Health Watch (Phantom Tooth Pain)

Cracking the Mystery Behind Phantom Toothache

BY PRAMITA BOSE

Dentists Dr. Vimal Arora and Dr. Anmol Agarwal unravel the secrets behind the mysterious disorder of phantom tooth pain.

Photo Courtesy: Pexels.com

Causes

This strange tooth ache occurs as a result of damaged nerve fibres at the site of restorative intervention. This can happen either due to traumatic tooth extraction or a prolonged nerve tissue inflammation, also known as neuritis, which might intensify secondary to insufficient healing response associated with certain systemic diseases like osteoporosis.

The onset of atypical odontalgia is commonly evoked by a nerve injury following a dental procedure. While digging out a tooth, pain gets generated from the edentate area. The condition is more common in women than men and widely affects the age group of 35-60 years.

The pathological mechanism of this disorder indicates “short-circuiting” or dysfunction of the nerves that carry the pain sensation.

Telltale Signs

A person enduring phantom toothache could encounter a slew of symptoms given below:

Patients describe phantom tooth pain as an inexplicable burning sensation at the site of tooth extraction with varied intensity and bothersome nature. Such sensations are also called altered sensorium wherein an individual is not able to differentiate between pain, pressure, prick, hot and cold, and visibly feels intolerable pain out of every sensory input.

Phantom pain can be manifested as a throbbing agony around the affected area, susceptible to hot and cold. Sometimes it could be felt while chewing or just touching the sensitive area.

It definitely provokes a gamut of reactions ranging from anxiety and fear, changes in the sleep pattern, difficulty in concentrating at work to an irritable mood.

Unsettling Nerves

Often it is probed whether the nervous system or the brain have a role to play in the nerve-racking phantom tooth pain. “As far as the nervous system is considered, one has to be aware that the brain has no pain sensors. It just processes the sensory input and in case of a phantom tooth pain what gets altered is the sensory input from the damaged nerve fibres,” shares Dr. Agarwal.

The actual cause is cited as the malfunction of the nerve that forms the pain pathway to carry it from the jaw to the brain. “This may undergo a change due to an injury during a dental procedure or because of heavy medications that the patients are put on for multiple medical conditions,” notes. Dr. Lt. Gen. Dr. Vimal Arora, chief clinical officer of Clove Dental.

Duration

The pain could persist from three weeks to six months and many a time, do not even respond to the treatment applied.

Acute Condition: This may resolve with medications and recovery within a shorter period (one-three weeks).

Chronic Condition: This lasts longer than three-four months or beyond the normal healing time. It may or may not respond to medical treatment at all.

Phantom pain may span a longer duration depending on its actual cause. “As we discussed that such pains arise from impaired free nerve endings, targeting neural cure could therefore yield promising results. Given that such conditions also affect the patient psychologically, behavioural management might then provide some relief to the patients concerned. Another method — though considered debatable — calls for replacing the damaged tooth to recreate proprioception (awareness of the body’ position and movement) that might benefit specific cases,” asserts Dr. Agarwal.

Precautions

Certain precautionary measures should be embraced by people with other health issues while being treated for phantom tooth pain. Patients with pre-existing illness and medical conditions should look for possible drug interactions and always adopt a customised treatment plan.

a.  People on blood thinners should be monitored with certain NSAIDs (Nonsteroidal Anti-Inflammatory Drugs: ibuprofen and naproxen) due to potential bleeding in the GI (gastrointestinal tract).

b.   People with underlying heart or kidney maladies should carefully choose medication and local anesthetics.

c.   People with weakened immune system (like arthritis) or ongoing cancer care have a higher possibility of contracting an infection. Hence, creating an absolute germ-free environment in the dental operatory is a must.

“Patients with other systemic disorders like uncontrolled diabetes, osteoporosis, neuralgias etc. must first know and understand well that these conditions could aggravate their pain. So, before intervening to treat the phantom tooth pain, their comorbidities must be thoroughly checked and kept within limits,” opines Dr. Agarwal.

Dental Clinic Visit

A person braving phantom tooth pain should consult a dentist or a clinician right from the start. Otherwise, the delay in treatment may worsen the case.

“A dental specialist diagnosing atypical odontalgia and atypical facial pain should be consulted at once. A low frequency laser therapy can be meted out to patients to offer them some relief from the pain. A missing tooth on one side will coerce the patient to chew from the other side, thus resulting in an imbalance in occlusion or malocclusion, TMJ (temporomandibular joint) pain and in worse cases, can also lead to cervical spondylitis (neck arthritis),” recommends Dr. Arora.

Medication

Suggesting medicines to dwindle the phantom tooth pain, Dr. Arora says: “Although the medications must be taken under a strict medical supervision, some commonly used drugs are tricyclic antidepressants and anticonvulsants with properties of pain subsidence.”

Dr. Agarwal’s prescription reads: “neurotropic drugs or drugs that lead to neural repair along with potent anti-inflammatory medication are really helpful. At the same time, multivitamins and antioxidants emerge as favourable and promote healing. In extreme cases, anxiolytics are also considered.”

Affecting Other Organs

Phantom pain can also affect other body parts and organs apart from teeth. Limbs, breasts, internal organs and spinal cord are to name a few. “Phantom pain is a complex phenomenon that is yet to be fully grasped or assimilated. So at the moment, dental and medical practitioners can mainly deliver supportive therapy to the affected patients,” dispenses Dr. Arora.

“The biggest example is the phantom limb pain, which is commonly felt by a patient after his/her limb amputation,” agrees Dr. Anmol Agarwal, principal consultant of oral and maxillofacial surgery, dental implantology and TMJ disorders at Yashoda Super Specialty Hospital. “Similar pain can be felt after removing gall bladder, kidney, uterus or prostrate by the surgical knife,” he adds ahead.

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