DENTAL WORK | DENTAL
Having any dental work done during a facial neuralgia attack can be a
nightmare at best and impossible at the worst. A sympathetic
dentist may be willing to inject some local anesthetic near the trigger
point where the pain is the worst. This may alleviate the pain for
a while, if done properly. However, the dentist should definitely
know what he/she is doing.
If you are
having major dental work done, Dr. Parker Mahan, member of the TNA
advisory board recommended the following at the 1998 Trigeminal
Neuralgia Association convention:
- Explain your
facial neuralgia to your dentist. It's very important your dentist
understands your condition.
- Try and schedule
any dental work during a pain remission.
- Talk with your
doctor about increasing the dosage of any medications you're taking
for facial neuralgia a day or two before you have major dental work
- Request your
dentist to use Marcaine without epinephrine as your local
anesthesia. Marcaine is a long-lasting anesthesia and should
make it less likely you'll need many injections. Epinephrine is used
to prolong the numbing effect of a local anesthetic but can also
trigger nerve pain.
- Request your
dentist to inject the anesthetic as far away from any of your
trigger points as possible.
- Take a
pain-killing medication such as codeine several hours before your
dental procedure and take it after the procedure. The goal is to
keep yourself painfree as long as possible both before and after
your dental procedure.
- If you are
nervous or anxious about your dental procedure, think about asking
your dentist to use laughing gas or IV anesthesia.
- Drink only
lukewarm fluids to avoid stimulating the nerves in your mouth.
Dr. Mahan recommends
having only dental procedures that are truly necessary, explaining that
major dental work for someone with a facial neuralgia condition has the
potential to increase facial neuralgia pain or end a remission.
HYGIENE FOR PEOPLE WITH TN
by Michael Pylon DDS
aka Mike on the Bike
Dental hygiene can be
challenging for people with Trigeminal neuralgia since even light
contact with the face can trigger severe pain. As a result, many people
with TN end up with dental problems which aggravate their condition even
more. As a dentist, my main interest is in prevention… stopping dental
problems before they start, an approach that always pays off in the long
But before talking
about hygiene strategies, let's take a look at the three biggest enemies
to your dental health: bacteria, plaque and tartar.
Gum problems and tooth decay are caused by bacteria that live in your
mouth. These bacteria appear shortly after birth and are your constant
Plaque is an invisible bacterial film on the teeth which can cause decay
and gum problems. It can be removed with brushing and flossing. Dental
plaque starts to form within 20 minutes after a thorough brushing or
dental hygiene appointment. It begins with a precipitation of a film
from your saliva. This film forms the mesh on which dental plaque forms.
Bacteria adhere to this film and within 72 hours reaches the
"mature" stage where it produces acids that decalcify teeth.
The bacteria can produce toxins, which can cause gum problems and tooth
Tartar is a calcium carbonate precipitate that forms along the lower
teeth and sometimes on the upper molars. It is from salivary flow. It
cannot be removed with brushing and requires professional cleaning.
Instead of exploring the exact mechanism of how plaque plays a role in
causing dental caries and gum problems, let's cut to the chase and
examine how to fight plaque. This invisible bacterial film forms mainly
along the gum line, both below and above the gum tissue and on the
teeth. Plaque usually does its damage between the teeth and in the
grooves on the tooth's biting surfaces.
The traditional ways
of removing plaque are brushing and flossing. Since plaque takes 72
hours to build up to a mature level, a person with TN need not feel
guilty about not being able to maintain optimal dental hygiene on a
daily basis. But on "good" days, the more thorough you are
with your brushing and flossing, the better.
Try to do your brushing and flossing shortly after taking your
medication, when the medication is most effective and less of a chance
to trigger a pain episode with your brushing.
If you can floss your teeth, floss first before brushing. Use a waxed
floss as studies show it works just as well as unwaxed floss which can
be uncomfortable on the gum tissues. When flossing, run the floss down
the teeth to just below the gum line. The floss should be buried in the
pockets between the teeth and the gums. Go up and down with the floss,
don't do a 'sawing' action. Floss until there is a squeaky sound along
If you have trouble
flossing buy some "flossers" at a drugstore or supermarket.
These are toothpick sized "thingies" shaped like a hacksaw
with a small piece of floss. Some people find it easier to use "flossers."
Rinse well after
flossing. If cold water triggers a TN response, use warm water. Don't
use a mouth wash to rinse as most contain alcohol which can irritate the
tissues in your mouth.
When you have finished flossing, it's time to brush. Again, use warm
water if required. Brush one tooth at a time. Don't do a shoeshine
back-and-forth action, rather place the bristles of the brush in the gum
pocket and brush towards the biting surface. After brushing, put some
tooth paste in your mouth and rinse with this instead of water or a
By using a fluoride
tooth paste and rinsing with it for several minutes after brushing, you
will help strengthen the surface of the teeth. Indeed, some feel it
helps to prevent immediate plaque build up.
Tools of the Trade
I usually recommend a Teledyne Water Pik. These are little pumps that
shoot a jet of water that can be directed where floss usually is used.
Use warm water as well, if cold water is a problem.
I also am a strong
believer in the Braun Oral B electric toothbrush. They have received
great reviews in Consumer Reports. Our family has had 2 of these
toothbrushes for 6 years and they keep right on a truckin'. :-) They are
particularly great along the gum line. Even
if you use a Water Pik or electric toothbrush, you should continue to
floss your teeth.
If brushing and flossing are too painful, use a soft cloth to wipe
your teeth clean. Try to be slow and thorough. If one area of your mouth
is just too painful, then avoid that area and try again another day when
your pain level is not so high.
If you absolutely
cannot brush, floss or wipe, you can at lease use a mouth wash or rinse
to help control plaque. Use a non-alcohol, anti-plaque mouth wash
with fluoride. Ask your pharmacist (Chemist in the UK) which ones they
carry. Again, heat the mouth wash in warm water before using, if cold is