Aims: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. Methods: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. Results: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P .001). Pain frequency (P .001) and GCPS (P .001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. Conclusion: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition. Keywords: neuropathic pain, orofacial pain, prognosis, prospective study, trigeminal nerve