Diagnostic Accuracy of Quantitative Sensory Testing to Discriminate Inflammatory Toothache and Intraoral Neuropathic Pain

Author(s)

Porporatti, Andre Luis ^[1] ; Costa, Yuri Martins ^{[2, 1]} ; Stuginski-Barbosa, Juliana ^[1] ; Bonjardim, Leonardo Rigoldi ^[3] ; Hungaro Duarte, Marco Antonio ^[4] ; Rodrigues Conti, Paulo Cesar ^[1]

Affiliation

^[1] Univ Sao Paulo, Bauru Sch Dent, Dept Prosthodont, BR-17012901 Bauru, SP - Brazil

^[2] Univ Sao Paulo, Bauru Sch Dent, Dept Biol Sci, BR-17012901 Bauru, SP - Brazil

^[3] Aarhus Univ, Dept Dent, Sect Orofacial Pain & Law Funct, Aarhus - Denmark

^[4] Univ Sao Paulo, Bauru Sch Dent, Dept Endodont, BR-17012901 Bauru, SP - Brazil

• Document type: Journal article
• Source: JOURNAL OF ENDODONTICS; v. 41, n. 10, p. 1606-1613, OCT 2015.
• Web of Science Citations: 7

Abstract

Introduction: A differential diagnosis between inflammatory toothache (IT) and intraoral neuropathic pain is challenging. The aim of this diagnostic study was to quantify somatosensory function of subjects with IT (acute pulpitis) and atypical odontalgia (AO, intraoral neuropathic pain) and healthy volunteers and to quantify how accurately quantitative sensory testing (QST) discriminates an IT or AO diagnosis. Methods: The sample consisted of 60 subjects equally divided (n = 20) into 3 groups: (1) IT, (2) AO, and (3) control. A sequence of 4 QST methods was performed over the dentoalveolar mucosa in the apical maxillar or mandibular area: mechanical detection threshold, pain detection threshold (PDT), dynamic mechanical allodynia, and temporal summation. One-way analysis of variance, Tukey post hoc analyses, and z score transformation were applied to the data. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the QST methods were calculated (alpha = 5%). Results: Somatosensory abnormalities were found for the AO group, which is consistent with a low detection threshold to touch and pain and the presence of mechanical allodynia. For the IT group, no somatosensory abnormality was observed when compared with the control group. The most accurate QST to discriminate the diagnostic differences between IT and healthy individuals is the PDT. The diagnostic differences between AO and healthy individuals and between IT and AO are best discriminated with the mechanical detection threshold, PDT, and dynamic mechanical allodynia. Conclusions: The proposed QST methods may aid in the differential diagnosis between IT and AO with strong accuracy and may be used as complementary diagnostic tests. (AU)

• FAPESP's process: 13/15496-1 - Comparative Evaluation of Somatosensory Mechanisms Involved in Genesis of Somatic, Visceral and Neuropathic Orofacial Pain.
• Grantee: André Luís Porporatti
• Support Opportunities: Scholarships in Brazil - Doctorate