Independent Reasercher, 20122 Milano, Italy.
Department of Oncology and Haematology-Oncology,, University of Milano, 20122 Milano, Italy.
F1000Res. 2021 Apr 23;10:317. doi: 10.12688/f1000research.51845.3. eCollection 2021.
Orofacial pain represents a challenge for dentists, especially if it does not have an odontogenic origin. Orofacial neuropathic pain may be chronic, is arduous to localize and may develop without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect this condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacological tailored and adapted therapies, after conventional medications had failed. Additionally, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given. A 68-year-old man complained of chronic throbbing and burning pain in a maxillary tooth, which worsened upon digital pressure. Symptoms did not abate after amitriptyline therapy; psychological intervention along with antianxiety drug were supplemented and antidepressant agent dosage were incremented. The patient reported improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old man complained of chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while carbamazepine therapy had not been sufficient to control pain. Due to concerns with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favorably changing clinical outcomes. Comorbid psychiatric disorders have a negative impact on orofacial pain, and dentists should consider adopting tailored therapies, such as psychological counselling and behavioral and psychopharmacologic strategies, besides conventional treatments. They also must be familiar with the signs and symptoms of orofacial pain, obtaining a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis may prevent pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims.
颌面疼痛对牙医来说是一个挑战，尤其是如果它不是牙源性的。颌面神经性疼痛可能是慢性的，难以定位，并且可能在没有明显病理学的情况下发展。共存的精神疾病，如焦虑和抑郁，会对这种情况产生负面影响。本文介绍了一例非典型牙痛和一例三叉神经痛的病例，这些病例在常规药物治疗失败后，采用了心理和精神药理学的定制和适应治疗。此外，还对颌面疼痛具有挑战性的鉴别诊断相关的病理学进行了概述。一名 68 岁男性抱怨上颌牙齿持续搏动和烧灼感疼痛，数字按压时疼痛加剧。阿米替林治疗后症状并未减轻；补充了心理干预以及抗焦虑药物，并增加了抗抑郁药物剂量。患者报告说，他的病理状况采用多学科方法治疗后有所改善并感到满意。一名 72 岁男性抱怨上颌牙齿持续出现刺痛、间歇性、剧烈、放射状和类似电击样疼痛，分布在三叉神经上。心理干预和开处方抗抑郁药和抗焦虑药后疼痛不再复发，而卡马西平治疗不足以控制疼痛。由于担心共存的精神疾病，我们采用了以患者为中心、定制和平衡的治疗方法，从而改善了临床结果。共存的精神疾病对颌面疼痛有负面影响，牙医除了采用常规治疗外，还应考虑采用定制的治疗方法，如心理咨询和行为及精神药理学策略。他们还必须熟悉颌面疼痛的症状和体征，全面了解鉴别诊断相关的病理学。及时诊断可以防止疼痛的慢性化，避免复杂性增加和向颌面神经性疼痛和法律索赔的转变。
