Atypical odontalgia mimicking trigeminal neuralgia

This case report highlights the diagnostic and therapeutic challenges involved in differentiating between trigeminal neuralgia (TN) and atypical odontalgia (AO), two distinct yet clinically overlapping orofacial pain disorders. Initially, the patient was misdiagnosed with trigeminal neuralgia based on the presentation of episodic, sharp, stabbing pain along the distribution of the trigeminal nerve. Despite conventional management for TN, the patient's symptoms persisted, leading to further investigation. Comprehensive clinical evaluation and imaging revealed the underlying cause to be atypical odontalgia, characterized by continuous pain localized to the dentition and alveolar structures without overt dental pathology. Correct diagnosis allowed for targeted management of AO. The introduction of amitriptyline, a tricyclic antidepressant with proven efficacy in neuropathic pain, resulted in significant symptom relief and improved quality of life. This case underscores the importance of considering AO in the differential diagnosis of orofacial pain and highlights the therapeutic potential of amitriptyline in its management.