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

André Luís Porporatti; Yuri Martins Costa; Juliana Stuginski-Barbosa; Leonardo Rigoldi Bonjardim; Marco Antônio Hungaro Duarte; Paulo César Rodrigues Conti

doi:10.1016/j.joen.2015.07.006

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

J Endod. 2015 Oct;41(10):1606-13. doi: 10.1016/j.joen.2015.07.006. Epub 2015 Aug 22.

Authors

André Luís Porporatti¹, Yuri Martins Costa², Juliana Stuginski-Barbosa³, Leonardo Rigoldi Bonjardim⁴, Marco Antônio Hungaro Duarte⁵, Paulo César Rodrigues Conti³

Affiliations

¹ Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil. Electronic address: andreporporatti@yahoo.com.br.
² Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; Section of Orofacial Pain and Jaw Function, Department of Dentistry, Aarhus University, Aarhus, Denmark.
³ Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
⁴ Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
⁵ Department of Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.

PMID: 26307507
DOI: 10.1016/j.joen.2015.07.006

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 (α = 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.

Keywords: Diagnostic accuracy; inflammatory toothache; intraoral neuropathic pain; persistent pain; quantitative sensory testing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Neuralgia / diagnosis*
Neuralgia / etiology
Pain Measurement / methods*
Pain Threshold
Pulpitis / physiopathology
Toothache / diagnosis*
Toothache / etiology