Face Pain Info Pages - Part 6a

What if I Need Dental Work?

For a Trigeminal Neuralgia or neuropathic facial pain patient, the discovery of a dental cavity -- or worse, an infected abscess -- can precipitate a very real medical and emotional crisis. Especially if you have trigger zones in the mouth or jaw, it can be very tempting to run for the hills rather than even attempting to have your teeth CLEANED, much less having a dental filling. Unfortunately, this understandable flinch reaction can cause you a lot of downstream trouble and even more pain than you have already. So what do you do if it seems you really must have dental work?

·         Consult with your neurologist or other primary-care provider who manages your facial pain. Depending upon how much your dentist knows about neuropathic facial pain, it may be prudent for these two medical professionals to schedule a telephone consultation before your next dental appointment.

·         When you consult with your doctor, ask about temporarily "loading up" on some of your medications (increasing your doses for a few days), to prevent breakthrough pain that might be caused by the dentist's disturbing the mandibular or maxillary nerves. During the past few years, I've talked with several patients who have found success in pain avoidance by this approach.

·         If you must have anesthesia for the procedure that the dentist proposes, then ask about the use of nitrous oxide (so-called "laughing gas") as a twilight anesthesia, and as an alternative to having Xylocaine or Novocaine injected into the gum.

·         If root canal is recommended, be sure that there is conclusive X-ray evidence of abscess or other observable evidence beyond the pain itself before authorizing that procedure. Then ask whether the endodontist uses a Sargenti-type paste in the procedure. If he or she does, then ask about alternatives. If the doctor refuses such alternatives, then fire him or her with extreme prejudice and find someone else who understands the risks of formaldehyde exposure for the facial nerves.

   About Major Dental Procedures:   Many members of Living with TN report that their pain emerged after major dental work, or surgery to correct TMJ Disorder or bite problems.   Such trigeminal pain is probably best characterized as "iatrogenic trigeminal neuropathic pain" rather than "trigeminal neuralgia".  Thus it is particularly important for patients to insist that dental specialists provide conclusive radiological imaging which confirms the presence of such mechanical disorders, before having surgery which may cause permanent damage while failing to address an underlying problem which is neurological in origin rather than mechanical or dental.  Also of concern,  some patients are allergic to metals commonly used in corrective or reconstructive surgery to the face -- particularly titanium or the nickle used in hardening titanium. If you know that you have allergies to metals, then tell  your dentist in advance of any facial surgery to correct for bite or TMJ issues. [Discovery Credit:  Carol Harmer and Tinkerbell, members of Living With TN]

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Face Pain Info Pages - Part 6a

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