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Fibromyalgia: An update for oral health care providers – Source: Oral Surgry, Oral Medicine, Oral Pathology, Oral Radioliology, and Endodontics, Nov 2007

  [ 225 votes ]   [ 5 Comments ]
By R Balasubramaniam, et al. • • October 30, 2007

Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, stiffness, nonrestorative sleep, fatigue, and comorbid conditions. Fibromyalgia has undergone a major paradigm shift in recent years. It is no longer considered a musculoskeletal disorder per se; rather, it represents one end of a spectrum of disorders characterized by chronic widespread pain.

Hence, oral health care providers may be the first to recognize signs and symptoms of this complex disorder and are often consulted to participate in the management of FM patients.

This medical management update will review the epidemiology, classification, etiology and pathophysiology, clinical presentation, and therapeutic advances in FM. This review will also highlight issues that are important to the oral health care provider, including orofacial manifestations and dental considerations for patients with FM.

Source: Oral Surgry, Oral Medicine, Oral Pathology, Oral Radioliology, and Endodontics. 2007 Nov;104(5):589-602. PMID: 17964475, by Balasubramaniam R, Laudenbach JM, Stoopler ET. Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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Oral health/Oral Health providers and fibromyalgia AND a personal story
Posted by: DocDebbee
Nov 8, 2007
I am a FP physician with severe fibromyalgia. My mild symptoms began about 10 years ago then rapidly progressed over a 2-year period. About 5 years before that, I developed a very painful TMJ syndrome and wore a splint for several months on 2 separate occasions. I was treated by both a general dentist and an orthodontist. The orthodontist obtained an MRI which showed a definite mismatch between the epicondyle and the joint. I never had surgery, but over time, the joints seemed to have corrected themselves to the point that I have NO clicking in either. Most recently, I had 4 upper frontal teeth recapped, the originals being 22 years old with, obviously, the old-type metal they used to use. My gums had become quite inflamed despite good brushing and I had severe decay into the bone of one of two of the teeth. Fortunately, they were all able to be saved and re-capped. I did notice shortly after that that I felt somewhat better, more than could be attributed to just weather or other changes. I have decay in 2 lower teeth and will be having a root canal in 2 teeth and, unfortunately, will lose one tooth down there. I am not practicing at this time, so I don't have the access to sample antibiotics that I once did, which I believe, "unconsciously" keep down infections over time. After this recent episode, I was on a trip for 2 weeks with my husband when my lower teeth began to hurt to the point I couldn't join him for some activities and began to hurt more in general. I got some Levaquin 500mg once a day for 3 days and was fine by the second day. (I'd found that to work best for my patients with oral infections after they had failed the Amoxicillin, doxecyclin, or Keflex their dentists had given them.) Shortly after this, I read something about oral health and fibromyalgia. This certainly clicked with me. The major area where this affected me positively is my decreased me for breakthru meds. I believe when these lower teeth are fixed, my overall pain will likely improve again. Another "treatment" which had helped was increasing my water intake to 9-10 8-oz glasses a day. This certainly helped the "body" functions, but this also helps increase oral fluid flow and also washes the teeth several times a day. Because some of my medications have contributed to dry mouth, another hazard leading to dental problem, I've taken Evoxac 30mg up to 3 times a day for several years. I've been surprised that none of the dental providers have known of the product. Few doctors have as well. (I don't recall why I learned of it anymore.) It is used by patients with Reynauds' for their dry mouth problems. This could be a great boon for dentists to recommend to patients they note with dry mouths. Of an unfortunate note, I have been severely criticized and ostracized by my medical community, both locally and statewide, due to my ability to treat this condition successfully as it goes outside the "acceptable zone." I use narcotics and patients get out of their beds and back to functioning normally. What a terrible thing! Through a series of miscommunications and misunderstandings, I lost my ability to practice. Most unfortunate is many patients have lost THEIR ability to obtain the treatments which had allowed THEM to function normally, all because so many other doctors don't want to risk being known as someone who prescribes "controversial meds for a controversial condition." While not everyone needs such treatment, those that do are desperate for it and are NOT going to "abuse" it, as they will assure any doctor with the courage to treat them. Perhaps if the dental community can truly become educated on this condition, THEY can come to our rescue. I have an excellent relationship with my general dentist. He has sent patients with severe pain problems to me over the years as he knew of my training in the subject...and he can attest to the downhill condition of my oral health--although most of it came from the stress that occurred when I was forced to stop doing what I loved and had to start defending my ability to continue doing it. DocDebbee--and we'll leave it at that.
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Equally frustrated health care worker with FMS
Posted by: Im~An~RN~with~Fibro
Nov 8, 2007
You know, DocDebbee, if I ever 'get through this', I swear I am going to become a private advocate for chronic pain patients. I am deeply disappointed in the health care community. One would hope that the stigma of this DISease (yes I know its not classified as a disease) would be letting up by now. I have found that the few physicians that ARE willing to treat chronic pain patients are taking advantage of their monopoly while treating 'us' as if we are sub-human drug seekers. People are human and mistakes are made. Miscommunication with a pharmacy tech (or ANY health care worker) can result in disaster and take months to overcome. I had a tech misunderstand a medication refill request (for ULTRAM?!?!? that doesn't even work for me any longer!!) and send a request to the WRONG doctor for a refill for a drug I did not even TAKE anymore. I was on a pain contract with a different doctor...and a computer glitch continued to request said refill every month!! Finally someone listened to me and believed me that it was an ERROR, however in the meantime it was a nightmare and took months to overcome . That's only ONE of the horrors I have experienced, and I am still under scrutiny for it.

I cannot imagine being someone outside the medical field and having the same problems, never really knowing what it was they did wrong or what it was that went wrong. I only know that I am very disturbed at this discovery and experience and too dang sick to do much about it at this point!

When are we going to get HELP? And, while we are on the topic: there is something very wrong when a registered nurse is not able to get health insurance; not to mention the possibility that the illnesses at hand were quite possibly 'triggered' due to occupational hazards. (High stress, little support; regular exposure to suspect viruses and bacteria; shift work...etc.) Though I loved my job as a hospital float-bedside med/surg nurse, I am no longer able to do it.

I could write a book here, but it seems you already have an idea of what I am saying. Good luck and Blessings to you and your family.



Update for oral health care providers
Posted by: holly49
Nov 11, 2007
Thank you, DocDebbee, for sharing your personal story and info re: oral health as it pertains to fibro. Thanks for sharing your knowledge on how fibro can affect your teeth. I am going through some extensive dental work now due to the fibro. I am sorry you were force to stop practicing medicine due to the narrowmindedness of some ignorant people when it comes to treatment of fibro. One of my doctors saw how much pain I was in and how the medication I had been using was not helping. That doctor prescribed the "dreaded" narcotics. If not for that doctor I would not be able to live the somewhat active life I do. I do not abuse it but use it as directed. If not for that medicine I would spend most of my time at home, in bed, and in pain. Hang in there and maybe someday you will be back treating patients again.
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