A case of atypical odontalgia with coexisting odontogenic inflammation

Inamoto Kaoru, Arai Eri, Miura Kazuhito, Nakagawa Sayuri, Watanabe Yutaka, Yamazaki Yutaka

doi:10.11268/jjpsd.36.1-2_33

It is difficult to diagnose toothache of unknown cause, especially intractable chronic odontogenic pain or atypical odontalgia. We report a case of atypical odontalgia in the left mandibular second premolar with acute alveolitis. A female in her 70s presented with dull pain in her left mandibular second premolar. Five years prior, she had undergone repeated treatment for pain in the lower first premolar and second premolar, which were abutment teeth for a removable partial denture of the mandible. The symptoms of the former disappeared after frequent root canal treatment, but the latter did not improve. After consulting multiple physicians, psychogenic involvement was suspected and she was referred to our department. Examination revealed no obvious dental or atypical odontalgia findings, but air trap was noted. She was administered herbal medicine Hangekobokuto, which was ineffective, followed by amoxicillin to no effect. A remarkable effect was observed with escitalopram oxalate. However, shortly thereafter, perimandibular inflammation of the lower second premolar suddenly developed. Her symptoms disappeared following tooth extraction after anti-inflammatory therapy. However, five months later, when a new denture was made, oral burning mouth syndrome developed.<br>Odontogenic and non-odontogenic pain may coexist presenting as toothache, and it is necessary to consider the possibility.

A case of atypical odontalgia with coexisting odontogenic inflammation

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