Evaluation of Patients with Atypical Odontalgia through Quantitative Sensory Testing (QST) and Controlled Pain Modulation (CPM)

Author(s)

André Luís Porporatti

• Document type: Master's Dissertation
• Press: Bauru.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
• Defense date: 2013-03-26

Examining board members

Paulo Cesar Rodrigues Conti; Carlos dos Reis Pereira de Araujo; Andréa Lusvarghi Witzel

• Advisor: Paulo Cesar Rodrigues Conti

Abstract

Atypical Odontalgia (AO) is a chronic orofacial painful condition, which occurs in dentoalveolar structures and oral mucosa. AO is difficult to diagnose because it is associated with the absence of any clinical and radiographic alterations. Repetitive dental procedures are made, with the aim to relief pain. Sensory pathophysiological aspects and pain maintenance and perpetuation are still poorly understood. The aim of this study were: (1) evaluate somatosensory abnormalities in AO patients through quantitative sensory testing (QST), (2) evaluate mechanisms of pain modulation through the controlled pain modulation test (CPM), and (3) assess the psychological features such as anxiety, depression, sleep quality and quality of life through selfreported questionnaires. A total of 50 subjects were included, consisting of 25 subjects with symptomatic AO (19 women, 58.25 +- 12.17 years old) and 25 subjects in the control group (19 women, 58.92 +- 7.39 years old)(p>0.05). QST encompassed Mechanical Detection Threshold (MDT), Pain Detection Threshold (PDT), Dynamical Mechanical Allodynia with a cotton swab (DMA1) and with a toothbrush (DMA2), Cold Pain Detection (CPD), Heat Pain Detection (HPD) and Wind-up Ratio (WUR). Pain modulation was performed by CPM and psychological evaluations through Anxiety Inventory and Beck Depression Index, the Pittsburgh Sleep Quality and Quality of Life Questionnaire SF-36. QSTs were repeated after the administration of an anesthetic cream (2% Benzocaine). Statistical analysis was performed using the \"t\" test, paired t test and nonparametric Mann-Whitney test considering a significance level of 5%. Results indicated that AO subjects showed sensory gain through heat (HPD) and cold (CPD) stimuli and dynamic mechanical stimuli (DMA1, DMA2 and WUR), and sensory loss to mechanical stimuli (MDT, PDT). Moreover, CPM reduced pain intensity significantly only in the control group. A topical anesthesia showed a significant reduction in pain intensity in affected subjects. Furthermore, subjects with AO had symptoms of depression and anxiety, poor sleep quality and poor quality of life compared to healthy individuals. This study emphasized that somatosensory abnormalities are found in subjects with AO, which involves participation of peripheral sensitization associated with allodynia and hyperalgesia, suggesting central sensitization abnormalities. Pain modulation system proves deficient and psychological conditions are affected in subjects with AO. (AU)

• FAPESP's process: 11/14915-5 - Evaluation of patients with atypical odontalgia through quantitative sensory testing (QST) and conditioned pain modulation test (CPM): a case-control study.
• Grantee: André Luís Porporatti
• Support Opportunities: Scholarships in Brazil - Master