[dr.Todd]

Hello all,

I am a dentist in Long Beach, CA and today I saw my first RSDS pt. She was unfortunately in extreme pain. I was able to anesthetize her and get what I believe to be the offending tooth removed quite easily. I called her tonight and she is unfortunately suffering again. I am confident (and hopeful) that the pain will resolve soon.

Onto my question though... when I see her in the future, what would make her visits easier? Short appointments? Long lasting anesthetics? Nitrous Oxide? Do patients with RSDS often suffer from increased post-operative pain?

Bottom line: What should your dentist know and do to make a visit more comfortable?

Dr. Todd

[Desi]

Originally Posted by dr.Todd

Hello all,

I am a dentist in Long Beach, CA and today I saw my first RSDS pt. She was unfortunately in extreme pain. I was able to anesthetize her and get what I believe to be the offending tooth removed quite easily. I called her tonight and she is unfortunately suffering again. I am confident (and hopeful) that the pain will resolve soon.

Onto my question though... when I see her in the future, what would make her visits easier? Short appointments? Long lasting anesthetics? Nitrous Oxide? Do patients with RSDS often suffer from increased post-operative pain?

Bottom line: What should your dentist know and do to make a visit more comfortable?

Dr. Todd

Hello Dr. Ok, you said that you were able to anesthetize your patient who has RSD Ok, shouldn't you have give her antibiotics first? did you? Did you also get the "Right" tooth as you posted, that";"I do believe I got the offending tooth". You mentioned that she was also in pain. well, she is going to be in pain, don't ya think since you just extracted it today! Even before I had RSD I had pain for the first 3-4 days after an extraction!!! I think the patient should tell YOU what he/she would like, be it long lasting anesthetics, or some other pain relieving medication. We are the best people to answer your questions. Did you ask her? I believe to make her more comfortable is to just listen to her, ask what SHE wants. Well, good luck Dr. and remember we are the ones who will tell YOU want helps, what doesn't. Desi

[miss irie]

Hello. The following article was taken from the American RSDHope website, www.rsdhope.org

*****
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.

[dr.Todd]

Thanks for the article miss irie,

I read that about an hour before I posted and that's exactly what got me thinking about the topic. I just want to make sure that she is as comfortable as possible and was looking for some first hand advice that others may have from their personal experience.

[dreambeliever128]

I admire you for coming on here and wanting to know what you could do to make your RSD patient more comfortable with pulling a tooth or any dental work and what might keep them from being in more pain with the RSD later.
You are the first Dr. or Dentist that I have seen come on here to ask about this. There might have been others but I haven't seen any before. I wish there were more like you. I can't praise you enough.

Some patients don't always know what would work for them to keep the RSD from going into a flare or being made worse. I would say the more you learn about RSD and what keeps it from flaring and what causes it to get worse might help.

You also might read about more meds that you could use to help keep the pain to a low amount.

The article Miss Irie put up is a good one and I'm sure there will be more to come on and tell you some of their experience with dental work and RSD.

Also give her more time, the pain might die down on it's own, it could be just maximized by the RSD but not the RSD itself.

I have a PCP that reads up on medical problems that his patients have and he dives right in to take care of them when they can't find specialist to do the job. That's what makes me think you are a good Dentist. One who cares.

Ada

[dr.Todd]

Thanks Ada. That really means a lot to me. I am here to learn. All to often as medical care providers we get caught up treating diseases and not the patient. I am here to hear about the your experiences of treatment and how I can do it better.

Dr. Todd

[HopeLivesHere]

Thanks so much for caring. In my case I took the responsibility for what I needed.
I had a crown done 2 years ago.
My dentist wanted my pain management doctor to come to his office to give me anesthesia because he was afraid to stick me with a needle to give me the block I needed. My pain management doctor said "no way."

I told him to just give me the block but he refused.
So he told me to take a lot of my pain meds and he did the crown without anesthesia.
It really hurt when he drilled out that tooth without novocaine
It hurt for a few days, but like someone said, it would hurt even if I didn't have RSD. But a little valium or xanax would help a lot.
You are a caring doctor to make yourself knowledgable about RSD.

By the way, I had surgery in Long Beach 3 weels ago.

There is a dentist in New Jersey named Mark who has severe RSD.
He only visits occasionally. I wish he were here now to talk to you.
His story is very sad.

Thanks for your kindness, Glad someone found us who does not have RSD !!
Hope

[shiney sue]

Just courious do you ever work with folks who have Sjogren's Syndrome
and Micro-valve?? Do not in any way want to take this away from RSD.
Im in Mo. do i check with who,to make sure i'm headed in righ direction.
Good for you to want help from people who have problems hope you keep
posting. Sue

Well done Dr. Todd for braving the lion's den.



I don't recall either a dentist or doctor visiting us here in a professional capacity before, though we've had at least one dentist in our forum with RSD (where is Markdoc anyway, guys??)

Major kudos!!
all the best

[allentgamer]

Hi Dr Todd!

Wow! I wish more health professionals would think like you do. It would make our worlds a little bit better for sure.

It has been 2 years since I had a root canal done, and I still have a sensitive painful spot on my jaw. If anything just brushes the skin there it causes a sharp intense pain. The tooth has pretty much fallen apart, but I would rather have that problem then go through another round with a dentist. Probably would need a surgeon at this point though

I agree with the shorter visits, and the second anesthesia given after the work is done, or just before it is completed. I would also agree about even giving some pain meds, or something to relax the patient before hand.

You are an exceptional doc, and I wish I lived close enough to make an appointment