Takenoshita Miho, Miura Anna, Shinohara Yukiko, Mikuzuki Rou, Sugawara Shiori, Tu Trang Thi Huyen, Kawasaki Kaoru, Kyuragi Takeru, Umezaki Yojiro, Toyofuku Akira
Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan.
Psychosomatic Dentistry Clinic, Dental Hospital, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan.
Biopsychosoc Med. 2017 Aug 3;11:21. doi: 10.1186/s13030-017-0106-8. eCollection 2017.
Atypical odontalgia (AO) is a disease characterized by continuous pain affecting the teeth or tooth sockets after extraction in the absence of any identifiable cause on clinical or radiographic examination. Antidepressants, such as amitriptyline, are reported to be effective in the treatment of AO; however, their efficacy varies depending on the case. In this article, we report three types of AO and discuss its heterogeneity and management.
In the first case, a 58-year-old woman presented with a heavy, splitting pain in the four maxillary front post-crown teeth, as if they were being pressed from the side. Her symptoms abated with 20 mg of amitriptyline. In the second case, a 39-year-old woman presented with a feeling of heaviness pain on the right side of maxillary and mandibular molar teeth, face, whole palate, and throat. She was unable to function because of her pain. Her symptoms drastically subsided with 3 mg of aripiprazole. In the third case, a 54-year-old woman presented with a tingling sensation on the left mandibular second premolar and first molar, and an uncomfortable feeling on her provisional prosthesis that made it unbearable to keep the caps on. Her symptoms diminished with 2 mg of aripiprazole added to 30 mg of mirtazapine.
AO shows various features and responses to drugs. It is considered not only a purely sensory problem, but also a considerably complex psychological problem, such as rumination about the pain. Investigating the difference in pharmacotherapeutic responses might help to advance the treatment of AO.
非典型牙痛（AO）是一种疾病，其特征为拔牙后牙齿或牙槽窝持续疼痛，而临床或影像学检查未发现任何可识别的病因。据报道，抗抑郁药如阿米替林对AO治疗有效；然而，其疗效因病例而异。在本文中，我们报告了三种类型的AO，并讨论了其异质性及治疗方法。
第一例中，一名58岁女性上颌四颗前牙烤瓷冠后出现沉重、撕裂样疼痛，仿佛牙齿被从侧面挤压。服用20毫克阿米替林后症状缓解。第二例中，一名39岁女性上颌和下颌磨牙、面部、整个腭部及咽喉右侧出现沉重疼痛感。疼痛导致她无法正常生活。服用3毫克阿立哌唑后症状大幅缓解。第三例中，一名54岁女性左下第二前磨牙和第一磨牙有刺痛感，其临时假牙佩戴不适，无法忍受戴着牙冠。服用30毫克米氮平并加用2毫克阿立哌唑后症状减轻。
AO表现出多种特征及对药物的反应。它不仅被认为是一个纯粹的感觉问题，也是一个相当复杂的心理问题，比如对疼痛的反复思索。研究药物治疗反应的差异可能有助于推进AO的治疗。
