and evaluation after 12 months revealed no significant mar-

ginal bone resorption.

Discussion.—The narrow ridge was augmented hori-

zontally to better support endosseous implants. Osseo-
integration of all implants was achieved in about 4 months.
Thus horizontal alveolar distraction allowed the placement
of endosseous implants in this partially edentulous patient.

Clinical Significance.—Presented is anoth-

er technique to augment a narrow alveolar
ridge to provide sufficient bone for implant
placement.

Oda T, Suzuki H, Yokota M, et al: Horizontal alveolar distraction of

the narrow maxillary ridge for implant placement. J Oral Maxillofac
Surg 62:1530-1534, 2004

Reprints available from T Oda, Dept of Oral & Maxillofacial Surgery,

Nagoya Univ Graduate School of Medicine, 65 Tsurumai-cho,
Showa-ku, Nagoya 466-8550, Japan; e-mail: toda@med.Nagoya

Fig 4.—A, Intraoral view of splint on the maxillary dentition to

protect the buccal mucosa from distraction rod (arrow) during
distraction. B, Occlusal view of augmented ridge and distrac-
tion rod after distraction. (Reprinted from Oda T, Suzuki H,
Yokota M, et al: Horizontal alveolar distraction of the narrow
maxillary ridge for implant placement. J Oral Maxillofac Surg
62:1530-1534, 2004. Copyright 2004, with permission from the
American Association of Oral and Maxillofacial Surgeons.)

Pain and Pain Control

Trigeminal neuralgia and atypical odontalgia

Background.—During any 6-month period, an estimat- the body. Because of the convergence of sensory neurons
ed 22% of the general population experiences orofacial to higher centers, it can be difficult to locate and interpret
pain. In addition, the head and neck region is affected by pain symptoms in the head and neck region. Conditions
persistent and chronic pain more than any other area of that mimic dental pain include trigeminal neuralgia and

Volume 50 • Issue 4 • 2005 219

atypical odontalgia. The clinical characteristics, epidemiol-
ogy, pathophysiology, and treatment of these neuropathic
conditions were outlined.
Trigeminal Neuralgia.—Facial neuralgia caused by
trigeminal neuralgia affects 4 to 5 persons per 100,000 pop-
ulation and is often found in women older than age 40. The
condition affects about 1% of patients with multiple sclero-
sis, and multiple sclerosis is present in 2% to 8% of patients
with trigeminal neuralgia. The characteristic pain of trigem-
inal neuralgia is described as sudden, stabbing, shooting,
burning, or having a paresthesia sensation and is generally
unilateral. The pain can be present for a few seconds or
minutes, then disappear for a while before reemerging.
Rarely do the pain episodes occur during sleep. Trigger
areas are often found around the nose and mouth and can
be stimulated by talking, chewing, tooth brushing, or just
light touch. A nerve block may not work, but local anes-
thetic used over the trigger area reduces the pain. No clear
mechanism of pain production has been identified.
Prevention of pain is the goal of treatment, which usually
includes anti-seizure/antiepileptic medications such as car-
bamazepine, baclofen, and phenytoin. Relief is obtained in
75% to 80% of patients within 24 to 72 hours. This response
to anticonvulsant agents has been used to confirm the di-
agnosis. Topical capsaicin has been used with some success
to block nociceptive fibers in the trigger areas. When nerve
compression is involved, microvascular decompression
surgery can obtain relief. Diagnostic information obtained
by magnetic resonance imaging can potentially improve
surgical treatment.
Atypical Odontalgia.—Idiopathic and phantom tooth
pain are other terms used for atypical odontalgia. This rare
condition is usually manifested as persistent toothache
after pulp extirpation, apicoectomy, or tooth extraction.
Causes include facial trauma and inferior alveolar nerve
block. Between 3% and 6% of patients having endodontic
treatment develop atypical odontalgia. The pain of this dis-
order is usually throbbing or burning, is constant, and in-
volves the teeth or alveolar process in the absence of any
identifiable odontogenic cause. Sleep is generally undis-
turbed, and some patients have a brief period free of pain
when they first awaken. The patient may have difficulty lo-
calizing the pain, which is usually worst where the original
trauma occurred but may radiate to other areas on one or
220 Dental Abstracts
both sides of the head and neck. Women in their mid 40s
are affected the most, but patients of all ages, except chil-
dren, have been reported. Usually, the molars and premo-
lars in the maxilla are involved. Relief is rarely obtained
with analgesics, even narcotic agents, and local anesthetic
blocks give ambiguous results. The condition may be mis-
takenly diagnosed as normal posttreatment or posttrauma
discomfort. Patients exhibit a high level of demoralization,
yet this may be the effect of the chronic pain or the cause.
Generally, this is a diagnosis of exclusion and requires the
recognition of neurologic signs involving other teeth or
nearby structures innervated by the same nerve. No clear
causative mechanism has been identified. Treatment in-
volves the use of tricyclic antidepressants alone or with
phenothiazines. These produce low-grade analgesia in low
doses. Pain has been reduced by the topical application of
capsaicin, which depletes C fibers of substance P and re-
duces their ability to stimulate the neurons that relay pain
signals to the central nervous system.
Discussion.—Recognizing the characteristics of odon-
togenic versus neuropathic pain conditions is essential in
managing pain of the head and neck. The next step is to dif-
ferentiate between the symptoms characteristic of the pos-
sible conditions. Orofacial pain diagnosis can be complicat-
ed by the neuropathic conditions trigeminal neuralgia and
atypical odontalgia, whose manifestations and treatment
have been outlined.
Clinical Significance.—What clinician has
not been presented with patient complaints
of a “toothache,” the origin of which cannot
be ascribed to a tooth, sinus, muscle, or
other readily demonstrable source? Pre-
sented is a useful discussion and suggestions
for differentiating odontogenic from neuro-
pathic pain.
Matwychuk MJ: Diagnostic challenges of neuropathic tooth pain.
J Can Dent Assoc 70:542-546, 2004
Reprints available from MJ Matwychuk, 8-166 Moos Tower, 515
Delaware St SE, Minneapolis, MN 55455; e-mail: mmatwychuk
@hotmail.com