Dental Issues related to Neuropathic Facial Pain and Trigeminal

Neuralgia

Patients suffering from face pain, including TN (Trigeminal Neuralgia) 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.

TNA 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 case TN pain flares up right before an appointment.

• Be well medicated.  If 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 dose of medicine. To prevent a breakthrough, your dentist may want to increase the dose 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 bupivicaine without epinephrine for the local anesthetic.  Bupivicaine 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.