Treatment Outcome in Atypical Odontalgia: Determinants of Pain Relief

Objectives: Atypical Odontalgia (AO)-a continuous pain in the teeth or in the tooth socket after extraction in the absence of any identifiable cause- is a rare but difficult challenge for most dentists. Little is known about management and clinical outcome of AO because pain mechanism is still debated. This study aimed to: (1)observe the pharmacological response up to 16 weeks and (2)examine factors associated with pain remission.
Methods: This study retrospectively reviewed 165 AO patients, aged between 19-83 years from June 2015 to August 2017. Pain intensity, catastrophizing aspects and depressive status were measured via Visual-Analogue-Scale (VAS), Pain-Catastrophizing-Scale (PCS) and Zung-Self-Depression-Scale (SDS), respectively. Duration of pain, psychiatric history and medication were also collected. Early responses were observed at 4 weeks and the final outcome was pain remission (VAS) at 16 weeks after taking medication. Paired tests compared baseline and 16 weeks. Bayesian regression explored the possible determinants of pain relief at 16 weeks.
Results: Among 165 patients: 60 were referred to psychiatrists or other clinics, 23 were lost to follow-up within 16 weeks and 82 (48 female, 34 male) were prescribed and followed up in our clinic. After 4 and 16 weeks, there were 38 (46.3%) and 54 (65.9%) patients have at least 30% reduction of pain. VAS, PCS, and SDS at 16 weeks were significantly decreased (P<0.001) compared to baseline. There were no significant differences of medications at baseline variables and outcome responses. Regression model revealed that 4 elements: sex, SDS at baseline, VAS at 4 weeks and the change score of PCS can account for 52.5% of VAS at 16 weeks.
Conclusions: Two-thirds of patients have more than 30% pain relief after 16 weeks of treatment. Depressive state and early response might be associated with long-term remission. Interventions to decrease catastrophizing may improve pharmacotherapies outcome in AO patients.