OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients

Abstract

BackgroundAtypical odontalgia (AO) manifests as continuous pain in the region of one or several teeth, in the absence of signs of dental pathology. Currently, there is insufficient evidence to establish treatment guidelines for AO. The aim of this study was to describe the effectiveness and safety of treatment with OnabotulinumtoxinA (OnabotA) on a series of patients with AO.MethodsNine patients with AO (four males and five females, aged between 31 and 77 years) received injections of OnabotA in the region of pain. The dosage used in each procedure ranged between 10 and 30 U, spread between 4 and 12 injection sites along the gums (n=9), the lips (n=3), and the hard palate (n=1). The median follow-up time was 27 months (interquartile range, IQR 20–40) and the median number of injection sessions per patient was seven (IQR 4.5–9). The assessment variables included the change in the maximal intensity of pain on a 0–10 numerical rating scale (NRS), the response latency, and the duration of the effect.ResultsAll patients experienced a significant improvement, with ≥50% of reduction in the intensity of the maximal pain. The median of reduction of maximal pain after treatment was six points on the NRS (IQR 5–8.5). The response latency was 2–15 days and the duration of the effect was 2–6 months. No significant adverse reactions were registered.ConclusionOnabotA may be a safe and effective option for the treatment of AO.

A review of persistent idiopathic dentoalveolar pain (formerly PDAP/Atypical odontalgia)

“…This short therapeutic window means that lidocaine injections are not routinely used. Localised botulinum toxin injections have been reported to produce significant reductions in pain and few side effects in patients suffering from PIDP. It must be noted that this therapy is new, so no RCTs or comparisons with placebos are currently available and papers on the topic comprise of case studies rather than trials with the largest study containing just 9 patients.…”

Atypical odontalgia: pathophysiology, diagnosis and management

“…Currently, there is insufficient evidence to establish a treatment protocol for AO 25 . Tricyclic antidepressants, antiepileptics, anesthetics, and botulinum toxin, although reducing the pain of the patient 3,22,25 , have limited activity and have no proven effectiveness [25][26][27] . Generally, the dental surgeon is the first healthcare professional with whom the AO patient consults.…”

“…García-Sáez et al 25 The use of botulinum neurotoxin type A has been shown to reduce pain in patients with AO. However, randomized controlled trials (RCT) are suggested to prove their effectiveness.…”

“…Like diagnosis, AO treatment is challenging 23,50 . Currently, there is insufficient evidence to establish a treatment protocol 25 . Tricyclic antidepressants are the most cited drugs in case reports and case-control studies, and for many authors, they are considered the first choice in treatment 27,35 .…”

“…The good results regarding pain remission point it as a promising drug in the treatment of AO. However, as with tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors, the use of botulinum neurotoxin type A should be proven to be effective through more RCT 20,25,26 . Thus, the information obtained from the articles found can be summarized: 1) In cases of doubt, not performing endodontic and surgical treatments, as AO would be unnecessary and worsen the patient's pain 49 ;…”