FWD:RSD Patients and Dentistry

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From: byrd45 (Original Message) Sent: 8/18/2005 7:46 AM
Reflex Sympathetic Dystrophy Patients and Dentistry
by Dr. Aldino P. Maggiulli

Reflex Sympathetic Dystrophy Syndrome (RSD) 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 RSD.
This article shares one such asset which was discovered in a dental
setting.
It is apparent that patients with RSD can't be treated in the usual
manner as other dental patients. This was discovered when a patient with
RSD 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 RSD 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 RSD 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 RSD 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 RSD patient. This experience
demonstrates that RSD patients can't be treated like traditional patients.

Thanks to Will's help, the conclusion to draw is that it is best to
give RSD patients short dental appointments. RSD 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 RSD.