What a "breath of fresh air" to find a dentist on this forum. It is a dentist who saved my life from the ravages of facial pain and I will ever be thankful for his expertise and quality care and concern. You are ever so kind to be concerned about doing what we call in education" best practices" for treating a patient with RSD. I have both RSD and fibromyalgia and must receive special treatment for my dental care. Also, I am aware of the consequences of dental procedures which can cause painful reactions due to both conditions.
From experience I can tell you that short procedures are best for the patient. Also, from experience I can tell you that any extraction (at least in my situation) caused extended periods of pain far beyond normal. My facial pain specialist (dentist) gave me injections directly into the gums to calm down the nerves which became hyper - excited due to the extractions. His injections provided almost immediate relief. (Thus, do not be surprised if your patient experiences continued pain) Also, I know that I cannot have any root canals as they are even more apt to cause nerve irritation. Thus I will choose to have an extraction and follow up injections.
You may want to consult with facial pain specialists in the area to see if they have suggestions on how to treat RSD and/or fibro patients.

I could write a book about these conditions and how they have a nervous system connection and we must be concerned about dental and medical treatment. My chronic pain condition began in my face from a dental procedure.
Thank you for your concern and interest. I do hope you continue to check in on this as well as other forums. There is also a dentistry forum here.
Best wishes,
Sydney

Hi Doc,

My dentists is fabulous like you are you.

He only uses Marcaine on me.

Thanks for caring about us. Hugs, Roz

http://www.postgradmed.com/issues/1999/08_99/smith.htm

Thanks all for the warm welcome.

There is not a lot of literature out there as relates to RSD and dental treatment, so I've been spending a lot of time sifting through the research.

I saw the patient first thing this morning and she is already doing much better.


A few things that may be helpful to those of you whose medications are drying out your mouth (like my patient): Keep your mouth moist (water with a little lemon juice, sugar-free gum or candies, suck on ice, etc), talk to your dentist about prescribing a prescription strength fluoride toothpaste and an antibacterial mouthwash like chlorhexidine.

And though it may be painful, I highly recommend getting infected teeth addressed. The last thing anyone needs is a constant site of infection (goes for periodontitis as well). Many dental schools have a clinic devoted to oral facial pain that may be of some assistance in more complex cases. And most any oral surgeon can remove teeth under general anesthesia.

Thanks again for all the kind words. My thoughts are with all of you.
Dr. Todd

Also, I use marcaine at the end of most surgical procedures (RSD or not). It's great stuff for post-op pain!

Dr.Todd
Not only RSD but many chronic pain patients need special attention.
dental needs are an anxiety issue to non-issu patients let alone this with high pr special needs pain addressed.

My daughter would have not the short term novacain used as it did not numb well. Also, enzymes in valium can reduce the effectivness. She also needed nitrous. If the patient is in need of a tooth pulled, a back one, my daughter would go to an oral surgeon and versed or twilight was used.

Antibioics and pain medication started immediatly.
ALSO, many patients have a pain contrac; a prior phone call, not post op one to the Pain doctor would reslove any problems medicating pain post op.

I had a PCP taht was manageing meds refused the oral surgeon to provide a script post op for tylenol III for a tooth that was in terrible shape.
I had to camp out in his officewith a crying patient to request him provide the script for pain. By this time the pain wa so high, it was extremly difficult to control. THAT WAS MEAN AND UNCALLED FOR!

ANother thing is Alodynia, hyper pain signals. When a terry cloth goes across the skin it can feellike a million picks of needles or terrible pain. The brain has received so many pain signals over an extended time that it reads pain HYPER.

You are to be commended. To find a dentistthat will take the challange of a difficult patient is tough, nearly impossible. The last reg. dentist I had used for our family their center for 35 years, since I was in high school; told me right out my adult daughter had too much pain and jumped around he would not treat her.Thankfully he could contril the abscess, and then the referral to the oral surgeon again helped.
New PCp for pain at that time was very helpful.

Thanks for your concern, check on some of the other forums for MS MD, Chronic pain and other issues, even children that have ADHD, bipolar or mental health issues are more challanging. More rewarding too.
Dianne

PS I made ice bags of frozen peas, or 1 part Alcohol and two parts water for slushy to use on pain area.

ALSO confirm tooth problem with xrays. Once a sister had a tooth pulled and it was actually comning from a bad sinus problem. Rule out fascial neuralgia nerves making the tooth painful too.

Hi Again Doc,

Here is a clinical trial which relates RSD and dental somewhat. I wish I knew how the results ended with this drug. Hugs, Roz

Official Title: Neurotropin for Acute Dental Pain and for Chronic Neuropathic Pain
Further study details as provided by National Institutes of Health Clinical Center (CC):Primary Outcome Measures:
Efficacy of Neurotropin for acture pain.

Total Enrollment: 100 Study start: September 2000

Patients with Reflex Sympathetic Dystrophy, re-named Complex Regional Pain Syndrome, type I (CRPS-I), have chronic, post-traumatic pain that spreads beyond the distribution of any single peripheral nerve without evidence of major peripheral nerve damage. A similar disorder, Causalgia, re-named CRPS-II, presents with clear evidence of nerve injury. No successful drug treatment exists for these disorders. Neurotropin is a non-protein extract of cutaneous tissue from rabbits inoculated with vaccinia virus. Neurotropin has been used extensively in Japan to treat reflex sympathetic dystrophy and other painful conditions; however, the drug has not undergone clinical therapeutic testing in the United States. This protocol is to carry out double-blind, placebo-controlled, crossover studies about clinical efficacy of Neurotropin for acute pain in dental outpatients and for chronic pain in outpatients with CRPS-I or II.

http://www.clinicaltrials.gov/ct/sho...006289?order=2

I just want to alleviate the fears of a few of you who have mentioned how I should go about diagnosis and treating specific dental issues. My emergency exams always start outside the mouth; palpation of muscles, lymph nodes, review of medical Hx, radiographs (PA and BWX), etc. Appropriate antibiotics and pain meds are Rx'd in cases when called for. I dont even want to look in the mouth until I have checked everything else.

As you might imagine, managing emergencies in a dental office with an already full schedule can be quite a challenge.

Thanks again for all the tips and leads. Frozen peas are a great idea!


Dr. Todd

Hi Doc Todd,
Whoa!! Specifically -
NO ICE FOR RSD SUFFERERS!!
Don't care what the medical profession says, about 98% of the RSD forum members agree that ice *promotes* RSD symptoms. This forum has a history going back about 10 years, through several incarnations, and that is "The First Rule of RSD Tx".

I can tell you that if anyone put ice on my RSD arm I'd be right back with my Big Red Balloon arm of 2 years ago - and ice hurts me like freezing hell.

And one other thing, very important: research shows that applying clinical amounts of antioxidant before and after surgery - of any kind - can help to stop the RSD spreading to previously unaffected areas. Much of the research has been done on Colles fracture (which, incidentally, is how my RSD started), using vitamin C, but it applies to all surgery nonetheless. It's such a simple precaution, but the statistics are staggering. Most of us take antioxidants now anyway as a matter of course, but look at the literature, surgery needs megadoses.

OK, I'm done! Just remember...no ice...no ice....no ice...NO ICE !!!!!
all the best.

Hi Doc Todd,
I wish all medical professionals were as concerned as your are. I have a dentist (in Placentia) and I explained RSD to him. He has done 5 crowns on me. The worst pain for me was from the shots. It lasted for days and my face was even bruised once. I do the shorter visits and he and the hygenist are gentle with me. Once, I had to stop a cleaning early because the pain was flaring too much. I didn't want to quit before it was finished but knew I had to. Now, they are more gentle with me. Please understand that we are not necessarily afraid of dentists as are alot of dental patients but know our bodies and limits (try to, anyways). It didn't used to bother me to go to the dentist, now I dread it. I need some perodiontal work but keep putting it off.
Linmarie

Artist I don;t have RSD in my face, nor did my daughter,
Sorry it hurts your arm and body, or others. It is so helpful when one can tolerate it.

For migraines, and tooth problems we had to use ICE for the pain. It confused the nerves and helped calm pain signals. Especially the back of my skull cervogenic aches.

When my Left foot RSd is bad, I have to do the same thing, lay the foot on ice pack to take the burning mostly, and swelling down.

My daughters RSD arm needed an incline; wet towles and a fan blowing on it.

Hope everyone is having a calm day,
Dianne