Trigeminal Neuralgia and Future Dental Procedures

Patients suffering from facial pain are often concerned that dental procedures will aggravate their pain. TN patients who are pain free are at little or no risk, yet they still fear work within their mouth. Dental work is hardest on those with constant neuropathic facial pain.

Tips for Keeping Dental work as painless as possible

• Go to the dentist when you're not hurting. Make sure your dentist knows you have TN so he or she will be flexible to schedule you appointments (maybe even on short notice) during periods when your pain goes into remission, This will also help the dental staff to understand in case you have to cancel in the event TN pain flares up right before an appointment. 

• Be well medicated. lff you don't have remissions or must have dental work done during an active pain cycle, consult your doctor so you're on an optimal does of medicine. To prevent a breakthrough, your dentist may want to increase the does of any TN medications you are taking for a day or so before and after the procedure. 

• Also try to schedule your appointment during the time of day when you're least likely to get pain or when your medication is at peak effectiveness (usually about one hour after taking a dose). 

• Several hours before the procedure, take a pain-killing medication such as codeine. Take it again after the procedure. The goal is to have at least five hours after the procedure during which you're pain free,

• Topical anesthetics. Most dental patients need numbing compounds mainly for tooth repairs, crown work, extractions and the like. However, even teeth cleaning and exams may bring on pain for facial pain patients. Topical sprays or gels can be used to temporarily numb the gums. 

• Touch the sensitive area last. If there's a trigger zone that usually sets off the pain, ask the dentist or hygienist to examine and clean everything else first. 

• Switch local anesthetics. if you need treatment, discuss with your dentist the type of anesthetic to be used. Ask your dentist to use Marcaine without epinephrine for the local anesthetic. Marciane is long-acting, so you're less likely to need multiple injections, which might increase the risk of pain. You may want to ask in advance, because the average dentist doesn't keep this particular drug in stock. Epinephrine is a vasoconstrictor, it's sometimes added to local anesthetics to prolong their numbing effect. Epinephrine can trigger nerve pain. 

• Consider the injection point. Ask the dentist if possible to inject the local anesthetic at a site as far as possible from known, active TN trigger points. 

• A knockout. if all else fails and you absolutely need dental work, discuss the possibility of a general anesthetic (either lV or inhaled) to put you to sleep while the work is being done. This type of anesthesia can reduce emotional trauma.

Dental Health and TN

I n June, Ms Elizabeth Harris, a Dental Hygienist in Calgary, spoke to the Calgary group and led a discussion on the difficulties some people with TN have maintaining good dental health. Everyone agreed that it can be a challenge to clean one’s teeth when the slightest touch can precipitate an attack.

Elizabeth suggested there are some things that might help with the daily cleaning regime:

• Use an extra soft toothbrush or Delicate post surgical brush

• Use waxed dental floss or dental yarn

• Use a Braun Oral-B electric toothbrush with extra soft heads

• Use a Teledyne Water Pik with warm water

• Brush and floss at a time of day when you are least likely to have TN

• Use an antibacterial fluoride rinse

• Use Prevent toothpaste or Sensodyne toothpaste (the original one) and don’t rinse with water after brushing, just spit out the toothpaste and allow the fluoride film to stay on the teeth.

• Avoid using alcohol based mouthwashes

She also recommended the use of Peridex, an antimicrobial mouth rinse, for those times when the pain is just too severe to brush. Peridex requires a prescription from your dentist.

Elizabeth suggested there are some things you can do before and during a Dental Appointment to make things easier for you.

Before the Appointment:

• Try to schedule your appointment during pain remission

• Drink warm rather than hot or cold fluids, to avoid stimulating the nerves in your mouth

• Talk to your MD about increasing your TN medications for a few days prior to the appointment

• Make sure your Dentist and/or dental hygienists know you have TN and may have to cancel appointments on short notice if the TN becomes active. Ask for “short notice appointments”.

• Take codeine or another analgesic several hours before your appointment. 

• Switch local Anesthetics. Call your dental office to make sure that they have Mepivacaine 3%, Carbocaine 3% or Marcaine without epinephrine in stock.

• Request nitrous oxide, or oral sedation such as Atavan or IV sedation (Valium or Phenobarbital

During the appointment

• Ask the dentist to inject the local anesthetic as far away from your trigger points as possible.

• Ask the assistant to replace the water bottle with warm water and use warm water to drink and “swish” with

• When having your teeth cleaned, you can ask the hygienist to apply topical anesthetics to the gum to decrease the sensations and ask to do the most sensitive part of your mouth last.

Some Dental Experiences

Jan in Calgary: Prior to my MVD I was in desperate need of a dental cleaning but could not stand for anyone to touch that part of my mouth. The Hygienist suggested the use of a local injection to numb the area around the main trigger points and that worked like a charm. 

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Mar 2020 Diane (Calgary):  When I would go for any dental work they would give me extra freezing, especially for a cleaning.  It would give me relief from the cleaning and also give me relief for hours afterwards.

In terms of pain medication I only got real relief when I used Baclofen, I believe at 60mg.

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