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02/14/2013 11:47 AM

Dental Care for CRPS - RSD Patients

jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

Most of us are aware that there are factors that cause tooth decay for RSD/CRPS patients. These include:

1) Medications which cause dry mouth - saliva protects teeth and reduces gum disease and dental decay. Information from an article found on the RSDSA website entitled "CRPS Patients and Dentistry: A Dentist's View" states:

Many medications reduce saliva flow, causing a completely dry mouth (xerostoma) or they can radically alter saliva thickness, causing it to be thick and ropey. Either condition allows bacterial plaque to grow even faster and more tenaciously than normal. Combining this with a soft, sugary diet can wreak havoc on dental health. Many people who live with pain may rely upon "comfort" foods, which are often high in fats and sugars, causing overall health concerns and an increase in dental disease.

2) Bone re-absorption is an issue for the entire body as the presence of inflammatory chemicals causes a change in the polarization and bone material leaches out of the body, leading to osteoporosis (otherwise known as Sudeck's Atrophy).

The article "Systemic Complications of Complex Regional Pain Syndrome" published in Neuroscience and Medicine in 2012 by the Department of Neurology at Drexel University states in Section 8: "Musculoskeletal System" states:

"Bone and joint pain are suffered by a majority of CRPS patients. X-rays of the affected extremities demonstrate bone lakes (intracortical excavation) associated with periarticular, trabecular and periosteal demineralization and bone resorption [151]. These changes are thought to be the result of osteoclastic activation possibly from nociceptor release of substance P [152]. During bone resorption,activated osteoclasts reduce pH enough to depolarize pain afferents which densely innervate bone [151]. Magnetic resonance imaging often reveals bone marrow edema and triple phase bone scans demonstrate pooling in the late phase [151, 153] in 30 to 50% of patients.

Pathologic fractures are very common in CRPS-I patients. A frequent fracture occurs in the 5th metatarsal bone. Most patients suffer fractures during their usual activities or with minimal trauma. Experimental evidence demonstrates that bone formation and maintenance are critically dependent on an intact small fiber innervation which is dysfunctional in CRPS-I patients [2] [154-156]. These fractures are difficult to heal which may also be a reflection of dysfunction of bone innervation."

3) Subjective evidence from our own pool of CRPS patients on this web site corroborate this. I am aware of at least 2 patients who have lost the entire upper or lower teeth as a result of CPRS, and others who have described their teeth "crumbling", caps falling off, and other concerns.

4) The primary issue for CPRS patients, in my opinion, is how to obtain effective dental care while overcoming the worries and concerns of receiving dental care which many fear my cause a spread of CRPS symptoms. This is due to the needles, as many of us have heard of needlestick injuries causing spread, the fear of surgical operations such as root canals and deep drilling, and adequate sedation to prevent muscular tension and emotional distress.

I have come across two article which provide advice for CRPS patients undergoing dental treatment. These articles may prove helpful for those whose dentists are unfamiliar with the risks and complications stated above. These resources are:

a) http://www.rsds.org/pdfsall/Siegelman_Summer.pdf

b) http://www.rsds.org/3/education/rsd_dentistry.htm

5) Another option is to work with your PM and you dentist to obtain appropriate "sedation" during the dental work to prevent pain during the work an reduce inflammation after the work is done. When I had a crown replaced, I was unable to manage with nitrous oxide and novocaine, and opted for "Sedation Treatment" which included taking a valium the night before the procedure, another the morning of the procedure, and receiving a sublingual agent which completely relaxed my body leaving me in a state of subalert but not subconscious anesthesia. I did have some swelling for a week afterward, but the procedure was comfortable for me and I am sure that if I were subjected to the same treatment using traditional methods, the simple muscular tension would have caused more follow up pain. To read about Dental Sedation go to:

http://www.kailuadentalarts.com/Sedation.aspx

What is Sedation Dentistry?

"Sometimes referred to as “comfortable” or “relaxation” dentistry, the terms describe the feelings most patients experience during their oral sedation appointments. The purpose of oral sedation is to allow a dentist to work more effectively by helping a patient become as comfortable as possible with the use of sedative medications administered orally and sublingually.

Dr _______ has been specially trained using safe medications that help our patients be completely comfortable while their dentistry is being done. One of the benefits of sedation are that patients remember little to nothing of their time in the dental chair by the next day. With sedation, a patients apprehension and hypersensitivity to pain is virtually eliminated thus reducing the likelihood and severity of post-operative discomfort."

As this topic has come up several times in the last month, I hope these resources and information is helpful to the community.

Aloha,

Jenny

Post edited by: jpcrps, at: 02/14/2013 11:50 AM

Post edited by: jpcrps, at: 02/14/2013 11:54 AM

Post edited by: jpcrps, at: 02/14/2013 11:55 AM

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02/15/2013 03:44 PM
weepandsmile
 
Posts: 43
Member

Thank you Jenny for the Dental Info...although i am doing well right now sure do not want anything to stir this RSD up again....am going to ask if my dentist can do the dental sedation,if not will have to look further for a dentist...i am checking in to seeing a osteopathic physician to help with preventative therapy with herbs etc. with RSD,Raynaud's Disease, hypothroid and gerd ...Have been reading on line about the herbs good for all of these conditions...have had good results with ones i have used for different issues and really better than alot of some drugs...knowing that what works for one doesn't always work for the other person...will try to give some info on this sometime....it is great how we can share and learn...hugs wilma

02/15/2013 05:02 PM
jkb
 
Posts: 369
Member
I'm an Advocate

Thanks Jenny, I just wanted to mention that I have a very bad problem with dry mouth and I use "Biotene PBF" and it works pretty well for the dry mouth, and it is supposed to loosen the plaque biofilm also...Jon

02/16/2013 04:45 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

I want to thank both of you for your feedback and replies. There is a lot we don't know about how this condition affects other parts of the body. If you or others have additional info to share, please continue with the replies. This will help us to build a library of information and build our own knowledge base about the condition.

JKB - I will have to look into that toothpaste - how long have you used it ~ is a prescripton required? Sounds like you are pleased with it.

WILMA - It is interesting that the list of other symptoms you mention (Raynaud's Disease, hypothroid and gerd)are all discussed in a paper i recently provided a link to (due to copyright, I will just briefly point you in the direction of the topics - it is a kind of long research paper)

Title: Sytemmic Complications for CRPS.

Location of link: http://www.mdjunction.com/forums/reflex-sympathetic- dystrophy-discussions/research/10424738-systemic- complications-of-complex-regional-pain-syndrome

As this topic fits more closely with that one, I will point out the sections of the paper discussion these topics in that post (see below)

I am very interested in becoming more knowledgeable about the many factes of this condition, I am really happy to see your comments and participation.

Love,

Jenny


02/17/2013 02:08 PM
jkb
 
Posts: 369
Member
I'm an Advocate

Jenny, it is a mouthwash type item and it is OTC...It does work well

02/18/2013 02:29 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

Link to prior post on same subject may shed additional light on this topic. Many of the prior members (many are not longer active and I am sad not to see them around) describe their problems with dental issues such as:

Root infections

Teeth breaking of at that the roots

Thousands of dollars spent on root canals

Dentures.

There is a wealth of info as we sometimes go round and round the mulberry bush - hoping to bring the topic together with the inclusion of this older post:

http://www.mdjunction.com/forums/reflex-sympathetic- dystrophy-discussions/lounge/800671-dental-root-decay-from- rsd

Post edited by: jpcrps, at: 02/18/2013 02:30 AM


03/03/2013 03:27 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

Jon,

Found the mouthwash. It is awesome. I see on the pkg they also have special toothpaste and a product you can use intra-day for dry mouth. Thank you for the info. I have a dental cleaning coming up and hope to have a good one (I ate too much candy as a kid).

I am going to ask his opinion of this product.

Again,

THANK YOU for this tip - I don't want all my teeth falling out!

Love,

Jenny

Post edited by: jpcrps, at: 03/03/2013 03:28 AM


03/05/2013 06:56 AM
lauralee123
lauralee123  
Posts: 6
New Member

All this info on teeth was so helpful...I was going to ask about teeth decaying while having CRPS...I have a tooth that the big filling fell out on a molar tooth about a yr ago...luckily it doesnt hurt...i recently had to 2 upper back teeth pulled because of the decaying up my the roots and I didnt have dental insurance and I was in so much pain...didnt have many options...and the swelling and the pain was intense ...I have had teeth pulled years ago and It was nt that bad ...so I guess the pain of dental problems are worse in pain when having CRPS...Thanks for the post...

03/06/2013 07:28 AM
hope4peace
hope4peace  
Posts: 62
Member

Since my CRPS/RSD started I have also noticed my fillings falling out and some previous root canals/crowns are now breaking apart...as if I already hated to go to the dentist now add this on top and I am allergic to Valium and anesthesia, so I have been putting of going...thanks for the info perhaps when I get insurance coverage I will just bit the bullet and get them all pulled!! but thanks Jenny great info!!~ Tammi

03/07/2013 10:38 PM
maddiesgram
maddiesgram  
Posts: 2330
Senior Member

Just a note of warning to all RSD/CRPS patients: Please take care of your teeth much more diligently than you ever have before! Last May I had to have my remaining 19 teeth pulled due to both the terrible condition they were in and my inability to pay for ongoing root canals and crowns, with the extreme likelihood that what had caused the severe problems the past few years of decay, teeth falling out without warning, root canals, teeth crumbling, etc, would just continue. The situation was dire and after 5 opinions I went with a wonderful dentist who did his part for free as a ministry to me and called his friend down at the dental college and got me in to see him, a top guy, which also saved tons of money. These things were huge blessings to me as I had NO money to do this. I still had to pay, but a good friend loaned me the money (she is super wealthy). It was a breeze compared to what I thought it would be like. No fun, but no nightmare either.

What I want you all to know is that the normal way of caring for your teeth is no longer adequate. Be diligent in brushing, flossing and getting your teeth cleaned! I brushed my teeth as always, but didn't realize that processes much different than before RSD and meds were going on. By the time I saw the dentist who helped me, a very level and soft spoken man, he told me that my situation had become LIFE-THREATENING! My primary care physician had warned me of the same thing in my most last visit with her. That is a very scary thing to hear. Please do all you can and know that I am not exaggerating.

If you have to borrow money to get your teeth cleaned, do it! Dental work is so expensive and you might spend $100.00 for a cleaning, but save thousands. I do not know exactly why our teeth have such serious issues when we have RSD, but am sure medications are part of it as others have explained. Yet, most of us will be taking at least one medication, and most of us take more than that. And I'm thankful for my medications! The oral surgeon who saw me at the dental hospital asked me if I had been using crystal meth! I actually laughed politely,explaining that I'd never used an illegal drug in my whole life, which is the truth. But it did hurt that he thought that of me. Mainly the whole thing has made me very sad.

When I was first told that I needed full dentures just before my daughter's wedding when I had just gone in to get my teeth WHITENED, I was shocked and instant decided to kill myself instead. Along with the pain and loneliness, the isolation and financial problems, the weight gain and weakness from being sedentary, it seemed like too much. And really, it almost is, but whatever comes our way we must just keep walking through it and trying to look for those things that make life worthwhile, as well as any kernels of hope that we might get better. In just six years my life has changed so much. Dentures are awful and now they are loose, I guess from bone loss (I have an appt.), and it has become hard to talk or to eat with them. It's so humiliating. Please take my story and the many stories of others to be a BIG warning to you and don't let this happen to you. I only wish that someone had warned me! I could have flossed all day, used special mouthwash, and brushed many times a day to keep this from happening. I had never even met or seen anyone with dentures and honestly didn't know that people still lost their teeth. Never could I have imagined this.

This summer when my old friends from high school get together for a fun weekend, I will be too mortified to go. Just please remember that things are not what they use to be in your mouth if you have RSD and if you take medications for it. Save not only your smile, but also your ability to chew, eat in public, speak without sloppy noises, and how you look. It really CAN happen to you if it did to me.

Gail

(Errors are due to my **** Kindle!!!)

Post edited by: maddiesgram, at: 03/07/2013 11:03 PM

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