<p>Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation</p>

Abstract

Purpose To explore the challenges faced in the diagnosis and treatment of atypical odontalgia (AO) and other persistent idiopathic facial pain (PIFP). Patients and Methods This retrospective multi-centric cross-sectional study utilized clinical information (eg, clinical manifestations, history of consultations and treatments prior to correct diagnoses) from patients’ medical records. Their economic parameters were also extracted from medical insurance databases. Each variable collected was statistically analyzed. Differences of variables between AO and other PIFP were statistically tested. Results A total of 394 patients were included in this study. On average, the diagnostic delay was 34.8±14.2 months, a median of 7 consultations were performed prior to a correct diagnosis, and 5 ineffective prescriptions were issued. Patients with AO suffered from longer diagnostic delays than patients with other PIFP (38.4±14.3 months vs 31.6±13.4 months) and were more likely to receive invasive dental treatments (73.3% vs 4.3%). The median total cost of treatment for a single patient before correct diagnosis was 8506.3 yuan. Patients with AO spent more than patients with other PIFP (10,146.5 Yuan vs 3864.0 Yuan). Conclusion Patients with PIFP were frequently misdiagnosed and the length of diagnostic delay was observed to be long. Ineffective medications, unwarranted procedures, and unnecessary economic burden were imposed on the patients. Patients with AO are in a worse situation than patients with other PIFP. As significantly urgent and unsatisfactory results of misdiagnosis of PIFP have been reported in our study, more attention should be paid on the research and education in this field.

Outcomes and Predictors of Response of Duloxetine for the Treatment of Persistent Idiopathic Dentoalveolar Pain: A Retrospective Multicenter Observational Study

“… 5 A retrospective multi-centric cross-sectional study including a total of 394 patients found that the average diagnostic delay of AO was much longer and costed more than patients with any other persistent idiopathic facial pain (PIFP). 6 When patients are misdiagnosed, they often take drugs that do not work, sometimes even undergo several unnecessary surgeries which does not alleviate but rather aggravate the pain. This rare clinical challenge, as one of the representative chronic orofacial pains, 7 result in unsatisfactory treatment outcomes and severely affect patients’ quality of life.…”

“…Analgesics were avoided in this study to prevent interference with the results. After taking duloxetine, pain was relieved by an average of 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days after beginning treatment. These results are consistent with the results reported by Yasuda et al's study 29 which reported the pain relief efficacy of duloxetine in patients with diabetic neuropathy (DNP) in the first week of administration.…”

Worldwide prevalence estimates of burning mouth syndrome: A systematic review and meta‐analysis

“…The clinical patients, we included mainly came from the department of oral medicine, department of oral pathology and maxillofacial surgery, and oral medicine was indicated as optimal when compared to other dental specialties ( Brailo et al., 2006; Fattori et al., 2019; Li et al., 2015; Netto et al., 2011). The data in clinical settings revealed that BMS patients had a high demand for medical consultation and further management (Xiao et al., 2020). In addition to dental department, a retrospective study found that BMS patients also sought help from multiple clinics and other medical specialties such as otorhinolaryngology, dermatology, neurosurgery, and anesthesia departments (Freilich et al., 2020; Xiao et al, 2020).…”

“…Thus the financial burden of this disease could not be easily described. It was reported the cost of correct diagnosis was 1,570.7$ for patients with atypical odontalgia and 1,316.8$ for those who had persistent idiopathic facial pain (Xiao et al, 2018). Breckons's study showed that chronic orofacial pain patients' out‐of‐pocket costs were 463.5$ and indirect costs were 1,728.7$ for medical care every six months (Breckons et al., 2018).…”

“…The forest plot of included clinical-based studies multiple clinics and other medical specialties as otorhinolaryngology, dermatology, neurosurgery, and anesthesia departments (Freilich et al, 2020;Xiao et al, 2020).…”