The Whole Tooth

CRPS and dental problems go hand in hand.  The medications we take can cause the salivary glands to quit working and the patient can end up with intense dry mouth which can cause the bacteria in the mouth to stay on the teeth longer than usual causing the teeth to literally rot in your mouth.  I started having dry mouth in 1999 because of the opoid medication that I was taking because of my injury.  When I was moved from the Orthopedist to a Pain Management specialist and he started adding more drugs; the dry mouth became more intense.

I started carrying a drink with me wherever I went and I always had a piece of gum or a mint or a piece of hard candy in my mouth to stimulate the saliva but the lack of saliva and the mints and drinks all caused my teeth to deteriorate faster than normal.  I also have to admit that I have a life-long fear of dentists that goes back to when I was six years old and the dentist hit a nerve when drilling out a cavity so I only went to the dentist when I absolutely had to.  In 2005 I started having major pain whenever I ate and when I went to the dentist my sensitivity was so high that he couldn’t accomplish even a regular cleaning.  He suggested that I find a sedation dentist because of the sensitivity.

I will tell you that it is not as easy as it sounds.  I finally found a doctor that I liked and who would take me on and we scheduled the first real appointment to see what needed to be done. 

He ordered Valium for me to take an hour before the appointment and when I sat in the chair they put me on nitrous; something I highly recommend.  The news I received was horrible.  I needed to have two teeth pulled because they had deteriorated so far that the dentist could not save them.  I also needed 22 root canals.  The dentist explained that I had two options; the first was to go through the prolonged dental work and have the teeth fixed whether it be a root canal, crown or implant.  The teeth would be fixed in small sessions to limit the amount of pain I would have after the procedures as well as prevent any additional problems with rsd/crps.  I also have a small mouth so fitting instruments and fingers in my mouth made it so crowded that it actually added time to what a healthy person would normally use.  The second option was to admit me to a hospital and pull all my teeth in preparation for dentures.  The dentist explained that the rsd/crps had eroded the bone of  my jaw and so he was doubtful that I would be able to have a pair made that would be a good fit.  He explained that pulling the teeth or a pair of ill-fitting dentures could cause an infection that could possibly lead to me having a feeding tube for the rest of my life.  After reflection, discussions with my pain doctor and case manager, and two second opinions; I chose to sit in the chair and fight for my teeth.

It wasn’t easy and it took longer than he thought it would but after almost a year my teeth were saved.  In order to maintain my teeth he recommended that I see him every three months instead of the usual six.  I went through periods where my teeth felt and looked fine and then I would go through periods where the titanium posts some of the teeth were mounted on would break and have to be fixed.  I also ended up having two more teeth pulled because they had become thin and brittle after being whittled down by the dentist.  I also ended up having several crowns replaced and another root canal.  In 2011, the dentist decided to send me to a periodontist in order to have a deep cleaning and ward off gingivitis.  The two of them decided that it would be necessary for me to be seen every three months, alternating between the two dentists. 

I am happy to report that my teeth and gums are now healthier than they have ever been.  I use a prescription toothpaste and mouthwash to assist with sensitivity and dry mouth.  I can also say that even though I am nervous before a dental appointment that I am no longer scared of the dentist.  I still use the Valium and nitrous but; the appointments are shorter because I am not flinching at his approach. 

The important thing to remember is that no matter how bad it is you have got to fight for your teeth and keep them as long as you can.  Dental experiences vary from person to person and this is only my story but, I hope that my experiences will encourage those with rsd/crps to ask their dentist about seeing them more often.  Dry mouth and meds go hand in hand so keep an eye on your smile!