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