The atypical odontalgia

What is atypical odontalgia?

Atypical odontalgia is a rather unknown clinical picture. It used to be called phantom pain, but atypical odontalgia is a serious dental disease. It is characterized by permanent neuropathic pain and should be treated in any case. The pain can persist for years and severely restrict the affected person in his or her daily life. In addition, finding a diagnosis is not easy and usually takes a long time.

These symptoms may indicate an atypical odontalgia

Atypical odontalgia often causes permanent pain. This is often felt as a dull pain under pressure. But short or stabbing pain can also occur at irregular intervals.

Patients can often sleep at night and feel no pain at this time. The pain usually begins somewhat delayed after dental treatment and can persist for several years. Another indication of atypical odontalgia is persistent pain even after the previous disease has healed and no clear signs of inflammation.

Possible causes of atypical odontalgia

Among the possible causes of atypical odontalgia may be “deafferentiation of the peripheral trigeminal nerves” (nervus trigeminal = facial nerve). In this case, the nerves are irritated by dental treatment to such an extent that the transmission of impulses is disturbed and signal transport is interrupted. This causes over- or underreactions at the nerve endings and spontaneous activity can trigger pain in the corresponding supply area of the nerve. Atypical odontalgia can be the result especially in case of tooth removal (extraction), surgical intervention in the jaw area, apicoectomy or root canal treatment. However, it is very rarely observed.


Since there are no clinical or radiological findings for atypical odontalgia, making a diagnosis is a challenge for the dentist. Often it is not possible to find the exact cause of pain. This is a diagnosis of exclusion, which is very important in order not to make false diagnoses at an early stage. In addition to the dentist, a visit to the internist and a neurologist can also be helpful.

Treatment of atypical odontalgia

Atypical odontalgia is a diagnosis of exclusion, which unfortunately is very long in many cases. Therefore, the patience and cooperation of the patients is very important for a successful therapy. There are various treatment options for atypical odontalgia.

A causal therapy, i.e. to eliminate the cause of the pain, is unfortunately not possible, as the exact cause cannot be determined. The drug therapy of atypical odontalgia includes tricyclic antidepressants such as Amitriptyline®. These are administered in low doses.

Thus, they only work against pain and not on the psyche. By administering the drug, the pain is supposed to be felt as less severe and thus provide relief. Furthermore, capsaicin in ointment form can be applied to the affected area several times a day.

Capsaicin is said to relieve nerve pain and promote blood circulation. A complete cure of atypical odontalgia is associated with a long therapy period. Nevertheless, it is possible that patients are and remain free of complaints after successful therapy.

Many patients feel a little better already after the beginning of the therapy, as the different forms of therapy gradually lead to the relief of symptoms. It is important not to stop the therapy early or to interrupt it for a longer period of time. Since atypical odontalgia is a diagnosis of exclusion, it will take a long time before the exact diagnosis can be made.

During the therapy, relief will gradually appear. Complete recovery from atypical odontal pain can take up to several years. The combination of drug therapy and relaxation therapy can have a positive influence on the duration of treatment.