Dental Care

Phantom Tooth Pain: Symptoms, Diagnosis and Treatment

Phantom tooth pain appears to be fairly common, although it has not been fully researched and its frequency has not been accurately established.

It is a painful chronic disorder that can be frustrating for several reasons, including being difficult to diagnose and treat.

Several names have been used for the condition that is commonly called phantom tooth pain. In part the multiple names probably stem from the fact that the causes of this disorder remain somewhat unclear.

At various times the condition has also been called neuropathic orofacial pain, idiopathic odontalgia, neurovascular odontalgia, oral neuropathic pain and, perhaps most frequently, atypical odontalgia (AO).

However, no matter which name you prefer, the condition causes persistent, lingering pain in a person's tooth or jaw but has no identifiable physical cause. Phantom tooth pain bears some resemblance to the phantom limb pain some amputee's experience.

A physical problem with the teeth is always suspected but is rarely the cause.


The symptoms of this painful and frustrating condition include the following:

  • moderate to severe throbbing tooth pain

  • tooth pain triggered by pressure and/or hot or cold temperatures

  • tooth pain lingering after a dental procedure

  • tooth pain that begins at the site of a dental procedure but spreads throughout one side of the mouth or extends throughout the entire mouth

  • tooth pain in single or multiple locations

  • tooth pain despite dental X-rays that do not reveal any tooth decay or other damage.


As mentioned earlier, the causes of this condition are uncertain. It is theorized, however, that this pain signal might be caused by a damaged or dysfunctional nerve.

This theory has not been definitively proven but it is supported by the finding that at least some cases of phantom tooth pain occur after certain dental procedures, including root canals, fillings and tooth extractions.

Research indicates that some people who suffer from recurrent cluster or migraine headaches may be predisposed to phantom tooth pain.


Atypical odontalgia is a condition that can be difficult to diagnose and treat. Patients with this disorder often feel pain despite the absence of any identifiable physical cause.

A series of specific diagnostic tests sometimes results in the proper diagnosis, but more often a diagnosis is arrived at by eliminating potential other causes of the patient's persistent pain. Unfortunately, misdiagnosis is not a rare occurrence.

Your dentist or doctor will take your history, perform a physical examination and ask whether you have had any invasive dental procedures. Dental X-rays will be taken and an MRI or CT scan might be performed.

You might also be asked a battery of questions, including your pain's intensity and location, whether any particular circumstances are associated with the onset of pain, whether anything improves or worsens the pain, and whether your pain is periodic, continuous or intermittent.

Because phantom tooth pain is not associated with any detectable physical problem, you might also be asked whether you experience depression, anxiety or any psychiatric disorder. In the end, diagnosis is a process of elimination where other causes for the pain are ruled out.


Assuming a proper diagnosis, the appropriate treatment involves pain management, not surgery. The most effective way to achieve pain management depends on whether the pain originates in the peripheral nervous system (consisting of the nerves in the torso, arms, legs, face and mouth) or in the central nervous system (the brain and spine).

Treatment for peripheral nerve pain can include injections of steroids, local anesthetics, or the application of topical pain-relieving creams. Topical applications of capsaicin (related to cayenne pepper) are frequently effective.

If the pain stems from the central nervous system, medications such as antidepressants, anticonvulsants or narcotic pain relievers may be appropriate. Acupuncture and certain other alternative medical procedures may also be suggested.

Unfortunately, some phantom tooth pain patients are not diagnosed properly. In those cases, unnecessary dental procedures like root canals and tooth extractions might be performed as attempts to stop the pain. Sadly, these procedures will not help when the problem is phantom tooth pain.

Pain may continue to persist in areas where a tooth has been extracted or in a tooth that has had its nerve removed. In fact, surgery may actually worsen the condition, causing additional or more widespread pain and sometimes the development of temporomandibular disorder.


Some people develop persistent tooth pain and go from dentist to dentist, only to be told repeatedly that nothing is wrong with their teeth. This unexplained pain often, but not always, begins after a dental procedure such as a root canal, an extraction or a filling.

Because diagnosis is so difficult, many unnecessary teeth extractions and root canal procedures are performed in failed attempts to alleviate the pain.

Recently recognized as a condition that merits a more thorough understanding, dental professionals now take phantom tooth pain seriously. Extensive research regarding prevention and treatment is currently being conducted.

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