Even from childhood, if we were asked to name some environments that conjure up thoughts of pain, a visit to a dentist would be at or close to the top of the list.
Of course, for most people this is entirely misleading, harking back to the days when dental hygiene was universally poor and dentists were little more than a side show attraction. When talking about pain, memories can be very long indeed! However, for those already suffering chronic pain, dental issues generally can be a huge concern. But why?
At its most basic level, many chronic pain sufferers are naturally reluctant to attend a dentist for fear of additional pain. Certainly, that fear may be well founded. Take Complex Regional Pain Syndrome (CRPS) as an example. As symptoms of the condition, many people suffering CRPS develop swollen gums and brittle teeth. Some reports suggest that 75% of CRPS sufferers have dental issues, often serious. As we all know, whilst it is improving slowly, awareness of CRPS among the medical profession generally is poor. However, among the dental profession in isolation it is woeful. That is not surprising when you consider that dentists generally receive no training in pain beyond that directly related to their dental work.
For somebody suffering CRPS, the thought of undergoing any sort of dental procedure, even an injection of local anaesthetic, is often terrifying. [See our earlier article of CRPS and Surgery – Unhappy Bed Fellows.]
The side effects of pain medications are often a contributory factor in worsening dental health. Some, particularly opioids, affect the ability of the salivary glands to produce saliva, resulting in Dry Mouth (Xerostomia). An important role of saliva is to protect teeth and gums from tooth decay and gum disease.
Brushing and Flossing
Pain, loss of strength and lack of manual dexterity in the upper limbs can affect the ability of some people to brush and floss their teeth properly. Further, those whose condition results in often extreme pain in the region of their head, neck and face are naturally reluctant to attack themselves with a toothbrush or dental floss.
It is often commented that the diet of many people suffering chronic pain suffers from seeking comforting, sugary food, with its inevitable impact on dental health.
So, what can be done?
At the risk of stating the obvious and whilst far from easy, the starting point is to find a sympathetic dentist. It may be that your pain specialist is able to recommend somebody suitable. After all, it is unlikely to be the first time that they will have been asked for such a recommendation.
However, it may simply come down to reverse dental education, ie educating the dentist. Again, maybe your pain specialist can write to the dentist to explain a little more about your condition, raise some red flags and make some helpful recommendations. Frankly, a dentist is likely to take your condition a little more seriously in the face of guidance from a fellow medical professional.
One of our clients for whom this recently proved helpful told us that guidance was offered to the dentist on anaesthetic procedure. They were also asked to limit session times and do as much as possible to keep them relaxed – not the easiest of requests in the circumstances!
Of course, even if a suitable dentist can be identified (and/or educated), there is going to be the often overriding issue of cost. Dental treatment has become increasingly expensive and, as a result of their condition, many people suffering chronic pain have a reduced or even zero earning capacity.
For those in litigation, their legal representative should be able to arrange funding. For others, there is no easy answer.