Aim: To investigate time-dependent variability and influence of test site and stimulation area size on intraoral cold detection, warmth detection, and heat pain thresholds. Methods: Thirty healthy volunteers (15 women and 15 men) participated. Six extra- and intraoral sites were examined, and cold detection, warmth detection, and heat pain thresholds were measured. Time variability and influence of spatial summation were also studied at one site-the tip of the tongue-three times over a 6-week period. One-way ANOVA for repeated measures and paired sample t test compared mean values and SD within and between sites for all thresholds. Results: Several between-site differences were significant (P < .05). Lowest intraoral thresholds for all stimuli were measured at the tongue site, and at the tongue, thresholds for warmth detection and heat pain, but not cold detection, decreased with increasing size of stimulation area (P < .05). Overall, thresholds at the tongue site varied nonsignificantly over time (P > .05). Conclusion: Test site affects orofacial thermal thresholds substantially, whereas time variability and spatial summation on the tongue appear to be modest.

The German Research Network on Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detecting somatosensory abnormalities. Reliability is an important scientific property and has been adequately tested for cutaneous QST. This study evaluates intraoral sites for which no reliability trials have yet been published. Inter- and intra-examiner reliability of 13 QST measures at intra- and extraoral trigeminal sites were investigated. Twenty-one healthy volunteers from Malmö University, Malmö, Sweden (13 women and 8 men, mean age 40.4 years, range 24–71) participated. Two independent examiners previously trained in the DFNS QST protocol examined the participants using the entire protocol. Each participant was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1–3 weeks, one examiner re-examined all participants (intra-examiner reliability). The measurements were made on the skin of the right cheek, the tip of the tongue, and bilaterally on the gingival mucosa of the upper premolar region. The intraclass correlation coefficient (ICC) or kappa was used to calculate variations. Most tests had acceptable to excellent inter-examiner (ICC 0.41–0.89) and intra-examiner (ICC 0.43–0.87) reliability. For each test, inter- and intra-examiner reliabilities at intra- and extraoral sites were similar. No significant differences between right and left sides were found intraorally. We conclude that inter- and intra-examiner reliabilities of most QST measures are acceptable for assessing somatosensory function in the orofacial region.

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.

AIMS: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. METHODS: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. RESULTS: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P < .001). Pain frequency (P < .001) and GCPS (P < .001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. CONCLUSION: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition.