How to Manage Dental Care with Chronic Pain

By Dr. Michael Cooney, Clinical Director

(This article was also republished in May 2023 by Pain News Network)

More than 75 percent of the chronic pain patients we have treated also suffer from chronic dental issues. People with myofascial pain syndrome (MPS) require the highest levels of specialized dental care due to the highly sensitive nature of their conditions.

No one wants to add to your pain, but maintaining your dental hygiene now can save even more discomfort in the future. I sought out the advice of a local dentist who specialized in treating patients with chronic pain conditions and asked him for advice to share with our Calmare blog readers:


Call your dentist in advance and explain that you will require special care due to the specific nature of your neuropathic pain disease. Request a callback from the hygienist and/or dentist to discuss your treatment before your appointment and discuss steps they can implement to help avoid as much discomfort for you as possible. It is common for people to require special care for many conditions, so don’t be embarrassed–you are advocating for your health!

Advise your pain management provider or PCP that you have scheduled dental care or maintenance (teeth cleaning) and ask about pre- and post-treatment medication recommendations to help minimize pain. Confirm the dentist can consult with the doctor about your upcoming dental care prior to treatment and complete any necessary privacy documents beforehand.


Regular dental visits are the same as the need for a general overall check-up with your primary care doctor every year—if you don’t do it, any potential issues will have ample time to grow and become more serious (and more complicated to treat) after the issue is finally diagnosed.

Do the due diligence in locating a dentist who treats patients with chronic nerve pain and understands your special issues. Once you’ve found one, ask about specific tools to help minimize and control pain, dental or otherwise, before, during and after treatment.

One unfortunate byproduct of chronic pain management is the common use of medications. These medications often contribute to ‘dry mouth,’ and without adequate saliva, tooth decay and gum disease are more likely to flourish.

This dry mouth condition is called xerostomia and it has major dental consequences such as:

  • Interference with normal swallowing patterns
  • Taste alterations (dysgeusia)
  • Interference with speech
  • Inability to maintain oral tissue integrity
  • Mucositis (chronic mouth irritation and inflammation)
  • Dental decay
  • Erosion

To combat this condition, keep hydrated by sipping water throughout the day, use sugarless gum or sugarless hard candy. You may also wish to use a moisturizing mouth spray, which your dentist can provide.


Over time, gums pull away from the teeth and form pockets that often become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place.

If not treated, the bones, gums and tissue that supports the teeth are destroyed, requiring the diseased teeth to be extracted.


Understandably, people with chronic pain avoid potential pain triggers, including dental visits. So when tooth or gum pain or sensitivity presents, it is often in the latter stages of decay when the tooth cannot be salvaged. The unfortunate result is the need to remove the tooth.


In the comfort of your home, brush teeth a minimum of twice daily and floss. (Yes, we know it’s gross, but isn’t it better to get that stuff out of your mouth and into the garbage?) Give your tongue a good brushing to remove bacteria that leads to plaque and chronic bad breath.

Twice-yearly tooth cleanings and exams are necessary to prevent and offset any issues before they become more serious and require more invasive treatment. Before your visit, talk with your treating physician to determine any special protocol or medication requirements needed. Be sure that your doctor and dentist are in touch to fully understand the nature of your care needs.

After your cleaning or dental treatment, allow extra time to rest and recover. Eat soft food for a few days and avoid foods (meats, popcorn, hard candy) that can potentially become lodged in those clean and disease-free pearly whites! Prevention of dental disease may very well pay off in good overall health, allowing your immune system to perform at its optimal level and play an essential role in offsetting future pain.


Dr. Michael Cooney is one of the original Calmare Certified providers of scrambler therapy in the U.S. He specializes in treating patients battling severe neuropathy as a result of fibromyalgia, CRPS / RSD, diabetes, shingles, post-surgical pain and pain after chemotherapy. To learn more, call 201-933-4440 o email us at

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