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Last Updated 09/15/06














Dental Tips



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:

  1. Explain your facial neuralgia to your dentist. It's very important your dentist understands your condition.
  2. Try and schedule any dental work during a pain remission.
  3. 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 done.
  4. 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.
  5. Request your dentist to inject the anesthetic as far away from any of your trigger points as possible.
  6. 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.
  7. If you are nervous or anxious about your dental procedure, think about asking your dentist to use laughing gas or IV anesthesia.
  8. 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.

 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 run.

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 companions.

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 decay.

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.

Fighting Plaque 
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 the root.

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 mouth wash.

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.

Other Tips
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 a problem.

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