title: Botulinum Neurotoxin Type-A for the Treatment of Atypical Odontalgia.
abstract: Atypical odontalgia (AO), a subform of persistent idiopathic facial pain, is defined as a continuous toothache in which a thorough examination reveals no dental pathology. AO is believed to be a neuropathic condition, given that some cases are preceded by dental procedures. Different topical and systemic medications have been used for the treatment of AO, but their effect is often unsatisfactory. The authors aimed to assess the effect and safety of botulinum neurotoxin type-A (BoNTA) in a series of patients with AO.
  
  
  
  Four patients with refractory AO (2 males and 2 females, aged 31-72) were treated with local injections of BoNTA to the painful area. BoNTA was injected at various sites into the gums, and two patients had additional injections in the hard palate or the upper lip. The total dose of BoNTA for each procedure was 15-30 U, and the total number of injection points was 6-12. The follow-up ranged from 6 to 20 months. Two patients received two cycles of BoNTA, while the remaining patients received three and five cycles each, respectively.
  
  
  
  All patients obtained significant relief with complete or almost complete reduction of pain. The analgesic effect was apparent after a latency period of 3-14 days, and the effect persisted for 2-6 months. There were no adverse events reported from any of the interventions.
  
  
  
  The responses to BoNTA injections in this series agree with those previously observed in neuropathic pain. BoNTA injections may be a safe and effective option for the treatment of AO.
authors.affiliation: *Headache Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain mlcuadrado@med.ucm.es.
authors.forename: María-Luz
authors.initials: ML
authors.lastname: Cuadrado
authors.affiliation: *Headache Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: García-Moreno
authors.affiliation: School of Medicine, Universidad Alfonso X El Sabio, Madrid, Spain.
authors.forename: José-Antonio
authors.initials: JA
authors.lastname: Arias
authors.affiliation: Neurology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pareja
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D014098:Toothache / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
keywords: Atypical Facial Pain; Atypical Odontalgia; Botulinum Neurotoxin Type-A; Neuropathic Pain; Orofacial Pain; Persistent Idiopathic Facial Pain