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      OnabotulinumtoxinA en el tratamiento de la odontalgia atípica: descripción de un caso clínico Translated title: OnabotulinumtoxinA in the treatment of atypical odontalgia: description of a clinical case

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          Abstract

          Resumen La odontalgia atípica (OA) se define como un dolor dental continuo en uno o varios dientes, en ocasiones precedido por procedimientos dentales, y que tras un examen completo no se detecta patología dental. Se presupone un origen neuropático cuya respuesta a tratamientos locales y sistémicos es insatisfactoria. Presentamos el caso clínico de una paciente de 50 años con OA tras extracción dental, que presentó una reducción significativa del dolor después del tratamiento local con OnabotulinumtoxinA (OnabotA) en el área sintomática. La respuesta a la administración de OnabotA en esta paciente concuerda con las observadas previamente en series reducidas de casos, por lo que podría ser una alternativa terapéutica en este tipo de dolores de difícil control.

          Translated abstract

          Abstract Atypical odontalgia (AO) is defined as a continuous dental pain in the area of one or several teeth, sometimes preceded by dental procedures in the absence of signs of dental pathology after complete examination. It is thought to have a neuropathic origin in which the response to local and systemic treatment is insufficient. We present the case of a 50-year-old patient with AO after dental extraction, who presented a significant reduction in pain after local treatment with OnabotulinumtoxinA (OnabotA) in the symptomatic area. The response to the administration of OnabotA in this patient is in line with what had previously been observed in small series of cases, so it could be a therapeutic alternative in this type of pain that is difficult to control.

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          Most cited references16

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          Botulinum toxin A in postherpetic neuralgia: a parallel, randomized, double-blind, single-dose, placebo-controlled trial.

          Cumulative evidence support a beneficial effect of botulinum toxin A (BTX-A) in postherpetic neuralgia (PHN). We aimed to assess efficacy, safety, and tolerability of BTX-A in the management of PHN, performing a randomized, double-blind, single-dose, placebo-controlled trial.
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            An update on pathophysiological mechanisms related to idiopathic oro-facial pain conditions with implications for management.

            Chronic oro-facial pain conditions such as persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and burning mouth syndrome (BMS), usually grouped together under the concept of idiopathic oro-facial pain, remain a diagnostic and therapeutic challenge. Lack of understanding of the underlying pathophysiological mechanisms of these pain conditions is one of the important reasons behind the problems in diagnostic and management. During the last two decades, neurophysiological, psychophysical, brain imaging and neuropathological methods have been systematically applied to study the trigeminal system in idiopathic oro-facial pain. The findings in these studies have provided evidence for neuropathic involvement in the pathophysiology of PIFP, AO and BMS. The present qualitative review is a joint effort of a group of oro-facial pain specialists and researchers to appraise the literature on idiopathic oro-facial pain with special focus on the currently available studies on their pathophysiological mechanisms. The implications of the findings of these studies for the clinical diagnosis and treatment of idiopathic oro-facial pain conditions are discussed.
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              Intraoral somatosensory abnormalities in patients with atypical odontalgia--a controlled multicenter quantitative sensory testing study.

              Intraoral somatosensory sensitivity in patients with atypical odontalgia (AO) has not been investigated systematically according to the most recent guidelines. The aims of this study were to examine intraoral somatosensory disturbances in AO patients using healthy subjects as reference, and to evaluate the percent agreement between intraoral quantitative sensory testing (QST) and qualitative sensory testing (QualST). Forty-seven AO patients and 69 healthy control subjects were included at Universities of Washington, Malmö, and Aarhus. In AO patients, intraoral somatosensory testing was performed on the painful site, the corresponding contralateral site, and at thenar. In healthy subjects, intraoral somatosensory testing was performed bilaterally on the upper premolar gingiva and at thenar. Thirteen QST and 3 QualST parameters were evaluated at each site, z-scores were computed for AO patients based on the healthy reference material, and LossGain scores were created. Compared with control subjects, 87.3% of AO patients had QST abnormalities. The most frequent somatosensory abnormalities in AO patients were somatosensory gain with regard to painful mechanical and cold stimuli and somatosensory loss with regard to cold detection and mechanical detection. The most frequent LossGain code was L0G2 (no somatosensory loss with gain of mechanical somatosensory function) (31.9% of AO patients). Percent agreement between corresponding QST and QualST measures of thermal and mechanical sensitivity ranged between 55.6% and 70.4% in AO patients and between 71.1% and 92.1% in control subjects. In conclusion, intraoral somatosensory abnormalities were commonly detected in AO patients, and agreement between quantitative and qualitative sensory testing was good to excellent.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                August 2019
                : 42
                : 2
                : 209-213
                Affiliations
                [2] orgnameHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Neurología Spain
                [3] orgnameInstituto Aragonés de Ciencias de la Salud orgdiv1Grupo de Estudio de Trastornos del Movimiento y Cefaleas Spain
                [1] orgnameHospital Reina Sofía orgdiv1Servicio de Medicina Interna orgdiv2Sección de Neurología Spain
                Article
                S1137-66272019000200009 S1137-6627(19)04200200009
                10.23938/assn.0638
                c9bb7004-b581-46d1-9f22-044b11bde843

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 31 January 2019
                : 29 March 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
                Product

                SciELO Spain

                Categories
                Notas Clínicas

                Atypical odontalgia,OnabotulinumtoxinA,Botulinum toxin A,Toxina botulínica A,Neuropatic pain,Dolor neuropático,Odontalgia atípica

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