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KMID : 0390320230330020013
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Chungbuk Medical Journal
2023 Volume.33 No. 2 p.13 ~ p.25
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Pain Management of Patient Having Atypical Odontalgia with Peripheral Nerve Block
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Shin Young-Duck
Seo Hae-Won
Yun Mi-Jung
Kim Gunn-Hee
Jung Eun-Jae
Kwon Mi-Young
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Abstract
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Background: Atypical odontalgia is a severe, persistent pain in the site where a tooth was extracted in the absence of clinical and radiographic evidence of tooth pathology. We present two cases of atypical odontalgia treated with peripheral nerve block and local infiltration.
Case 1: A 52-year-old woman was referred to the Pain Center by a neurologist for right gingival pain. The pain was constant, dull, intermittently sharp, and radiated to the temporal and forehead regions (Visual Analog Scale(VAS) Score 8). The gingival pain started after she received dental treatment on the right premolar tooth 3 years ago, and the right upper and lower premolars 15 and 45, respectively, and right lower first molar 46 were extracted without any improvement in pain. No clinical and radiological (computed tomography and magnetic resonance imaging) evidence of tooth pathology was found. She did not have depression. She was prescribed medications for trigeminal neuralgia in the Neurology Department for 9 weeks. Considering atypical odontalgia, she received 18 inferior alveolar nerve blocks and local anesthetic injections into the labial sulcus adjacent to the painful gingiva for 18 months at the Pain Center. Topical lidocaine and capsaicin cream were applied during that period. The pain VAS decreased to 2.
Case 2: A 58-year-old woman visited the Pain Center due to pain in the left gingival area with radiation to the tongue (VAS 7), jaw, and temporal areas since extraction of the left upper molar tooth (28) 10 years ago and the left lower molar teeth (37, 38) 3 years ago. She was referred to the Neurologic, Dental, and Internal Medicine Departments. Although she received medications, the pain did not reduce, and no abnormalities causing the pain were found. She received 6 facial nerve blocks, 3 inferior alveolar nerve blocks, 6 superficial cervical plexus blocks, 3 Stellate ganglion blocks, 3 local
sulcus infiltration, and pregabalin for 2 months, and the pain VAS decreased to 1 or 0.
Conclusion: In conclusion, patients with atypical odontalgia experience significant but not complete pain relief
from nerve blocks and local infiltration of anesthetics.
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KEYWORD
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Atypical odontalgia, Local infiltration, Nerve block, Pain
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