Fibromyalgia: Considerations for dental professionals

The mystery surrounding fibromyalgia and its symptoms are as vast as the opinions on the syndrome itself. Widespread aches and pain can be just as frustrating as finding an answer, as the root cause can take time to discover, and there is no definitive blood test to diagnose fibromyalgia. Experts believe that fibromyalgia “amplifies painful sensations by affecting the way your brain processes pain signals.”¹ The disorder changes the neurotransmitters that process stumuli, often in an extreme manner.

Diagnosis of the disorder involves a history of widespread pain for at least three months that cannot be explained by any other health condition.¹ While there is no blood test currently available to diagnose this disorder, the physician may perform a series of tests to eliminate other problems, such as lupus, rheumatoid arthritis, and inadequate thyroid function. The onset of symptoms may present after a physical trauma, surgery, infection, or significant emotional stressors, whereas other times the symptoms gradually build. Fibromyalgia affects more women than men, and genetics may play a role. It has also been linked to other conditions such as migraine headaches, irritable bowel syndrome, and temporomandibular (TMJ) disorders, to name a few.

Fibromyalgia symptoms can vary, and for some individuals, are influenced by stress. Symptoms often include not only pain, but also fatigue, even when the individual sleeps for long periods of time. The ability to focus and pay attention can be affected (commonly referred to as “fibro-fog”). For most of us, being exhausted constantly our would affect mental acuity.

As dental professionals, we will often see a patient who has listed fibromyalgia on his or her health history, but how it relates to treatment differs from case to case. Associated symptoms of fibromyalgia, like any disease or disorder, can change over time, as symptoms can often come and go in severity. Widespread pain is often described as a dull ache, and as mentioned above, other common complaints include tension headaches and TMJ pain, which are both relative to treating dental patients.¹ Stress can exacerbate bruxism and clenching and result in more TMJ discomfort; you can recommend an occlusal guard at night to alleviate these symptoms.

Because fibromyalgia symptoms are often treated with medications, xerostomia is a concern. You should educate your patients on caries prevention and take other appropriate measures to prevent xerostomia’s potential consequences. Common medications used to treat fibromyalgia pain include over-the-counter pain relievers, such as Tylenol and Advil, or even a prescription such as tramadol. The physician may opt to prescribe antidepressants such as Cymbalta or Savella to alleviate the fatigue as well as the pain. In addition, antiseizure drugs may be prescribed to reduce pain, such as Neurontin and Lyrica.¹

The daily discomfort of TMJ disorders related to fibromyalgia may keep patients from scheduling in anticipation of increased jaw pain after dental treatment. Alleviating the risk can put a patient’s mind at ease. You can use tools such as a bite block, and give the patient frequent breaks during treatment. In addition, you can recommend a warm, moist heat pack on the joint after treatment, which can reduce the risk of inflammation and discomfort. In cases where the patient has an extensive treatment plan, the dentist may consider breaking appointments into smaller blocks and possibly completing treatment with the aid of sedation if symptoms are severe.

A major factor in treating fibromyalgia symptoms is self-care. Stress plays an important role in inflammation, and physical, occupational, and counseling therapies can help manage the symptoms of fibromyalgia to lessen the pain. Improving strength and stamina while finding methods to reduce daily stress can lead to less tension in the body. Learning your stress limits and how to say “no” when it is just too much is a skill that can be hard to learn, but is necessary for those with fibromyalgia pain. Lifestyle alterations such as low-impact exercise will help keep the body strong, and good posture exercises help maintain muscle strength. The importance of quality sleep is often overlooked in fibromyalgia treatments. Encourage the patient to have a sleep apnea study if he or she exhibits signs of the disorder. Adequate sleep is essential for everyone, not just individuals that have chronic conditions, and will help to energize and lead to a clearer mind.

Fibromyalgia is a silent disorder that can make daily life full of pain and discomfort that can’t be explained. Generally some days are better than others, and learning one’s limits is a difficult lesson that takes time for those affected. As dental professionals, we are able to treat and counsel our patients on the implications of fibromyalgia medications and do our part to help reduce symptoms of a TMJ disorder that can often accompany fibromyalgia. Encouraging patients to adopt healthier self-care practices and providing support to those diagnosed can provide an understanding of this often undiagnosed and mysterious disorder.

Reference

1. Fibromyalgia. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780. Updated August 11, 2017.

Jamie Collins, RDH, CDA, is a practicing clinical hygienist in Idaho and Washington states. She has been in the dental field for nearly 20 years, both as an assistant and hygienist. With a passion for patient care, especially patients with higher risk factors, she enjoys sharing the tips and tricks of the dental profession through speaking and writing. In addition to clinical practice, she is also an educator, has contributed to multiple textbooks and curriculum development, and is a key opinion leader. Contact her at [email protected].