Diagnosis and management of persistent idiopathic facial pain following dental procedures: a retrospective study

Objectives: Persistent idiopathic facial pain (PIFP) is a rare, chronic disorder affecting the oral and maxillofacial region, without obvious clinical or neurological deficit. This study aims to evaluate the various dental treatments associated with PIFP and the pharmacologic treatment outcomes. Patients and Methods: This retrospective study included the patients with PIFP according to the definition of the International Classification of Headache Disorders (ICHD) 2018, who were treated from January 2020 to September 2024 at the authors’ hospital. The inclusion criteria were that PIFP occurred after dental procedures without a history of trauma or any clinical cause for the pain. Patient’s pain characteristics, location, triggering events, and response to related medications and treatments were investigated. Results: A total of 21 patients were identified, and most patients were related to dental implant treatment (n=15, 71.4%). Most patients experienced pain in the molar region (n=20) and experienced radiating pain to distant areas (n=16). Surgical treatment for pain control of PIFP, such as implant removal, tooth extraction or prosthesis removal, was attempted for 16 patients. However, 93.8% of these patients did not show relief of pain. The use of medications resulted in a significant decrease in pain for 18 patients (85.7%). Among 18 patients, 12 patients received with a combined medication therapy. The responsiveness to these medications was found to be tricyclic antidepressants (100%), gabapentin (57.1%), pregabalin (55.6%), clonazepam (54.5%), and Serotonin-norepinephrine reuptake inhibitor (50%). Conclusion: Since PIFP after dental treatment is highly related to dental implant treatment, differential diagnosis of the PIFP is important for patients who complain of persistent implant pain with no clear cause. Combined medication was effective in most patients with PIFP. Importance of the diagnosis of PIFP after dental treatment for pharmacologic management is emphasized.