The prosthodontist who replaced my 3 year failed composite filling with a crown on 19 clued me in on that one.

Cleo,

If your tooth required a crown, then a composite filling would not have been adequate. Perhaps that is the reason the filling "failed".

I really don't want people to get the wrong impression about composite fillings on posterior teeth. So just to clarify, they are an ideal restoration in many cases and can have a long life span. If a tooth requires an onlay or a crown, then there is no other restorative material that could take the place of the onlay or crown.

Thanks,
Bryanna

Thank you for your responses. I will be seeing the endodontist in the morning but I am also going to schedule an appointment with the oral surgeon. I'm leaning more towards having both teeth pulled. Will follow up after my appointments.

I have decided to have the two teeth pulled (#3 & #14). I will be called the oral surgeon tomorrow to schedule the extractions. Any questions I should ask or any concerns I need to think about? Thanks so much!!

Hi HockyMom,

Make sure the oral surgeon has your pre op xrays of both of these teeth. He may want to take his own, which is okay and it would not be exposing you to a lot of radiation. It is best that he have as clear an xray as possible of both teeth.

Issues to bring up with the oral surgeon....

**Make sure he has a descriptive history of these teeth and your CRPS and TN symptoms. As well as a complete medical history and medication list.

**When teeth are removed, the surgeon or dentist is trained to remove the periodontal ligament and diseased bone once the tooth is extracted. Unfortunately these steps are not "routinely" done. So it is wise to let the surgeon know that you want to be sure that the ligament and any diseased tissue and bone are removed at the time of the extraction to ensure the best possible post operative outcome. To be clear, this is not you "telling" him how to do the surgery, it is you "informing" him that you are aware that this needs to be done and want his reassurance that it will be done. Okay

**Ask him if he feels that it is best to do both at once or two separate visits given that you have CRPS and TN.

** Ask him if he feels it is wise for you to have just a local anesthetic or better to have a little IV sedation for the surgery. Sometimes it is easier and less traumatic for the patient to have the IV sedation... depends on the individual case.

** Ask him about placing bone grafts in both or either socket. What type of graft would he use and why? Not that you would know the difference of any of them but it is good to get his opinion on what he thinks is best in your case and why.

I hope this information is helpful to you. Please check in with us when you can.
Bryanna

I can only comment on the CRPS aspect of your post but I would recommend you look at the RSDSA website which has some limited but reliable resources for CRPS patients who require dental surgery. There is very little research or professional guidance for performing dental work in CRPS patients.

As I am sure you know, the general advice to any CRPS patient is to have no invasive procedures done, except in an emergency. Whether this dental work constitutes an emergency or is sufficiently serious that it could become one is for you and your dentist or oral surgeon to decide since only you have all of the necessary information. However, like many other medical interventions, it may well be unavoidable even if it isn't what might be classed as an emergency. The biggest risk is that the surgical trauma and associated post-surgical pain trigger 'new' CRPS in you mouth and face where you previously didn't experience any symptoms.

It is incredibly important that whoever is doing this dental work truly understands CRPS and the potential consequences of invasive, surgical procedures. The key considerations for a CRPS patient in these circumstances are the anaesthesia, reducing trauma and post-surgical pain control. The person doing the work needs to consider using deeper, longer lasting anaesthesia and/or anaesthetising a more extensive area than they would in a normal patient. The surgery should be carried out in such a way as to minimise any trauma even if this means that it takes longer or has to be done differently to a normal patient. In terms of pain control, again, it is important to try and ensure that any post-surgical pain is reduced to as near zero as possible for as long as its needed. This may mean using a pain control regime which would be considered excessive and unnecessary in a normal patient.

Hope that helps but please do check the RSDSA resources on there website and take copies to your dentist if you think they will be helpful.

Thanks so much for your replies Bryanna and Neurochic!

I did check out RSDSA and a site for Trigeminal Neuralgia but there isn't a lot of dental information and then I remembered NeuroTalk! I have held off on having root canals or extractions for two years but now I've got more pain and infection so I think it's time to take action.

I filled out all of the paperwork online and my dentist is sending my x-rays so I'm hoping the surgeon will review this information before I get there on Friday. I also plan to call the office tomorrow to make sure they have everything they need and again remind the receptionist of my medical history.

Wish me luck!

Hi HokeyMom,

I know this is a very difficult subject matter and the information about the correlation between dental matters, CRPS and TN is pretty much kept in a vault for only professionals to see. The literature is so complex that the lay person would not be able to understand it even if it were readily available. In addition to all that, there are so many variable factors and each case presents with it's own share of individualized problems and complications.

However, the first issues that are certain to be problematic and contributory to further long term suffering are the complications that arise from retaining teeth that are chronically inflamed and infected. It needs to be kept in mind that the inevitable outcome of root canaled or infected teeth is extraction. Some people have actually experienced the teeth to evulse on their own from the deterioration of the bone. This may seem like a grand and painless thing to happen! However, this action does not mean that the problem is solved nor does it mean that the infection over the years has not caused or contributed to poor health.

So although it is crucial to take into consideration your medical problems and how they intricately correlate with having oral surgery, it is just as crucial to be aware that retaining infected teeth is going to present a new set of systemic problems.

Is it ideal to have oral surgery when you have CRPS and/or TN? No. Is it wise to put off the surgery knowing that in the interim the infection and inflammation is going to become more widespread? No, it is not.

So hopefully you have found an oral surgeon who is well versed and experienced in cases such as yours and he will be able to guide you and treat you to the best of his ability. The outcome of removing those teeth and how that will affect your CRPS and TN, will not be known...... until it is known. I really dislike saying that, but it's true and no one can predict the outcome.

Please keep us posted on what takes place on friday. Fingers, toes, legs, arms, you name it... it's crossed!!

Bryanna

Met with the oral surgeon on Friday and will be having teeth extracted this Wednesday. He answered all of my questions and told me he would never consider implants for someone with my conditions (TN & CRPS). He suggested getting a removable bridge if I decide to fill the gaps. I will keep you posted after the extractions on Wednesday. Thanks again!

Hi Hockeymom,

I am glad to hear that the oral surgeon answered all of your questions and was straight forward with you about dental implants.

I often suggest to patients who are scheduled for oral surgery to plan their meals and buy the food ahead of the surgery date. This will make eating so much easier for the first week or so and it is very important to eat healthy during the healing phase. Soft nutritious foods are best for at least the first two weeks. Avoid anything that is chewy, spicy, or has seeds in it.

I'm sure you will do well. Please keep us posted.
Bryanna