Hi everyone,
Ive had rsd for over 10 years now and been in remission most of the time,i only had flare ups when having iv inserted for medical proceedures,or at times of great stress.
Since i developed rsd i never had injections for dental work because i was told that it could cause spread.,and was bad as it contained adrenalin,which was bad if you have had nerve blocks like i have.
I was really fortuneate till recently i had a dentist who never caused me any great discomfort and was very sympathetic and skilled.,so when i needed my teeth drilling she took it really slowly and always stopped if she caused me pain.
This dentist left to work in the middle east.
Recently i had several teeth break and fillings part come outwhile iwas on holiday away.
I told the new dentist about my rsd and she said that with an adrenalin free infusion it should be fine,and the drilling would be too painful without it,so i said ok as she seemed to know what she was doing,and i had learnt on your website that it was a good thingto block out the pain to prevent a reaction.
She gave me a numbing gell and then an adrenalin free jab of Citanes and i didnt even feel the needle go in
She drilled my upper tooth and refilled it It took an hour.
All went well and so far i had no reaction or spread.,and that is 2 months ago now.
I was so pleasedNow i could have treatment with an anesthetic,or so i thought.
I now need another tooth drilled and refilled,as its broken and needs refilling.
My regular dentist who replaced my good one said the tooth on the lower jaw would need a full femeral nerve block and the injection would be uncomfotable as it goes between gums and bone.She didnt want to proceed when i told her about my rsd (and having had nerve blocks with a lot of adrenalin ),unless the emergency room was open at the local hospital.
Is she right to be caucious or is she over reacting.?
Do you think the injection could cause my rsd to spread?
I know its a good idea to hide the trauma from the brain but would the trauma from the injection trigger spread.
I have very sensitive gums.
Has anyone had spread from dental work who was in remission like me.?
Im taking vitamin C and have found it Very effective in reducing flare ups!
Will that help prevent spread ?
I would be so greatful to hear from anyone with relavent input

Big gentle hugs

Flora

Anything CAN cause spread so it is good to be cautious. It's really up to you if you want to take the risk on something like that but it does sound pretty invasive. Have you looked into sedation dentistry? I did this when I needed a lot of dental work done this year and it worked out really well for me. There were no shots involved...it was all oral sedation with meds and such. Apparently I was technically conscious the entire time but have no memory of any of the work. You'd need to have someone with you though to drive you to and from the procedure though with that.

I needed a lot of dental work this year and I experienced spread from a lumbar sympathetic block a couple of years ago so I know I am prone to spread. I was very nervous and I won't let my dentist do any root canals. If the tooth needs to go then we just pull it. I spent a lot of money on bridge work...but feel a lot more comfortable with that vs doing any more invasive dental procedures.

Hope you are able to find a solution that works best for you. Take care and good luck!

Flora
I'm not very clear from your post why you don't want to have the local anaesthetic with adrenaline in it. You say "...and was bad as it contained adrenaline which was bad if you have had nerve blocks like me."

I don't know what sort of nerve blocks you previously had or where they were inserted which makes you think you can't have a normal dental anaesthetic injection. Maybe it would help people advise you if you could clarify what the previous treatment/problems were you had with the normal local anaesthetics containing adrenaline. It might also help us understand why the dentist is concerned to have the local hospital facilities available.

Adrenaline is added to dental local anaesthetic in order to prolong the action of the anaesthetic. It does this by causing only very localised vasoconstriction - this holds the dental anaesthetic in the local area better and for longer and it also helps to prevent bleeding.

Local dental anaesthetics containing adrenaline are not suitable for diabetics and people with certain other health conditions.

Such limited evidence and guidance there is for patients with CRPS undergoing dental treatment would recommend plenty of local anaesthetic applied to suitably block the possibility of any pain to make sure that any pain is fully blocked for as long as possible to make sure the treatment is not felt. Yes, it is possible for an injection to cause a spread of CRPS but having dental work done involving drilling into the teeth close to the nerves in the teeth is a bigger risk for trauma and pain which is more likely to cause a subsequent CRPS risk. You have had dental injections previously without any spread of your CRPS so I would have thought on balance, long acting and extensive local anaesthetic would be the best way to proceed before your next dental drilling and treatment.

There's no evidence that Vitamin c will prevent spread of CRPS symptoms in the dental circumstances you are asking about but it won't do you any harm.

Hi Flora

I have had sedation several times at the dentist (big phobia...) and it was great for me, reduced my anxiety beforehand because I knew I wasn't going to be aware of anything, and helped me sleep through the worst of the waking pain when I got home because of being zonked out lol You definitely need someone to drive you and be there for the rest of the day - I was always very smiley and a bit drunk coming out of it!

I've talked to my dentist about the CRPS and we have an action plan should I need any major work. He will try to see me as quickly as possible so that I am not in pain for too long, and will sedate me. He will use the other local anasthetic (not the normal lidocaine one, which I've read isn't as good for us) and use double amounts to really numb the area. After the treatment is complete he will again use the local to numb everything, so that everything in my mouth has a chance to settle down a bit before feeling comes back.

From everything I've read about dental work and CRPS (I've read a lot because of being so scared of it anyway...) the two most important things are to reduce anxiety and stress and pain before any work, and to delay any pain afterwards for as long as possible, and then really control it. Better to overdo the caution side IMHO.

I wish you loads of luck. Anything like this is fairly scary, but it can be managed if you have a compassionate and understanding dentist. I think there's a page on this on the RSDhope website that you can print and take to them to discuss it through.

Bram.

Hi Neurochic
Thanks for your reply,
In answer to to your question .
When i first was diagnosed with rsd 4 months after it started in my right elbow from tennis elbow,and spread to my hand and shoulder,which became enpinged.
I had 2 bracial plexus nerve blocks which worked very well and put me into compleate remission for over 2 years.i now only get a flareup when i have an iv into a vein or get very stressed etc.
My flare ups pre taking vitamin C used to be months to settle now its only 3weeks.
I recently started taking vit C and found that it controled my flareup,and shortened the episode.
In answer to your question re adrenalin---- Ever since i had the nerve blocks (10yrs ago )i get palpatations ( my resting heartbeat is pretty high )and cant go anywhere near caffine.At the time it made me feel very wobbly/ill for a week or so.My doctor said to avoid meds with adrenalin in them.I hope this answers your question.?
Thankyou for your reply
Flora

Hi Brambledog
Thanks for your helpful reply.
I will look at the page about dentistry.
Thanks for sharing your experience.
Just for the record. Becos i think you asked me a while ago to let you know.
I still havent had my invasive stomach investigations yet.
But i have taken lots of information and info to my doctor.Im taking things slowly re that!
Thanks to Neurotalk members help my doctor now understands me better.,and is more caucious about doing invasive stuff on me as a result.
So a big thankyou to everyone.
Flora
X

I have sedation dentistry as well they put me to sleep and on top give IV ketamine, and morphine as my RSD flares so easily and it helps so much.

I know we get so afraid it will spread but I have been poked so many times with no affect. 3 nerve blocks, epidurals, blood patch from a lumbar puncture. I've had plenty of dental work done. Having surgery for the SCS made mine spread. Done in the middle of my back...I don't know how dental work could cause RSD to spread. I've only heard of injury or surgery causing it.

You can't stay away from the dentist if it needs to be done. I know about letting things go to long without getting taken care of. If you have to do it then I would do it.