title: Diagnostic Accuracy of Quantitative Sensory Testing to Discriminate Inflammatory Toothache and Intraoral Neuropathic Pain.
abstract: BACKGROUND
  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.
authors: Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil. Electronic address: andreporporatti@yahoo.com.br.
authors: André Luís
authors: AL
authors: Porporatti
authors: 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.
authors: Yuri Martins
authors: YM
authors: Costa
authors: Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
authors: Juliana
authors: J
authors: Stuginski-Barbosa
authors: Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
authors: Leonardo Rigoldi
authors: LR
authors: Bonjardim
authors: Department of Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
authors: Marco Antônio Hungaro
authors: MA
authors: Duarte
authors: Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
authors: Paulo César Rodrigues
authors: PC
authors: Conti
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold; D011671:Pulpitis / Q000503:physiopathology; D014098:Toothache / Q000175:diagnosis* / Q000209:etiology
keywords: Diagnostic accuracy; inflammatory toothache; intraoral neuropathic pain; persistent pain; quantitative sensory testing