has been widely described (3).

Also in these cases it is necessary to be extremely careful with oral treatments, as the pain may worsen.

We must be very conservative, and treatment is based on medication, peripheral blocks and psychological support.

We generally use neuromodulatory drugs, whether anxiolytics, antidepressants, antipsychotics or antiepileptics (4).

References:

    1. Renton T. Chronic Pain and Overview or Differential Diagnoses of Non-odontogenic Orofacial Pain. Prim Dent J.2019; 7: 71-86.
    2. Woda A, Pionchon P. [Nociception and chronic oral and cervicofacial pain]. Ann Otolaryngol Chir Cervicofac.2007; 124 Suppl 1:S2-S10.
    3. Miura A, Tu TTH, Shinohara Y, Mikuzuki L, Kawasaki K, Sugawara S, Suga T, Watanabe T, Watanabe M, Umezaki Y, Yoshikawa T, Motomura H, Takenoshita M, Maeda H, Toyofuku A. Psychiatric comorbidities in patients with Atypical Odontalgia. J Psychosom Res.2018; 104:35-40.
    4. Bista P, Imlach WL. Pathological Mechanisms and Therapeutic Targets for Trigeminal Neuropathic Pain. Medicines (Basel).2019; 6.