CRPS Dentistry


READ ARTICLES BELOW  (if you have any articles to share in this category please send them to RSDHope )How is CRPS Affected by Dental Issues? Read the articles below for information from Dentists!


RSD and Dentistry, One Assessment – Dental Issues

Reflex Sympathetic Dystrophy Patients and Dentistry
by Dr. Aldino P. Maggiulli

Reflex Sympathetic Dystrophy Syndrome (RSD) usually develops after a traumatic episode. Any body part can be affected but the symptoms are mostly seen on the upper and lower extremities. Victims of an injury may develop a burning sensation or numbness on their extremities. Their pain varies day to day. They may develop problems maneuvering their limbs and have dexterity problems. Some people affected with this syndrome face great challenges while trying to accomplish even routine functions. It is important to share any asset which can provide comfort and consistent results to those who suffer with RSD. This article shares one such asset which was discovered in a dental setting.

It is apparent that patients with RSD can’t be treated in the usual manner as other dental patients. This was discovered when a patient with RSD came to my office for routine dental treatment. The patient, who we’ll call “Will” to provide confidentially entered my office on June 21, 2002. Will informed me that he bad been suffering with RSD for the past seven years. He mentioned that he had been involved in a car accident and the symptoms of the disease followed there after. Will was diagnosed with generalized gum disease and a second appointment was made for him to return for aggressive hygiene therapy. His treatment was initiated on July 22, 2002. Traditional dental anesthesia was given and treatment was delivered to the top right and bottom right gum tissues. Will didn’t tolerate the deep cleaning procedure well. He reported feeling fatigue and generalized aches. He still had to return to complete the left sides of his dentition. Will had to be motivated to continue. An agreement was made that his next appointments would be shorter. We would treat only the top left side and on a subsequent appointment treat the remaining bottom left side. Will reluctantly returned on August 6th. Traditional dental anesthesia was given only to the top left side. The appointment time was cut in half and Will reported feeling a little better than his first visit. He wasn’t tired but the aches associated with RSD persisted. A startling discovery was made on Will’s third visit. He reluctantly returned for the remaining bottom left gum treatment. 

Traditional dental anesthesia was given to the bottom left side. The appointment time was short, unlike his first marathon session treating two upper and lower right areas. This appointment was different in that a second dose of dental anesthesia was given to the patient before the gum treatment ended. Will, for the first time, felt great. The decreased appointment time combined with additional local anesthesia close to the conclusion of his gum treatment made this RSD patient completely comfortable and report no post-op sensation. It’s difficult to conclude any significant treatment protocol by revealing the results of just one RSD patient. This experience demonstrates that RSD patients can’t be treated like traditional patients. 

Thanks to Will’s help, the conclusion to draw is that it is best to give RSD patients short dental appointments. RSD sufferers tire easily and their symptoms may be exacerbated by lengthy dental procedures. The progression of treatment recorded also shows that two doses of local anesthesia are beneficial; one before treatment and one prior to the conclusion of dental treatment. The two dose application allowed this patient comfortable treatment and no fatigue or generalized ache post operatively. It should be noted that this two dose technique has worked consecutively for Will on multiple appointments since this writing, Will has even had a three unit bridge placed without complications and without increasing the symptoms felt with RSD.

CRPS Patients and Dentistry: A Dentist’s View
By Christopher R. Brown, DDS, MMPS

Dental decay, although not as rampant as it once was in the American population, still affects many people. Even though it has declined from historic levels, the incidence of tooth decay is unfortunately again on the rise due to poor eating habits and an increase in sugar consumption. Gum disease is estimated to affect over 90% of our population in one form or another. These problems can often be seen in people with chronic conditions.

Often dental health can be neglected because of pain. The bad news is that ignored dental disease will sooner or later raise its ugly head: A toothache or pain from gum disease can not only afflict those of you who have CRPS dentally, but complicate the entire painful syndrome.

People with CRPS are at especially high risk for several reasons. Depending upon the region affected, physical dysfunction and the lack of manual dexterity can affect your ability to properly clean your teeth. In addition, if a chronic pain syndrome affects your head and neck, there may be times that brushing and flossing just hurts too much. One missed day of dental hygiene can turn into long periods of time where hygiene is severally lacking.

Many medications reduce saliva flow, causing a completely dry mouth (xerostoma) or they can radically alter saliva thickness, causing it to be thick and ropey. Either condition allows bacterial plaque to grow even faster and more tenaciously than normal. Combining this with a soft, sugary diet can wreak havoc on dental health. Many people who live with pain may rely upon “comfort” foods, which are often high in fats and sugars, causing overall health concerns and an increase in dental disease.

Smoking or smokeless tobacco can also alter the bacterial level of your mouth, resulting in an increase of tooth decay and gum disease. Smokeless tobacco has the most direct effect of the two, because of its sugar content and the fact that it lays against the teeth and soft tissues of the mouth for an extended period of time, releasing toxins and tissue-destroying chemicals. Smoking and smokeless tobacco are unhealthy even under the best of situations and can rapidly deteriorate the health of people with CRPS.

Financial issues are also important. Even those who have insurance bear an economic burden of medical expenses, and dentistry is often expensive. Dental problems don’t go away on their own. As in any situation, prevention is the best “cure” for emotional, physical, and financial health. Brushing and flossing is a must. If you have particular areas that are constantly painful, using topical anesthetic rinsing gels may help. Even using your finger in a washcloth to act as a toothbrush is better than ignoring an area. Not removing plaque will only cause more pain in the future. Mouthwashes may be helpful, but they will not take the place of brushing and flossing. Also, your dentist may prescribe prescription rinses. Few dentists are trained in the field of head, neck, and facial pain beyond that of dental or periodontal work. 

Choose a dentist who is educated about CRPS or who cares enough to allow you to direct his or her education as to your personal situation. This may involve asking for a pre-treatment meeting with the dentist to discuss your health needs. Most dentists, if they are not aware of CRPS, will be glad to familiarize themselves so they can be a good provider and can customize their healthcare delivery for your specific needs. If they do not choose to do so, then find another dentist who will.

Once a good relationship is established, have your dentist outline a treatment plan that is both economically and physically reasonable. You should discuss your pain patterns, history of reactions to local anesthetics, how long you can hold your mouth open, triggers that initiate painful episodes, and any other nuances that are particular to your situation. Pay careful attention to gum treatment as well. Modern techniques can often avoid the painful scraping and cutting of the gums often associated with professional dental prophylaxis. Ultrasonic instruments have allowed hygienists to be thorough and gentle at the same time. “No pain, no gain,” should no longer be a hygienist’s mantra. More than likely, a reasonable treatment plan can be arranged to help keep you in good dental health.

Dental health begins at home. Suffering from CRPS does not really change your dental needs, but may dictate customized home care and professional service delivery. Many recent studies have linked chronic gum inflammation and infections to heart disease, stroke, and low birth weights. You must take great efforts not to let your teeth and gums get into such disrepair that drastic measures are needed. Talking to a local caring dentist will help provide optimal dental health and keep your financial investment reasonable as well. Prevention of dental disease may very well pay off in good overall health, allowing your immune system to perform at its optimal level. Remember, good dental health is good health.

Christopher R. Brown, DDS, MMPS, has a practice in Versailles, Indiana, dedicated to the diagnosis and treatment of head, neck, and facial pain. He is also a former president of the American Academy of Pain Management.

Updated November 23, 2006

linked from RSDSA

Dental Care and Chronic Pain by Siegleman and Summer

This is another article on CRPS / RSD and Chronic Pain and Dentistry hosted by our fellow CRPS Awareness organization, the RSDSA. To read the article CLICK HERE