Abiko Yoshihiro, Matsuoka Hirofumi, Chiba Itsuo, Toyofuku Akira
Division of Oral Medicine and Pathology, School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Ishikari-Tobetsu, Hokkaido 061-0293, Japan.
Int J Dent. 2012;2012:518548. doi: 10.1155/2012/518548. Epub 2012 Jul 9.
Patients with atypical odontalgia (AO) complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i) What is the prevalence of AO in the community? (ii) What psychological problems are experienced by patients with AO? (iii) Are there any comorbidities of AO? (iv) Is local anesthesia effective for the relief of pain in AO? (v) Are there any characteristic symptoms of AO other than spontaneous pain? (vi) Are antidepressants effective for treatment of AO? (vii) Are anticonvulsants effective for treatment of AO? Our literature search provided answers for these questions; however, there is insufficient evidence-based data to establish guidelines for the diagnosis and treatment of AO. Overall, some diagnostic criteria for neuropathic pain and persistent dentoalveolar pain disorder may be applied to AO patients. The patient's psychogenic background should always be considered in the treatment and/or management of AO. The clinicians may need to treat AO patients using Patient-Oriented Evidence that Matters approach.
非典型牙痛（AO）患者主诉有医学上无法解释的牙痛。目前尚无基于证据的诊断标准或治疗指南。本文基于文献中的现有知识，针对AO提出了七个临床问题，并讨论了其诊断标准以及治疗和管理指南。这些问题包括：（i）社区中AO的患病率是多少？（ii）AO患者存在哪些心理问题？（iii）AO是否有任何合并症？（iv）局部麻醉对缓解AO疼痛是否有效？（v）除自发痛外，AO是否有任何特征性症状？（vi）抗抑郁药对AO治疗是否有效？（vii）抗惊厥药对AO治疗是否有效？我们的文献检索为这些问题提供了答案；然而，尚无足够的循证数据来制定AO的诊断和治疗指南。总体而言，一些神经性疼痛和持续性牙槽骨疼痛障碍的诊断标准可能适用于AO患者。在AO的治疗和/或管理中，应始终考虑患者的心理背景。临床医生可能需要采用以患者为导向的重要证据方法来治疗AO患者。
