How would you treat a patient with neuropathic orofacial pain?
This summary is based on the article published in the Journal of the American Dental Association: Dental treatment for patients with neuropathic orofacial pain (September 2013)
A 56-year-old woman visited a dental office with acute dental pain in the left mandibular molar area. The treating dentist established a diagnosis of trigeminal neuralgia (TN) related to the left V3 branch, for which the patient was treated with nerve membrane–stabilizing anticonvulsants. The patient’s medical history included mild hypertension, hypothyroidism and intermittent low back pain for which she was being treated adequately by her physician.
The clinical examination revealed the left mandibular permanent first molar (tooth no. 19) had a large defective restoration. The dentist determined that placement of a full metal crown would be the treatment of choice for the restoration of tooth no. 19.
The dentist now faces the dilemma of bringing in the potential risk of reactivating the initial pain or exacerbating the patient’s ongoing condition.
Patients with current or controlled TN may be reluctant to participate in any activity or undergo any dental procedure (preventive or restorative) that involves manipulation to these hypersensitive areas. This may lead to progressive dental disease.
On the other hand, effective oral health maintenance may reduce the need for invasive dental treatments, with the added benefit of reducing the patient’s risk of developing complications associated with neuropathic orofacial pain (NOP).
It is very important for the dental team to recognize these issues and consider the following:
- Patient scheduling
- The use of local anesthetic and preemptive analgesia
- The implementation of preventive and hygiene procedures
- The adoption of the least invasive approach
- Dentists need to recognize and understand the concepts of NOP to provide appropriate treatment for patients.
- To provide the highest quality dental care for this unique patient population, they must incorporate into the final treatment plan factors such as communication among all health care practitioners and the patient, appreciation of and respect for the patient who is experiencing NOP and understanding the patient’s tolerance for potentially painful procedures.
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