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Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0002-7989-1541
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0002-9638-4648
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
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2011 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 12, no 44, p. 1092-1101Article in journal (Refereed)
Abstract [en]

Abstract AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2011. Vol. 12, no 44, p. 1092-1101
Keywords [en]
atypical odontalgia, chronic intraoral pain, cone-beam computed tomography, neuropathic pain, orofacial pain, radiography
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15784DOI: 10.1111/j.1365-2591.2011.01923.xISI: 000297248700003PubMedID: 21790664Scopus ID: 2-s2.0-80855131416Local ID: 13160OAI: oai:DiVA.org:mau-15784DiVA, id: diva2:1419306
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
In thesis
1. Chronic intraoral pain - assessment of diagnostic methods and prognosis
Open this publication in new window or tab >>Chronic intraoral pain - assessment of diagnostic methods and prognosis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were:•What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin?•What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis?Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients’ self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions.Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the percep¬tion of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use.Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125–0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results.Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1–3 weeks, at four sites—three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause.Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors.. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain charac¬teristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2011
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 220
Keywords
Neuropathic pain, Orofacial pain, Trigeminal pain, Clinical studies, Prognosis, Diagnostic methods, Quantitative sensory testing, QST, Chronic pain, Endodontics
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7711 (URN)12563 (Local ID)978-91-7104-387-0 (ISBN)12563 (Archive number)12563 (OAI)
Note

Note: the papers are not included in the fulltext online.

Paper IV in dissertation as manuscript with title "Longterm prognosis of atypical odontalgia. A 7-year prospective study"

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-05Bibliographically approved

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Pigg, MariaList, ThomasPetersson, KerstinLindh, ChristinaPetersson, Arne

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