People suffering from facial pain are often concerned that dental procedures will aggravate their pain. TN patients who are pain-free are at lower 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 because of a TN flare-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.
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
Because people with facial pain do not always respond as well as other patients to anesthetics, the local anesthetic may need to be of greater potency. If you need treatment, discuss with your dentist the type of anesthetic to be used. Ask your dentist to use Mepivacaine 3% or Carbocaine 3%, neither of which contains preservatives or a vasoconstrictor. You may want to ask in advance, because the average dentist doesn’t keep this particular drug in stock.
After the typical anesthetic, which is described above, an intraosseous injection may benefit the dental patient who has facial pain.
Epinephrine is a vasoconstrictor; it’s sometimes added to local anesthetics to prolong their numbing effect. Epinephrine can trigger nerve pain, especially in cases of trauma-induced TN. In these cases, ask your dentist not to inject a vasoconstrictor with local anesthetics in the area of nerve damage.
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.
If all else fails and you absolutely need dental work, discuss the possibility of a general anesthetic (either IV or inhaled) to put you to sleep while the work is being done. This type of anesthesia can reduce emotional trauma.
Note: this article originally appeared in the Fall 2014 edition of the Quarterly Journal. You can view the original edition here.