Fear of going to the dentist with facial pain

People suffering from facial pain are often concerned that dental procedures will aggravate their pain. Even if you have not had pain in a while, you may still fear work in your mouth. If you are in constant pain, dental work can be hardest on you. In order to avoid pain at the dentist office, or even the possibility of this pain keeps some people with facial pain from maintaining healthy dental hygiene and preventing worsening dental issues from developing. 

Tips for making dental work as painless as possible

• Go when you are not hurting. Make sure your dentist knows you have neuropathic facial pain so he or she will be flexible to schedule you appointments (maybe even on short notice) during periods when your pain goes into remission. This will also help the dental staff to understand in case you have to cancel because of a pain flare right before an appointment. 
• Be well medicated. If you do not have times of remission or must have dental work done during an active pain cycle, consult your doctor to ensure you are on an optimal dose of medicine. To prevent pain breakthrough, your dentist may want to increase the dose of any medications you are taking for a day or so before and after the procedure. Try to schedule your appointment during the time of day when you’re least likely to get pain or when your medication is at peak effectiveness (usually about one hour after taking a dose). Several hours before the procedure, take a pain-killing medication such as codeine. Take it again after the procedure. The goal is to have at least five hours after the procedure during which you are pain-free. 
• Ask for topical anesthetics. Most dental patients need numbing compounds mainly for tooth repairs, crown work, extractions and the like. However, even teeth-cleaning and exams may bring on pain for facial pain patients. Topical sprays or gels can be used to temporarily numb the gums.
• Touch the sensitive area last. If there is a trigger zone that usually sets off the pain, ask the dentist or hygienist to examine and clean everything else first.
• Switch local anesthetics. Because people with facial pain do not always respond as well as other patients to anesthetics, the local anesthetic may need to be of greater potency. If you need treatment, discuss with your dentist the type of anesthetic to be used. Ask your dentist to use Mepivacaine 3% or Carbocaine 3%, neither of which contains preservatives or a vasoconstrictor. You may want to ask in advance, because the average dentist doesn’t keep this particular drug in stock.
• Ask about an anesthetic booster. After the typical anesthetic, which is described above, an intraosseous injection may benefit the dental patient who has facial pain. • Epinephrine is a vasoconstrictor; it’s sometimes added to local anesthetics to prolong their numbing effect. Epinephrine can trigger nerve pain, especially in cases of trauma-induced TN. In these cases, ask your dentist not to inject a vasoconstrictor with local anesthetics in the area of nerve damage.
• Consider the injection point. Ask the dentist if possible to inject the local anesthetic at a site as far as possible from known, active trigger points.

Get knocked out. If all else fails and you absolutely need dental work, discuss the possibility of a general anesthetic (either IV or inhaled) to put you to sleep while the work is being done. This type of anesthesia can reduce emotional trauma.