Dental Work and the Fibromyalgia Patient

From the Fidonet FIBROM Echo
Date: 09-19-94
From: Linda Cummings
Subj: FMS in Dentistry


I wrote a message to J. Edward Kendrick, a dentist, in the Grand_Rounds echo concerning problems associated with the teeth with people who have FMS. I thought ya'll would like to see his answers:

* Originally dated 15 Sep 1994

[ Linda Cummings ] Because of the FMS and associated medication I must take to try to live with the FMS, I have (in my dentist's own words) "dry mouth syndrome." I've lost several teeth and had cavities show up so quickly that he couldn't believe it. Recently, I needed another root canal! It happened to be under a bridge.

[ J. Edward Kendrick ] I do not know of a logical relationship between problems with a tooth nerve (need for root canal) and FMS unless the "nerve problem in the tooth" is not really a problem with the tooth but originates with referred muscle pain. Myalgia has been know to be misinterpreted for nerve problems in a tooth. One reference on this is Janet Travell, M.D. and David Simon, M.D.'s text, "Myofascial Pain and Dysfunction-- The Trigger Point Manual" Volume 1, p. 220, p. 237, p. 274.

Findings in the tooth would likely include: scant x-ray evidence of apical radiolucency and vital pulp tissue on entering the tooth.

[ Linda Cummings ] He said the only information he has on FMS and how it affects the mouth is what I have printed out for him and taken to him.

[ J. Edward Kendrick ] I ran Grateful Med searches on FMS and 1) xerostomia, 2) Dental Care for Chronically Ill, and 3) Oral Manifestations. No abstracts were available on any of these topics as related to FMS.

[ Linda Cummings ] Figures. Just as my dentist reported to me...he knew of NO study done on patients with FMS and their dental problems. I think we should all make our dentists aware of the "dry mouth syndrome" and see if s/he won't write a paper for submission to whoever they submit these things to. ;-)

[ J. Edward Kendrick ] As you are likely aware, there is much to be learned about FMS. We don't know, for example, what the cause(s) is/are. As I understand FMS, some of the primary symptoms are pain, fatigue, and sleep disorders.

There is one area of dentistry which does overlap FMS and resulted in 19 abstracts from '91 to '93 in the Medline database. It is a condition called by several names, the most common is myofascial pain dysfunction (MPD). We do identify causality (know the cause) in many MPD patients. There appears to be a relationship to clenching/grinding of the teeth. Usually the patient is not aware of grinding or clenching. Overuse of muscles results in myalgia/pain from muscles. This pain can be incapacitating and can also mimic tension headache and migraine. Often, the patients identify other parts of the face, head or ears to report their problem and they do not connect the bite, (unconscious) habit of clenching/grinding, or chronic postures such as holding a phone against shoulder as the cause.

Some MPD and FMS patients can be clearly identified as having sympathetic nervous system activity which creates pain in muscles. My own investigations focus on sympathetic 'posturing' as a cause for many patients' FMS and MPD conditions. In making evaluation of a particular patient, I like to have data about the whole person. This complements findings about their mouths and muscles. Sympathetic nervous system activity is life-script related.

Your dry mouth is likely related to medication.

[ Linda Cummings ] I disagree with him on this point (and I see where Earla Pitt wrote him back commenting on his message to me saying that she was off all meds for a year and still had the "dry mouth syndrome").

[ J. Edward Kendrick ] Dry mouth can promote decay. Prescription fluorides for home use are often suggested for patients with dry mouth and a concern for preventing decay.

[ Linda Cummings ] True!

[ J. Edward Kendrick ] Your own investigations about your diagnosis are likely to help. Some patients just sit back and let the doctor control their destiny. The information I present in these posts could be taken to your doctor or dentist who are familiar with you. I can't prescribe for you in this conference.

J. Edward Kendrick

[ Linda Cummings ] And, believe me, I will print out his message and take it to my dentist.

Linda

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