CRPS Patients and Dentistry
By Dr. Aldino P. Maggiulli
CRPS usually develops
after a traumatic episode. Any body part can be affected but
the symptoms are mostly seen on the upper and lower extremities.
Victims of an injury may develop a burning sensation or numbness
on their extremities. Their pain varies day to day. They may
develop problems maneuvering their limbs and have dexterity
problems. Some people affected with this syndrome face great
challenges while trying to accomplish even routine functions.
It is important to share any asset which can provide comfort
and consistent results to those who suffer with CRPS. This
article shares one such asset which was discovered in a dental
setting.
It is apparent that patients with CRPS can't be treated in
the usual manner as other dental patients. This was discovered
when a patient with CRPS came to my office for routine dental
treatment. The patient, who we'll call "Will" to
provide confidentially entered my office on June 21, 2002.
Will informed me that he bad been suffering with CRPS for the
past seven years. He mentioned that he had been involved in
a car accident and the symptoms of the disease followed there
after.
Will was diagnosed with generalized gum disease and a second
appointment was made for him to return for aggressive hygiene
therapy. His treatment was initiated on July 22, 2002. Traditional
dental anesthesia was given and treatment was delivered to
the top right and bottom right gum tissues. Will didn't tolerate
the deep cleaning procedure well. He reported feeling fatigue
and generalized aches. He still had to return to complete
the left sides of his dentition. Will had to be motivated
to continue. An agreement was made that his next appointments
would be shorter. We would treat only the top left side and
on a subsequent appointment treat the remaining bottom left
side.
Will reluctantly returned on August 6th. Traditional dental
anesthesia was given only to the top left side. The appointment
time was cut in half and Will reported feeling a little better
than his first visit. He wasn't tired but the aches associated
with CRPS persisted. A startling discovery was made on Will's
third visit. He reluctantly returned for the remaining bottom
left gum treatment. Traditional dental anesthesia was given
to the bottom left side. The appointment time was short, unlike
his first marathon session treating two upper and lower right
areas. This appointment was different in that a second dose
of dental anesthesia was given to the patient before the gum
treatment ended. Will, for the first time, felt great. The
decreased appointment time combined with additional local
anesthesia close to the conclusion of his gum treatment made
this CRPS patient completely comfortable and report no post-op
sensation. It's difficult to conclude any significant treatment
protocol by revealing the results of just one CRPS patient.
This experience demonstrates that CRPS patients can't be treated
like traditional patients.
Thanks to Will's help, the conclusion to draw is that it
is best to give CRPS patients short dental appointments. CRPS
sufferers tire easily and their symptoms may be exacerbated
by lengthy dental procedures. The progression of treatment
recorded also shows that two doses of local anesthesia are
beneficial; one before treatment and one prior to the conclusion
of dental treatment. The two dose application allowed this
patient comfortable treatment and no fatigue or generalized
ache post operatively. It should be noted that this two dose
technique has worked consecutively for Will on multiple appointments
since this writing, Will has even had a three unit bridge
placed without complications and without increasing the symptoms
felt with CRPS.
Updated July 19, 2005
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